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Background: Proper understanding of concepts of physiology forms basis of good clinical practice. To make the lectures in physiology more interesting and understanding, one has to review the teaching methods at regular intervals. Aims and Objectives: This study is designed to get feedback regarding teaching methods in physiology from MBBS students of Government Medical College, Kozhikode, to make teaching more effective. Materials and Methods: Two hundred randomly selected students who successfully completed 1st-year MBBS are included in the study group. The standard questionnaire is shared to study group through Google forms and adequate time is given to record their responses. Descriptive statistics are used. Frequency is expressed in percentage. Results: Most of students prefer interactive teaching methodologies such as group discussion as their preferred mode of learning rather than conventional didactic lectures in whole batch. Students also like to have integration with other subjects and early clinical exposure to understand the concepts precisely. Conclusion: Teaching in small groups with proper integration and alignment with other subjects will make maximum results rather than the traditional teacher centered medical education. Periodic review of teaching methods is very much essential to make the subject more interesting.
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Background: Small-group discussion (SGD) plays an essential role in physiology to foster active learning by the students. Blunder lecture has been used to stimulate inquiry, reflection, and promote collaborative learning by cognitive conflict strategy. Aims and Objectives: The objectives of the study were as follows: (i) To compare the effectiveness of blunder lecture with tutorial for SGD and (ii) to assess the perception of students toward blunder lecture and tutorial. Material and Methods: An educational interventional study was conducted in the department of physiology among 116 Phase I MBBS students using tutorial and blunder lecture for SGD on two core topics of physiology which were already covered in didactic lectures. Blunder lecture included deliberate mistakes spread over the different levels of Bloom’s taxonomy. Blunders were identified and discussed during the group activity. The evaluation was done by validated pre-post tests and questionnaires. Results: There was a statistically significant gain in the mean score of the students who attended blunder lecture session in comparison to tutorial. Out of 116 students who participated in the study, 89% perceived blunder lecture as a challenging way to recollect prior knowledge. Conclusion: Blunder lecture is an effective reinforcement tool that can be used in SGD to facilitate the learning of the undergraduates.
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SUMMARY OBJECTIVE: This study aimed at the oral health problems of elderly patients with diabetes. A training course of integrated traditional Chinese and Western medicine was constructed, helping patients improve their oral health quality of life. METHODS: A randomized controlled prospective experimental study was conducted. A total of 190 elderly patients were divided randomly into an observation group and a control group with 95 cases in each. The control group received regular health education, while the observation group was based on the control group to implement the integrated experiential learning of traditional Chinese and Western medicine in small groups. The oral health knowledge, attitude, behavior, and blood glucose control status along with the oral health quality of life of the two groups were compared before the intervention and at 3-month postintervention. RESULTS: Three months after the intervention, the fasting blood glucose control and the 2-h postprandial blood glucose/glycosylated hemoglobin levels in the observation group were significantly better than in the control group, and the difference was statistically significant (p<0.05). The oral health quality of life in the observation group was significantly better than in the control group, and the difference was statistically significant (p<0.05). CONCLUSION: The small-group experiential learning model of integrated Chinese and Western medicine can promote the transformation of knowledge-beliefs-behaviors in elderly patients with diabetes, which is conducive to controlling blood sugar levels and improving the quality of oral health.
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Humains , Sujet âgé , Santé buccodentaire , Diabète/thérapie , Qualité de vie , Chine , Études prospectives , Apprentissage par problèmes , Médecine traditionnelle chinoiseRésumé
In the treatment of diabetes, insulin therapy is becoming increasingly important. However, it is reported that insulin initiation is often delayed due to psychological resistance in patients and physician’s concerns about patient education. One of the reasons for this problem is medical doctors’ inadequate understanding of insulin self-injection and patients’ perspectives. Therefore, we introduced a new strategy for learning this more effectively. We set student doctors as target learners. The learning strategy consists of experiential learning through the use of insulin injection model, in-patient interviews, and small group learning. Our new practice seems to be useful to understand the perception gap between medical professionals and patients.
