Exploring Medical Students' Learning Around Uncertainty Management Using a Digital Educational Escape Room: A Design-based Research Approach.

Introduction: Medical professionals meet many transitions during their careers, and must learn to adjust rapidly to unfamiliar workplaces and teams. This study investigated the use of a digital educational escape room (DEER) in facilitating medical students' learning around managing uncertainty in transitioning from classroom to clinical placement. Methods: We used design-based research to explore the design, build, and test of a DEER, as well as gain insight into how these novel learning environments work, using Community of Inquiry (CoI) as a guiding conceptual framework. This study represented a mixed methods pilot test of a prototype DEER. Twenty-two medical students agreed to participate, and data were collected through qualitative (i.e., focus groups, game-play observations) and quantitative (i.e., questionnaires) methods. Results: Eighty-two per cent of participants agreed or strongly agreed that the DEER supported their learning around uncertainty. Participants offered diverse examples of how the game had facilitated new insights on, and approaches to, uncertainty. With respect to the learning environment, multiple indicators and examples of the three domains of CoI - cognitive, teaching and social presence - were observed. Discussion: Our findings suggested that DEERs offer a valuable online learning environment for students to engage with complex and emotion-provoking challenges, such as those experienced at transitions. The study also suggested that CoI can be applied to the design, implementation, and evaluation of DEER learning environments, and we have proposed a set of design principles that may offer guidance here.

Building digital escape rooms for learning: From theory to practice.

Digital games are increasingly used to support learning across a diverse range of cognitive, affective and psychomotor domains in health professions education. Game-based learning will likely become an important competency for educators. However, educators can perceive game building as out of their reach due to a lack of expertise in digital technology. This toolbox offers advice to health professions educators who would like to build a simple game for learning known as a digital educational escape room.

"It's okay to not know " a qualitative exploration of faculty approaches to working with uncertainty.

BACKGROUND: Whilst it is recognised that a capacity to manage uncertainty is an essential aspect of working as a healthcare professional, there is little clear guidance on how to facilitate student learning in this domain. A lack of faculty development opportunities also suggests that health professions' educators may feel ill-equipped to assist students in developing effective approaches to uncertainty. The purpose of this study was to explore a faculty development intervention designed to help educators unpack students' experiences of uncertainty, and identify attributes which may help students to manage uncertain situations. METHODS: This qualitative study was informed by a constructivist methodological approach, where participants were encouraged to share meaning around the nature of uncertainty in health professions' education. Two 90-min faculty development sessions were held. These sessions invited participants to apply Han et al.'s taxonomy of uncertainty to role-played scenarios of student uncertainty within a focus group setting. Focus group data were collected, and examined using a two-stage, hybrid approach of deductive and inductive thematic analysis. RESULTS: Han et al.'s taxonomy helped participants to identify multiple sources and issues of uncertainty in the role played scenarios, thus unveiling the extent of uncertainties encountered by health professions' learners. Data analysis revealed four themes overall: "Sources of uncertainty", "Issues of uncertainty", "Uncertainty attributes", and "Learning environment." Participants also contributed to a list of attributes which they considered helpful to undergraduate health professions' students in managing uncertain situations. These included an awareness of the nature of uncertainty within healthcare practice, an ability to recognise uncertainty, and adopting attitudes of adaptability, positivity, and resilience. CONCLUSIONS: This study highlights the successful use of Han et al.'s taxonomy of uncertainty within a faculty development setting. Our findings suggest that the taxonomy is a practical and versatile tool that health professions' educators can use in shared reflections and conversations around uncertainty with students or colleagues.

The ubiquity of uncertainty: a scoping review on how undergraduate health professions' students engage with uncertainty.

Although the evidence base around uncertainty and education has expanded in recent years, a lack of clarity around conceptual terms and a heterogeneity of study designs means that this landscape remains indistinct. This scoping review explores how undergraduate health professions' students learn to engage with uncertainty related to their academic practice. To our knowledge, this is the first scoping review which examines teaching and learning related to uncertainty across multiple health professions. The scoping review is underpinned by the five-stage framework of (Arksey and O'Malley in Scoping studies: Towards a methodological framework International Journal of Social Research Methodology 8(1) 19-32, 2005). We searched MEDLINE, Embase, PsychINFO, ISI Web of Science, and CINAHL and hand-searched selected health professions' education journals. The search strategy yielded a total of 5,017 articles, of which 97 were included in the final review. Four major themes were identified: "Learners' interactions with uncertainty"; "Factors that influence learner experiences"; "Educational outcomes"; and, "Teaching and learning approaches". Our findings highlight that uncertainty is a ubiquitous concern in health professions' education, with students experiencing different forms of uncertainty at many stages of their training. These experiences are influenced by both individual and system-related factors. Formal teaching strategies that directly support learning around uncertainty were infrequent, and included arts-based teaching, and clinical case presentations. Students also met with uncertainty indirectly through problem-based learning, clinical teaching, humanities teaching, simulation, team-based learning, small group learning, tactical games, online discussion of anatomy topics, and virtual patients. Reflection and reflective practice are also mentioned as strategies within the literature.

