Designing Activities to Teach Higher-Order Skills: How Feedback and Constraint Affect Learning of Experimental Design.

Active learning approaches to biology teaching, including simulation-based activities, are known to enhance student learning, especially of higher-order skills; nonetheless, there are still many open questions about what features of an activity promote optimal learning. Here we designed three versions of a simulation-based tutorial called Understanding Experimental Design that asks students to design experiments and collect data to test their hypotheses. The three versions vary the experimental design task along the axes of feedback and constraint, where constraint measures how much choice students have in performing a task. Using a variety of assessments, we ask whether each of those features affects student learning of experimental design. We find that feedback has a direct positive effect on learning. We further find that small changes in constraint have only subtle and mostly indirect effects on learning. This work suggests that designers of tools for teaching higher-order skills should strive to include feedback to increase impact and may feel freer to vary the degree of constraint within a range to optimize for other features such as the ability to provide immediate feedback and time-on-task.

Outcomes of an Innovative Best Practice Clinical Immersion Framework: A Pilot Study.

BACKGROUND: Academic nursing has a long history of partnering with practice-based settings to provide clinical learning experiences for nursing students; however, these placements are not easily obtained, especially in pediatrics. APPROACH: A freestanding academic pediatric hospital and 3 academic nursing programs collaborated to provide clinical practice to nursing students hired in a practice-based internship program. A second aim was to pilot a best practice clinical immersion framework to provide academic credit to bachelor of science in nursing (BSN) students using a shared clinical syllabus and e-learning platform. OUTCOMES: Sixteen nursing students successfully completed the program; 11 (68.7%) completed the pre- and postevaluation with significant ( P < .05) changes in scores for 7 of the 20 questions. CONCLUSION: This best practice clinical immersion framework provided a strategy for obtaining clinical practice and academic credit, demonstrating the potential of innovative practice-academic partnerships. Further, this framework can be easily adapted in other practice-academic partnerships in all clinical areas.

Not just robo-students: why full engagement matters and how schools can promote it.

Research has long linked academic engagement to positive social, psychological, and physical developmental outcomes; however, qualitative studies in high-performing schools find that some students who work hard in school may be compromising their mental and physical health in the pursuit of top grades. Such research calls for closer and more contextualized examinations of the concept of engagement. This study examines academic engagement in a sample of 6,294 students (54 % female; 44 % White, 34 % Asian, and 22 % other racial or ethnic background) attending 15 high-achieving schools. Findings show that two-thirds of students at these schools are not regularly "fully engaged" in their academic schoolwork; that is, they do not regularly report high levels of affective, behavioral and cognitive engagement. Although most students report working hard, few enjoy their schoolwork and find it valuable. This lack of full engagement, particularly the absence of affective and cognitive engagement, is associated with more frequent school stress, higher rates of cheating, and greater internalizing, externalizing, and physical symptoms of stress. The study also finds that full engagement is strongly related to positive teacher-student relationships. Implications for practice and future research are discussed.

Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy.

OBJECTIVES: To investigate the effect of group cognitive behavioural therapy (CBT) for fatigue self-management, compared with groups receiving fatigue information alone, on fatigue impact among people with rheumatoid arthritis (RA). METHODS: Two-arm, parallel randomised controlled trial in adults with RA, fatigue ≥ 6/10 (Visual Analogue Scale (VAS) 0-10, high bad) and no recent change in RA medication. Group CBT for fatigue self-management comprised six (weekly) 2 h sessions, and consolidation session (week 14). Control participants received fatigue self-management information in a 1 h didactic group session. Primary outcome at 18 weeks was the impact of fatigue measured using two methods (Multi-dimensional Assessment of Fatigue (MAF) 0-50; VAS 0-10), analysed using intention-to-treat analysis of covariance with multivariable regression models. RESULTS: Of 168 participants randomised, 41 withdrew before entry and 127 participated. There were no major baseline differences between the 65 CBT and 62 control participants. At 18 weeks CBT participants reported better scores than control participants for fatigue impact: MAF 28.99 versus 23.99 (adjusted difference -5.48, 95% CI -9.50 to -1.46, p=0.008); VAS 5.99 versus 4.26 (adjusted difference -1.95, 95% CI -2.99 to -0.90, p<0.001). Standardised effect sizes for fatigue impact were MAF 0.59 (95% CI 0.15 to 1.03) and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of CBT. Secondary outcomes of perceived fatigue severity, coping, disability, depression, helplessness, self-efficacy and sleep were also better in CBT participants. CONCLUSIONS: Group CBT for fatigue self-management in RA improves fatigue impact, coping and perceived severity, and well-being. TRIAL REGISTRATION: ISRCTN 32195100.

Implementing a patient-led service for chronic conditions.

Many chronic conditions with fluctuating levels of disease activity are traditionally managed by lifelong regular medical reviews. However, this means appointments do not always coincide with patient need, while the volume of reviews makes it difficult to respond quickly to requests for help. Research in rheumatoid arthritis suggests that hospital-initiated reviews can be replaced by patient-initiated reviews, supported by nurse-led initiatives.

Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored.

OBJECTIVE: Fatigue is commonly reported by patients with rheumatoid arthritis (RA) but is rarely a treatment target. The aim of this study was to explore the concept of fatigue as experienced by patients with RA. METHODS: Fifteen patients with RA and fatigue (> or =7 on a 10-cm visual analog scale) were individually interviewed and asked about the description, cause, consequence, and management of fatigue. Transcripts were systematically analyzed by 2 researchers independently, relevant phrases were coded, and earlier transcripts were checked for the emerging codes. A random sample of analyses were independently reviewed. A total of 191 codes arising from the data were grouped into 46 categories and overarching themes. RESULTS: Vivid descriptions reflect 2 types of fatigue: severe weariness and dramatic overwhelming fatigue. RA fatigue is different from normal tiredness because it is extreme, often not earned, and unresolving. Participants described physical, cognitive, and emotional components and attributed fatigue to inflammation, working the joints harder, and unrefreshing sleep. Participants described far-reaching effects on physical activities, emotions, relationships, and social and family roles. Participants used self-management strategies but with limited success. Most did not discuss fatigue with clinicians but when they did, they felt it was dismissed. Participants held negative views on the management of fatigue. CONCLUSION: The data show that RA fatigue is important, intrusive, and overwhelming, and patients struggle to manage it alone. These data on the complexity of fatigue experiences will help clinicians design measures, interventions, and self-managment guidance.