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AIMS: Small group teaching in Pharmacology offers an effective platform to encourage interaction amongst peers and self-directed learning. The present study is an attempt to assess and compare the effectiveness and perception of students on two different pedagogical methods: Crossword puzzles and Student Led Objective Tutorials (SLOT). METHODS: Second year undergraduate students who gave their informed consent were divided randomly into two groups: one which received crossword puzzle as a teaching learning method and the other had SLOT during which the students conducted an interactive quiz with multiple choice questions prepared by themselves. The students' perceptions were recorded using a self-administered questionnaire. One week later, a unit test was conducted for both the groups and the performance of the students was compared. Statistical analysis was done using independent Student's T test with SPSS version 15.0. RESULTS: Analyses revealed a statistical significant difference (P<0.001) between the mean marks obtained in the SLOT group (n= 74; 6.5±3.8) and the marks obtained in the crossword group (n= 87; 4.2±2.9), with the students in the tutorial group performing better. The students opined that SLOT sessions helped them to understand Pharmacology better whereas crossword sessions enabled them to memorize the names of the drugs. CONCLUSION: The present study revealed that SLOT sessions fared better compared to the crossword puzzles in terms of improving the students' test scores. It fostered teamwork, self-directed learning skills and critical thinking. Crossword puzzles make the session more student friendly as it is fun and engaging but a careful design is inevitable as it may fail to test in-depth learning in students.
OBJETIVOS: O ensino de farmacologia em pequenos grupos oferece uma plataforma eficaz para estimular a interação entre pares e a aprendizagem autodirigida. O presente estudo procurou avaliar e comparar a eficácia e percepção dos alunos em dois métodos pedagógicos diferentes: palavras cruzadas e tutoriais objetivos conduzido pelo aluno (SLOT). MÉTODOS: Alunos do segundo ano de graduação, que deram seu consentimento informado, foram divididos aleatoriamente em dois grupos: um que recebeu palavras cruzadas como método de ensino-aprendizagem e o outro teve SLOT onde os alunos realizaram um questionário interativo com questões de múltipla escolha elaborado por si mesmos. As percepções dos alunos foram registradas por meio de um questionário autoaplicável. Uma semana depois, um teste foi realizado para ambos os grupos e o desempenho dos alunos foi comparado. A análise estatística foi feita usando o teste T de student de amostras independentes. RESULTADOS: As análises revelaram uma diferença estatisticamente significativa (P <0,001) entre as notas médias obtidas no grupo SLOT (n = 74; 6,5±3,8) e as notas obtidas no grupo de palavras cruzadas (n = 87; 4,2±2,9), com os alunos do grupo tutorial tendo melhor desempenho. Os alunos opinaram que as sessões de tutoria objetiva conduzida pelos alunos os ajudaram a entender melhor a Farmacologia, ao passo que as sessões de palavras cruzadas lhes permitiram memorizar os nomes dos medicamentos. CONCLUSÃO: O presente estudo revelou que as sessões do SLOT se saíram melhor comparativamente àquelas com as palavras cruzadas em termos de melhorar as pontuações dos alunos nos testes, assim como promoveu o trabalho em equipe, habilidades de aprendizagem autodirigida e pensamento crítico. As palavras cruzadas tornam a sessão mais amigável ao aluno, pois é divertida e envolvente, mas um design cuidadoso é inevitável, pois pode falhar em testar o aprendizado em profundidade nos alunos.
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Enseignement médical premier cycle , EnseignementRésumé
@#Didactic lecture promotes passive learning and fails to motivate students. Small group learning has been widely recommended as it helps to refine understanding of complex issues, to solve the problems, develop critical thinking and apply knowledge to new situations. PALS – a “peer assisted learning” mode where in students discuss in groups and learn from each other. They get motivated and set a platform, which encourages them to communicate and do problem solving. The present study was aimed to evaluate the effectiveness of small group teaching (SGT) and peer assisted learning (PAL) approach among pre clinical medical students. Small groups of students were selected for this study out of the big batch of students pursuing 2nd year MBBS program at AIMST University who were undergoing “respiratory system” block. At the end of lecture-based sessions, a few topics were selected for SGT- PAL session. Students were asked to complete the pretest questions on the selected topics and they were then explained the topics selected for this session. Students had SGT PAL on those selected topics. Then they completed the post test questions on the same topic. Responses obtained for the pre- test and post-test questions were analyzed using SPSS using paired t test and the perceptions on their own understanding using marginal homogeneity test, both showed a significant improvement. SGT and PAL approach helped students to improve understanding of important concepts and can be adopted more widely as an alternative to lectures.
