Where do we invest money to implement active learning on caries detection? An economic evaluation.

This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8-8.1), and the total cost of the teaching activity would be $684 (IQR:672-696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved.

Development of low-cost cardiac and skeletal muscle laboratory activities to teach physiology concepts and the scientific method.

Anatomy and Physiology courses taught at community colleges tend to focus laboratory hours primarily on anatomy as opposed to physiology. However, research demonstrates that, when instructors utilize active learning approaches (such as in laboratory settings) where students participate in their own learning, students have improved outcomes, such as higher test scores and better retention of material. To provide community college students with opportunities for active learning in physiology, we developed two laboratory exercises to engage students in cardiac and skeletal muscle physiology. We utilized low-cost SpikerBox devices to measure electrical activity during cardiac (electrocardiogram) and skeletal muscle (electromyogram) contraction. Laboratory activities were employed in Anatomy and Physiology courses at two community colleges in southeast Michigan. A 2-h laboratory period was structured with a 20-min slide presentation covering background material on the subject and experiments to examine the effects of environmental variables on nervous system control of cardiac and skeletal muscle contraction. Students were asked to provide hypotheses and proposed mechanisms, complete a results section, and provide conclusions for the experiments based on their results. Our laboratory exercises improved student learning in physiology and knowledge of the scientific method and were well-received by community college students enrolled in Anatomy and Physiology. Our results demonstrate that the use of a SpikerBox for cardiac and skeletal muscle physiology concepts is a low-cost and effective approach to integrate physiology activities into an Anatomy and Physiology course.

Optimizing resource utilization during proficiency-based training of suturing skills in medical students: a randomized controlled trial of faculty-led, peer tutor-led, and holography-augmented methods of teaching.

BACKGROUND: Suturing is a fundamental skill in undergraduate medical education. It can be taught by faculty-led, peer tutor-led, and holography-augmented methods; however, the most educationally effective and cost-efficient method for proficiency-based teaching of suturing is yet to be determined. METHODS: We conducted a randomized controlled trial comparing faculty-led, peer tutor-led, and holography-augmented proficiency-based suturing training in pre-clerkship medical students. Holography-augmented training provided holographic, voice-controlled instructional material. Technical skill was assessed using hand motion analysis every ten sutures and used to construct learning curves. Proficiency was defined by one standard deviation within average faculty surgeon performance. Intervention arms were compared using one-way ANOVA of the number of sutures placed, full-length sutures used, time to proficiency, and incremental costs incurred. Surveys were used to evaluate participant preferences. RESULTS: Forty-four students were randomized to the faculty-led (n = 16), peer tutor-led (n = 14), and holography-augmented (n = 14) intervention arms. At proficiency, there were no differences between groups in the number of sutures placed, full-length sutures used, and time to achieve proficiency. The incremental costs of the holography-augmented method were greater than faculty-led and peer tutor-led instruction ($247.00 ± $12.05, p < 0.001) due to the high cost of the equipment. Faculty-led teaching was the most preferred method (78.0%), while holography-augmented was the least preferred (0%). 90.6% of students reported high confidence in performing simple interrupted sutures, which did not differ between intervention arms (faculty-led 100.0%, peer tutor-led 90.0%, holography-augmented 83.3%, p = 0.409). 93.8% of students felt the program should be offered in the future. CONCLUSION: Faculty-led and peer tutor-led instructional methods of proficiency-based suturing teaching were superior to holography-augmented method with respect to costs and participants' preferences despite being educationally equivalent.

Benefit-cost analysis of an interprofessional education program within a residential aged care facility in Western Australia.

Interprofessional education (IPE) programs in residential aged care facilities (RACF) contributes to the care of older adults whilst providing an environment for students to learn and practise in an interprofessional manner. Clinical placements are provided by RACF through funding and support from universities in collaboration with the RACF. Conducting a benefit-cost analysis (BCA) can determine the sustainability of a clinical placement program such as an IPE program but there is limited research reporting the economic aspects of clinical placements even though it is a university and government priority. This study provides a benefit-cost analysis of an interprofessional education program offered by a residential aged care provider in Western Australia. Analysis using a BCA methodology was conducted to provide information about the level and distribution of the costs and benefits from different analytical perspectives over the three-year period of the IPE program. The analysis showed that the program was highly beneficial from an economic efficiency viewpoint, even though it did not present a financial gain for the aged care provider. The benefits accrued mainly to students in terms of increased education and skill, and to residents in terms of health outcomes and quality of life, while the cost was mostly incurred by the care provider. An IPE program in a RACF is a valuable educational learning experience for students and is also socially beneficial for residents and the broader health sector. For IPE programs in aged care to be sustainable, they require the development of collaborative partnerships with external funding.

