Virtual patients designed for training against medical error: Exploring the impact of decision-making on learner motivation.

OBJECTIVES: Medical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation. METHODS: Using a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies. RESULTS: Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions. CONCLUSIONS: The findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students' motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes.

Transforming medical education in Kazakhstan: Successful case of internationalization from Karaganda State Medical University.

BACKGROUND: Medical education in Kazakhstan has been literally transformed in the past 10 years. Kazakhstan inherited the Soviet-time discipline-based teacher-centered system of education when no decisions could be made independently. The curriculum was mostly governed in a traditional way, with lectures being the core, little use of e-learning tools, and assessment through oral exams and multiple-choice questions. Most of the universities still preserve the subject-based curriculum with elements of integrated learning. METHODS: Being the most active member of International Space Education, Karaganda State Medical University (KSMU) took the initiative to adapt the full integrated curriculum mostly based on problem-based, team-based learning, and use of virtual patient cases. The given approach was chosen because of active involvement of our University in nine Tempus and Erasmus+projects including reforming of Public Health and Nursing curriculum, human resources development, active learning, credit mobility, and move towards autonomy of medical schools. RESULTS: KSMU became the coordinator of two of these projects, taking its active position in internationalization of medical education. We actively use technology-based medical education, pro-actively adapting deliberate practice in acquiring essential practical skills, for which KSMU was recognized by an ASPIRE-to-Excellence Award in simulation. CONCLUSIONS: Kazakhstan hopes to become the leader in medical education in Central Asia and suggests other Universities in the area to adopt its approach to internationalization of medical education.

Computation of nonlinear parameters of heart rhythm using short time ECG segments.

We propose the method to compute the nonlinear parameters of heart rhythm (correlation dimension D2 and correlation entropy K2) using 5-minute ECG recordings preferred for screening of population. Conversion of RR intervals' time series into continuous function x(t) allows getting the new time series with different sampling rate dt. It has been shown that for all dt (250, 200, 125, and 100 ms) the cross-plots of D2 and K2 against embedding dimension m for phase-space reconstruction start to level off at m = 9. The sample size N at different sampling rates varied from 1200 at dt = 250 ms to 3000 at dt = 100 ms. Along with, the D2 and K2 means were not statistically different; that is, the sampling rate did not influence the results. We tested the feasibility of the method in two models: nonlinear heart rhythm dynamics in different states of autonomous nervous system and age-related characteristics of nonlinear parameters. According to the acquired data, the heart rhythm is more complex in childhood and adolescence with more influential parasympathetic influence against the background of elevated activity of sympathetic autonomous nervous system.