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Introduction: In Japan, multifunctional long-term care in small group homes and home-visit nursing (MLSH) was created for elderly people who continue to live in the community as one of the long-term care insurance services. The aim of this study was to clarify the benefits and challenges of, and ideas for nursing in MLSH.Methods: A semi-structured interview survey was administered to 11 nurses carrying out MLSH in the Kansai region, and the responses were analyzed qualitatively and descriptively.Results: The benefits of nursing were divided into five categories, including "nurses' expertise and ingenuity can be utilized" and "nursing can continue to support home life even in difficult cases." There were seven categories of challenges, including "difficult to judge, educate, and collaborate; this burdens nurses" and "difficult to educate and collaborate with care workers." There were six categories of nursing ideas, including "utilize knowledge and connections from study sessions, and external training at facilities" and "ensure that nurses and care workers can provide unified care." Conclusion: Although nurses considered it an advantage to support patients' home-based life in cooperation with patients' family members using professional originality, it was difficult for them to judge, learn, and collaborate with others. Moreover, nurses faced burdens. Strategies must be developed to provide nurses with training inside and outside of the facility, and also to strengthen connections with external resources. It is necessary to further review the system and disseminate knowledge about MLSH.
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Background: Medical schools in India are changing their educational programs and teaching strategies to ensure that students have active responsibility for their learning process and are prepared for lifelong, self-directed learning. Small group teaching (SGT) is one such tool which helps to make learning process student-centered. In this study, we have assessed the effectiveness of SGTs as a supplement to didactic lecture (DL). Objective: The objective of the study was to compare the effectiveness of tutorials versus seminar as a supplement to lecture class. Materials and Methods: In Department of Physiology, SVIMS, Sri Padmavathi Medical College for Women, a DL class on a topic was taken for 150 1st year MBBS students which were followed by tutorials for one half of students and seminar for other half of students on the same topic. It was done for two topics. An assessment was done each at the end of DL, tutorials, and seminar. Students were also asked to fill a feedback questionnaire about the SGTs on a Likert scale. Results: Tutorials showed statistically significant increase in scores in both the topics (6.955 ± 1.83, P = –0.012 and 6.65 ± 1.78, P = 0.006) whereas seminar showed statistically significant increase in only the first topic as compared to DL (6.84 ± 1.77, P = 0.013 and 6.27 ± 2.09, P = 0.25). There was no significant difference in scores between tutorials and seminar. Likert scale showed positive feedback about SGTs and students wanted more such sessions. Conclusions: Since there was a positive response from students regarding SGTs as a supplement to DL, we would like to adopt a mixed approach with SGT as a component of the overall course to ensure knowledge acquisition and retention by the students.
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Background: Teaching in India is still controlled by teacher-centered class room which would make them bored and exhausted. Educators now strive to provide the most productive class room experience for their students by facilitating small group discussions within the larger class such as seminar presentation by the students etc. Hence the present study was done to assess the perception of medical students regarding seminars in the curriculum towards a small group teaching activity. Objective is to assess the perception of medical students regarding seminars as a teaching learning activity.Methods: A cross-sectional observational study was conducted among 4th semester undergraduate medical students of Andhra Medical College, Visakhapatnam, Andhra Pradesh in the month of June 2016 to assess their perception regarding seminars in the curriculum. A pre-designed, pre-tested self-administered questionnaire was used to collect data.Results: Total number of study participants were 136. Majority 110 (80.9%) of them agreed that seminar is a good academic activity and is helpful in learning. Around 96 (70%) of the students opined that seminars help students engage in higher order thinking tasks. Majority 93.4% agreed that seminars help students to overcome nervousness. About 91.9% felt seminars improve self-confidence and personality development.Conclusions: Students view that, seminars are more effective in deep understanding of the subject and critical thinking than didactic lectures and helps the students to improve self confidence and communication skills.
