Two-stage Examinations in STEM: A Narrative Literature Review

Written, invigilated examinations are valued for their reliability, economy and academic integrity. Nevertheless, examinations are problematic. Final, summative examinations can disadvantage students who experience assessment anxiety, and students may not receive useable feedback. An alternative is the two-stage examination, where a traditional examination is followed by a group examination with similar questions. Students gain peer feedback on their examination performance, and can meaningfully apply this feedback. Use of this format in tertiary STEM education in universities has indicated that students prefer the format, although it has been little studied in Australia. Furthermore, its effects on reducing stress and fostering deeper learning are not well understood. The COVID-19 pandemic and switch to online learning has provided us with an opportunity to review our assessment practices and has led to a new willingness to test different examination formats. Here we provide a narrative review of the results of previous studies on two-stage examinations and, based on this and our experience teaching in large-cohort introductory biology courses at an Australian university, we propose a formula for employing them in this context.

A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

PURPOSE: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN: Randomized, controlled trial. SETTING: Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS: 74,811 adults. INTERVENTIONS: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES: Influenza vaccination. ANALYSIS: Intention-to-treat. RESULTS: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

Impact of Telemedicine on Prenatal Counseling at a Tertiary Fetal Center: A Mixed Methods Study.

INTRODUCTION: COVID-19 spurred an unprecedented transition from in-person to telemedicine visits in March 2020 at our institution for all prenatal counseling sessions. This study aims to explore differences in demographics of expectant mothers evaluated pre- and post-telemedicine implementation and to explore the patient experience with telemedicine. METHODS: A mixed methods study was completed for mothers with a pregnancy complicated by a fetal surgical anomaly who visited a large tertiary fetal center. Using medical records as quantitative data, patient information was collected for all prenatal visits from 3/2019 to 3/2021. The sample was grouped into pre- and post-telemedicine implementation (based on transition date of 3/2020). Univariate analysis was used to compare demographics between the study groups. Statistical significance was defined as P < 0.05. Eighteen semi-structured interviews were conducted from 8/2021 to 12/2021 to explore patients' experiences. Line-by-line coding and thematic analysis was performed to develop emerging themes. RESULTS: 292 pregnancies were evaluated from 3/2019 to 3/2021 (pre-telemedicine 123, post-telemedicine 169). There was no significant difference in self-reported race (P = 0.28), ethnicity (P = 0.46), or primary language (P = 0.98). In qualitative interviews, patients reported advantages to telemedicine, including the convenience of the modality with the option to conduct their session in familiar settings (e.g., home) and avoid stressors (e.g., travel to the medical center and finding childcare). Some women reported difficulties establishing a physician-patient connection and a preference for in-person consultations. CONCLUSIONS: There was no difference in patient demographics at our fetal center in the year leading up to, and the time following, a significant transition to telemedicine. However, patients had unique perspectives on the advantages and disadvantages of the telemedicine experience. To ensure patient centered care, these findings suggest patient preference should be considered when scheduling outpatient surgical counseling and visits.

Blended (online and in-person) Women's Health Interprofessional Learning by Simulation (WHIPLS) for medical and midwifery students.

BACKGROUND: Blended teaching combines traditional in-person components (simulation-based training and clinical-based placement) with online resources. Due to the COVID-19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program - to develop core obstetric and gynaecological skills - into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning. AIMS: To qualitatively evaluate the blended teaching program and explore how it contributes to learning. MATERIALS AND METHODS: This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework. RESULTS: Students reported that in-person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low-pressure simulation environments', 'peer-assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'. DISCUSSION: In-person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical-based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in-person opportunities and resources. Our study reveals key pedagogies of a blended (online and in-person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning.

Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series.

INTRODUCTION: In April 2020, novel coronavirus SARS-CoV-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies. METHODS: Awareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls. RESULTS: Musculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents. DISCUSSION: Risk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was "waiting for you." Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.

The cost of a single concussion in American high school football: a retrospective cohort study.

AIM: The potential financial burden of American football-related concussions (FRC) is unknown. Our objective was to describe the healthcare costs associated with an FRC and determine factors associated with increased costs. METHODOLOGY/RESULTS: A retrospective cohort study of concussed high school football players presenting between November 2017 and March 2020 was undertaken; 144 male high school football players were included. Total costs were about $115,000, for an average direct healthcare cost of $800.10/concussion. Visiting the emergency department (ß = 502.29, 95% CI: 105.79-898.61; p = 0.01), the initial post-concussion symptom scale score (ß = 0.39, 95% CI: 0.11-0.66; p = 0.01) and a post-concussion syndrome diagnosis (ß = 670.37, 95% CI: 98.96-1241.79; p = 0.02) were each independently associated with total costs. CONCLUSION: A granular understanding of cost-driving factors associated with FRC is the first step in understanding the cost-effectiveness of prevention and treatment methods.