Evaluation of a coaching workshop for the management of veterinary nursing students' OSCE-associated test anxiety.

BACKGROUND: High stress levels amongst undergraduates (particularly in relation to assessment) and efforts to improve mental wellbeing have been increasingly reported in the veterinary educational literature. However reports to date have primarily focused on the experiences of students of veterinary medicine, rather than veterinary nursing students. METHODS: The purpose of this mixed method sequential explanatory study was to establish the "Big-five" personality traits and quantify the level of test anxiety associated with objective structured clinical examinations (OSCEs) amongst a cohort of 23 final year veterinary nursing students at an Irish third level college. The 12 item Brief FRIEDBEN Test Anxiety Scale (B-FTAS) and the 20 item mini International Personality Item Pool (mini-IPIP) were used to identify test anxiety levels and personality traits in this cohort. Focus groups were then employed to examine the effectiveness of a coaching intervention in ameliorating this test anxiety. RESULTS: The initial, quantitative, phase found these students to have higher levels of test anxiety than previously reported for undergraduates sitting written examinations. No association was found between test anxiety and neurotic personality traits in this student cohort. In the qualitative follow up phase the coaching intervention was reported to have been helpful in equipping the students to better manage test anxiety. The OSCE stressors identified in this study closely resembled those previously reported by nursing and midwifery students. CONCLUSIONS: The shared experience of the coaching intervention and formative OSCE was reported to have been helpful in empowering the students to manage assessment-associated anxiety. Implications and recommendations for educators were identified.

Veterinary Students' Perspectives on Resilience and Resilience-Building Strategies.

In recent years, resilience has been lauded as a valuable, even necessary, facet of an effective veterinary practitioner. This study describes a mixed-methods research exploration of the impact of a self-care and mental well-being teaching intervention on the self-reported resilience of 105 first-year veterinary students enrolled at the School of Veterinary Medicine, University of Surrey, UK. Quantitative data were obtained through a questionnaire, the 10-item Connor-Davidson Resilience Scale (CD-RISC 10), which students completed before and after the teaching intervention. The median total score on the scale increased from 27 (IQR=25-30) to 29 (IQR=26-32) (p<.001), a medium effect size (r=-0.28). Student focus groups were held to allow qualitative data analysis of the students' perspectives on the teaching intervention and on the topic of resilience in general. The results of this study suggest that appropriate training in resilience-building strategies can help veterinary students build greater awareness of resilience, and potentially support their development of a more resilient approach in their personal and professional lives. In this study, veterinary students felt that resilience training was a valuable addition to the veterinary curriculum, and that resilience likely plays an important role in achieving a successful veterinary career. The study also suggested that veterinary students utilize a variety of different resilience-building strategies, including drawing on past experiences, seeking help from support networks, and developing an ability to change their perspectives.

Evaluation of the flipped classroom approach in a veterinary professional skills course.

BACKGROUND: The flipped classroom is an educational approach that has had much recent coverage in the literature. Relatively few studies, however, use objective assessment of student performance to measure the impact of the flipped classroom on learning. The purpose of this study was to evaluate the use of a flipped classroom approach within a medical education setting to the first two levels of Kirkpatrick and Kirkpatrick's effectiveness of training framework. METHODS: This study examined the use of a flipped classroom approach within a professional skills course offered to postgraduate veterinary students. A questionnaire was administered to two cohorts of students: those who had completed a traditional, lecture-based version of the course (Introduction to Veterinary Medicine [IVM]) and those who had completed a flipped classroom version (Veterinary Professional Foundations I [VPF I]). The academic performance of students within both cohorts was assessed using a set of multiple-choice items (n=24) nested within a written examination. Data obtained from the questionnaire were analyzed using Cronbach's alpha, Kruskal-Wallis tests, and factor analysis. Data obtained from student performance in the written examination were analyzed using the nonparametric Wilcoxon rank sum test. RESULTS: A total of 133 IVM students and 64 VPF I students (n=197) agreed to take part in the study. Overall, study participants favored the flipped classroom approach over the traditional classroom approach. With respect to student academic performance, the traditional classroom students outperformed the flipped classroom students on a series of multiple-choice items (IVM mean =21.4±1.48 standard deviation; VPF I mean =20.25±2.20 standard deviation; Wilcoxon test, w=7,578; P<0.001). CONCLUSION: This study demonstrates that learners seem to prefer a flipped classroom approach. The flipped classroom was rated more positively than the traditional classroom on many different characteristics. This preference, however, did not translate into improved student performance, as assessed by a series of multiple-choice items delivered during a written examination.