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Purpose: To clarify the strengths and problems of nursing in multifunctional long-term care in a small group home and home-visit nursing (MLSH).Methods: Selected case reports using Ichushi, the Current Index to Japanese Nursing Literature, and DiaL were extracted and categorized based on the descriptions of the strengths and issues of service in MLSH.Results: Strengths included "flexible and continual? users / family support", "care of users with high medical needs, including end-of-life care", "support for a smooth transition from hospital to home with consecutive stay", "reduction of economic burden of users using a fixed monthly system", and "cooperation between nurses and care workers, and growth by learning from each other". Problems included "difficulty in dealing with diverse needs", "economic burden of low-income users and welfare equipment", and "insufficient cooperation with other occupations inside and outside the office".Conclusion: The strengths of service in MLSH were demonstrated via the support of users with high medical needs and support during the transition period at home. The economic burden of users and cooperation with other occupations are both strengths and problems to be addressed. Support according to user characteristics and public awareness of the existence and strengths of MLSH are required.
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PURPOSE: Interprofessional communication skills are an essential competency for medical students training to be physicians. Nevertheless, interprofessional education (IPE) is relatively rare in Korean medical schools compared with those overseas. We attempted to evaluate the effectiveness of the first IPE program in our school. METHODS: In the first semester of the school year 2018, third-grade medical students (N=149) at the Seoul National University College of Medicine participated in ‘communication between healthcare professionals in the clinical field’ training, which consisted of small group discussions and role-play. To evaluate the effectiveness of this training, we conducted pre- and post-training questionnaire surveys. Comparing paired t-tests, we evaluated the students' competency in interpersonal communication and their attitude towards the importance of IPE before and after the training. The Global Interpersonal Communication Competence Scale (GICC-15) was used to evaluate competency in interpersonal communication. RESULTS: Out of 149 students, 144 completed the pre- and post-training questionnaires. The total GICC-15 scores before and after training were 55.60±6.94 (mean±standard deviation) and 58.89±7.34, respectively (p=0.000). All subcategory scores of GICC-15 after training were higher after training and were statistically significant (p<0.05), except for two subcategories. The importance of IPE score also improved after training but was not significant (p=0.159). The appropriateness of content and training method scores were 3.99±0.92 and 3.94±1.00, respectively. CONCLUSION: From the results, our school's IPE program demonstrated a positive overall educational effect. Deployment of systematic and varied IPE courses is expected in the future, with more longitudinal evaluation of educational effect.
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Humains , Prestations des soins de santé , Éducation , Relations interprofessionnelles , Capacité mentale , Méthodes , Jeu de rôle , Écoles de médecine , Séoul , Étudiant médecineRésumé
Context: Peer-assisted teaching and learning (PTL) is being experimented in different medical universities worldwide. It is a learner-centered approach involving students through active learning strategies. Aims: To study the student perception of PTL in methods such as group-led seminars and fishbowls, in classroom through various interactive activities; compare and find out the student acceptability and efficacy of each of these methods in learning conceptual topics such as various types of anemia. Subjects and Methods: Medical students of second-year professional course were subjected to PTL in classroom during allotted teaching hours for 10 successive sessions using group-led modified seminars, fishbowls, and different formality-level interactive activities such as street plays, prop sessions, quiz sessions, to make them understand the clinical features and presentation of different types of anemia through understanding of etio-pathogenesis. To ascertain the aspects that influenced learning, focus group discussions were conducted in small groups consisting of 14 students and one facilitator in each group. Qualitative thematic analysis was performed on transcripts of the audio recordings by authors. Results: The emerging themes from qualitative analysis of transcripts were pertaining to teacher, student, and organization. We found motivation, interest, and involvement of peer teacher, student behavior and collaboration, contact time between students and facilitator, preparation time, coherence with other curricular activities, group size and composition, suitability of topic for the kind of activity, and availability of material for preparation as few sub-aspects affecting learning. Conclusion: For PTL to be effective, adequate transfer of knowledge through good peer teacher involvement, learner receptiveness, and adequate contact time is needed. Proper preparation with suitability of topics for the type of activity, alignment of seminars with other activities, and course coherence are prerequisites for the same.
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Background: Pharmacology has always been one subject ultimatum and a cornerstone in building up competency, based on applied therapeutics among medical graduates in prescribing and practicing skills. A focus on an integrated strategical approach towards teaching pharmacology for better proficiency in achieving clinical skills is mandatory. Thus, this study has been done to assess the impact and retainment of overall knowledge gained on various domains, based on a revised method of teaching in pharmacology.Methods: An observational, questionnaire based comparative study was done in a medical college, in Chennai. The study included two group of students, one who have completed their pharmacology course based on the revised pattern of teaching with a comparative group of students who have not been exposed to the revised pattern of teaching. A feedback survey was also done.Results: The study results indicated that the average scoring based on the questionnaire was 84% with the students who have been exposed to revised pattern of teaching in comparison to the average scoring of 70% with the students who have not been exposed to the new pattern of teaching. The average scoring of the students who were found to agree to several questions on the new method of teaching was 74% and 22% of the students were found to disagree. 4% of students were non responders.Conclusions: The ultimate improvement in the outcome of health care education can be achieved through appropriate skill building through a simple strategical modification of the regular teaching pattern with an integrated approach involving pharmacologists and clinicians. A refresher course in pharmacology in the final year curriculum and CRRI involving pharmacologists is mandatory.
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Optimal strategies for learning professionalism have not been established to date. For the purpose of resolving this problem, the author developed a novel workshop activity in which scenarios describing unprofessional behavior were represented. In the scenarios, participants performed role play followed by small group discussions. Key words chosen during discussion were pooled and reconstructed into an association chart using KJ method. From 2014 through 2017, a total of forty-four junior residents participated in the activity. To estimate the effectiveness of the workshop, participants completed a post-activity questionnaires composed of a ten-point rating scale (higher value denotes a positive evaluation) and free commentary. Most residents indicated interest in this workshop (mean rating, 8.5±1.25, median, 9). Similarly, a considerable number of residents reported that the activity allowed them an opportunity to reflect on their behavior (mean, 8.05±1.43;, median 8). Qualitative analyses of free commentary was performed using Steps for Coding and Theorization (SCAT). Consequently, 6 themes were extracted: interest in learning professionalism, exchange of diverse values, importance of reflection, recognition of objectives, difficulty in understanding professionalism, and proposals for the workshop. On association charts, key words were sorted into four to six categories; these were further arranged in such a way as to converge toward the concepts of patient-centered care. We consider that our scenario-based workshop may be an effective strategy to facilitate learning professionalism for residents.
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PURPOSE: We tested the effect of team-based learning (TBL) on medical education through the second-year premedical students’ TBL scores in biochemistry classes over 5 years. METHODS: We analyzed the results based on test scores before and after the students’ debate. The groups of students for statistical analysis were divided as follows: group 1 comprised the top-ranked students, group 3 comprised the low-ranked students, and group 2 comprised the medium-ranked students. Therefore, group T comprised 382 students (the total number of students in group 1, 2, and 3). To calibrate the difficulty of the test, original scores were converted into standardized scores. We determined the differences of the tests using Student t-test, and the relationship between scores before, and after the TBL using linear regression tests. RESULTS: Although there was a decrease in the lowest score, group T and 3 showed a significant increase in both original and standardized scores; there was also an increase in the standardized score of group 3. There was a positive correlation between the pre- and the post-debate scores in group T, and 2. And the beta values of the pre-debate scores and “the changes between the pre- and post-debate scores” were statistically significant in both original and standardized scores. CONCLUSION: TBL is one of the educational methods for helping students improve their grades, particularly those of low-ranked students.
Sujets)
Humains , Biochimie , Enseignement médical , Propédeutique médecine , Apprentissage , Modèles linéaires , Écoles de médecineRésumé
Optimal strategies for learning professionalism have not been established to date. For the purpose of resolving this problem, the author developed a novel workshop activity in which scenarios describing unprofessional behavior were represented. In the scenarios, participants performed role play followed by small group discussions. Key words chosen during discussion were pooled and reconstructed into an association chart using KJ method. From 2014 through 2017, a total of forty-four junior residents participated in the activity. To estimate the effectiveness of the workshop, participants completed a post-activity questionnaires composed of a ten-point rating scale (higher value denotes a positive evaluation) and free commentary. Most residents indicated interest in this workshop (mean rating, 8.5±1.25, median, 9). Similarly, a considerable number of residents reported that the activity allowed them an opportunity to reflect on their behavior (mean, 8.05±1.43;, median 8). Qualitative analyses of free commentary was performed using Steps for Coding and Theorization (SCAT). Consequently, 6 themes were extracted: interest in learning professionalism, exchange of diverse values, importance of reflection, recognition of objectives, difficulty in understanding professionalism, and proposals for the workshop. On association charts, key words were sorted into four to six categories; these were further arranged in such a way as to converge toward the concepts of patient-centered care. We consider that our scenario-based workshop may be an effective strategy to facilitate learning professionalism for residents.
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Assessment drives learning, For the past years, we have been using an Traditional oral exam i.e. one examiner or tow examiner taking oral examination of one student, as a part of the examination process for the First MBBS formative and summative assessment. There appears to be tremendous variation on what constitutes the "traditional" oral examination. Studies analyzing characteristics of oral examinations vary most often by format and number of examiners. Considering above pros and cons of traditional oral examination and on the basis of examiners’ feedback, the new format of viva voce examination is started in the form of “Small Group Structured Oral Examination”(SGSOE). In SGSOE Students will be divided in the small group of 10 to 12 students in each group. They have to sit in chronological order in group. Two examiners will be assigned to group . For examination, according to roll no, they have to randomly select a chit from box. Than student has to give answer of main question mention in structured viva card of the topic Than rest of the students one by one, has to give answer of leading question related to that topic. after completion of Group Viva (GV) group of two examiner present at group viva will decides Marks, depending number of topic attend by all the students. Thus, It is one of the new exam systems designed to make an objective, valid and reliable assessment of different components of subject.
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Objective To introduce small group learning in the course of introduction to gen-eral practice to cultivate students' ability of active learning and innovation. Methods Totally 221 students of 2008 grade A and B classes were enrolled as teaching objects and were divided into 20 groups. Introduction to general practice was used as learning materials. One week before the class, teacher gave students learning task and A and B classes carried on class discussion respectively. Re-view speaking was conducted by the representatives of groups. Effectiveness was evaluated through the observation,interview,questionnaire survey and answer scoring points. Results Overall support per-centage to small group learning was 91%. Percentages of students who believed that small group learn-ing was beneficial to cultivating the ability of active learning and innovation were 88% and 73% re-spectively. Conclusions Introducing small group learning in the course of introduction to general practice is effective and conductive to training students' ability to study and innovate.
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Background: ‘What is the ideal way of teaching Ayurveda?’ – has been a debated question since long. The present graduate level curriculum lists out the topics from ‘contemporary medical science’ and ‘Ayurveda’ discretely, placing no emphasis on integration. Most of the textbooks, too, follow the same pattern. This makes learning not only diffi cult, but also leads to cognitive dissonance. Objectives: To develop and evaluate the effectiveness of a few integrative teaching methods. Materials and Methods: We introduced three different interventions in the subject Kriya Sharira with special reference to ‘cardiovascular physiology’. The instructional methods that we evaluated were: 1. Integrative module on cardiovascular physiology (IMCP), 2. case-stimulated learning (CSL), and 3. classroom small group discussion (CSGD). In the fi rst two experiments, we subjected the experimental group of graduate students to the integrative instructional methods. The control group of students received the instructions in a conventional, didactic, teacher-centric way. After the experiments were over, the learning outcome was assessed and compared on the basis of the test scores. The groups were crossed over thereafter and the instructional methods were interchanged. Finally, feedback was obtained on different questionnaires. In the third experiment, only student feedback was taken as we could not have a control group. Results: The test results in the fi rst experiment showed that the integrative method is comparable with the conventional method. In the second experiment, the test results showed that the integrative method is better than the conventional method. The student feedback showed that all the three methods were perceived to be more interesting than the conventional one. Conclusion: The study shows that the development of testable integrative teaching methods is possible in the context of Ayurveda education. It also shows that students fi nd integrative approaches more interesting than the conventional method.
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PURPOSE: This study was conducted to examine the effects of case-based learning on the coping ability of daycare center teachers in emergency situations. In the study knowledge of emergency treatment methods, attitude, intention and ability to perform CPR between were examined in an experimental group (daycare center teachers who participated in the small groups discussing case studies and comparing them with their own experience) and a control group. METHODS: The study was designed using a nonequivalent control group pretest-posttest design. Sixty-four teachers were recruited from 40 child daycare centers in S city located in J province. Thirty-three teachers were assigned to experimental group and participated in the case-based small group learning. The data were analyzed using the SPSS 18.0 program to perform chi2-test, Pearson correlation coefficients and t-test. RESULTS: The experimental group showed significantly higher posttest scores in knowledge, attitude, intention, and performance ability than those of the control group. CONCLUSION: The study results indicate that case-based small group learning on coping ability in emergency situation is effective in increasing knowledge, attitude, intention, and performance ability for daycare center teachers.