Simple and rapid system for two-dimensional gel electrophoresis technique: A laboratory exercise for high school students.

Polyacrylamide gel electrophoresis (PAGE) is the most classical technique favored worldwide for resolution of macromolecules in many biochemistry laboratories due to its incessant advanced developments and wide modifications. These ever-growing advancements in the basic laboratory equipments lead to emergence of many expensive, complex, and tricky laboratory equipments. Practical courses of biochemistry at high school or undergraduate levels are often affected by these complications. Two dimensional gel electrophoresis technique (2D-PAGE) used for resolving thousands of proteins in a gel is a combination of isoelectric focusing (first dimension gel electrophoresis technique) and sodium-dodecylsulphate PAGE (second dimension gel electrophoresis technique or SDS-PAGE). Two different laboratory equipments are needed to carry out effective 2D-PAGE technique, which also invites extra burden to the school laboratory. Here, we describe a low cost, time saving and simple gel cassette for protein 2D-PAGE technique that uses easily fabricated components and routine off-the-shelf materials. The performance of the apparatus was verified in a practical exercise by a group of high school students with positive outcomes. © 2018 by The International Union of Biochemistry and Molecular Biology, 46(3):237-244, 2018.

Capturing Change: Creating a Template to Examine the Educational Experiences and Outcomes of the AONE Foundation Nurse Manager Fellowship.

OBJECTIVE: The aim of the study is to create a mixed-methods evaluation template to examine the educational experiences and outcomes of participants in the Nurse Manager Fellowship (NMF) sponsored by the American Organization of Nurse Executives (AONE) Foundation. The focus was to capture change as reported by the nurse manager (NM) fellows and the senior leaders who sponsored them and to gain access to the participants' lived experiences as leadership learners. BACKGROUND: The AONE Foundation's NMF conducts a yearlong professional development program with a cohort of 30 fellows who meet 4 times a year in face-to-face sessions and complete a capstone project. METHODS: Four data collection methods were used. Participants completed 2 quantitative leadership program outcome surveys, as well as 1 qualitative measure to focus on self-perceived change outcomes. Their sponsors completed a qualitative perception of change measure. RESULTS: The participants' reflections, self-reports, and the sponsor observations capture impactful changes in the NM fellows' increases in knowledge and application in the spheres of self, organization, and community. The enhancement of the participants' self-identification as leaders was also demonstrated. CONCLUSIONS: The variety of data collection methods suggests both distinct choices in creating future evaluation templates for the fellowship and approaches that might be adapted by other organizations.

Cost-Effectiveness of Using Standardized Patients to Assess Student-Pharmacist Communication Skills.

Objective. To explore the cost-effectiveness of including standardized patients (SP) in the didactic curriculum for application and assessment of students' pharmacist-patient communication skills. Methods. Five role play/case study (RP/CS) activities from a communication skills curriculum were replaced with five SP encounters. Communication was assessed using a rubric. This study developed an economic model to examine the costs and effectiveness of replacing RP/CS events with SP events in knowledge-application and communication assessment. Costs consisted of SP hourly wages for training and delivery of SP events. Outcomes examined were the incremental cost-effectiveness ratio (ICER) per student. Results. The ICER comparing SP to RP/CS was $100.93 higher per student on first-attempt pass rates and $9.04 per one-point increase in the mean score. Conclusion. SP was more effective and more costly than RP/CS. Further research into students' willingness to pay needs to occur before determining if using SPs is cost-effective in teaching communication skills.

Comparative Study of Three Different Personal Response Systems with Fourth-Year Undergraduate Veterinary Students.

The purpose of this study was to compare three different Personal Response Systems that have been used in recent years at the School of Veterinary Science, University of Liverpool: a technology-free system (Communicubes), a handset delivery device (TurningPoint), and a cloud-based technology (Poll Everywhere) that allows students to use a range of personal computing devices to register their answer. All three systems offer a method to promote active learning, and lecturers were encouraged to use them. However, there are cost and logistical implications for each. The authors found that both staff and students did have particular preferences for a specific system. This preference was not the same for both groups. The outcome of the comparison is that further research is needed into cloud-based technology as it offers benefits to the students but is also a distraction.

Cost savings associated with pharmacy student interventions during APPEs.

OBJECTIVE: To quantify the impact of pharmacy students' clinical interventions in terms of number and cost savings throughout advanced pharmacy practice experiences (APPEs) using a Web-based documentation program. METHODS: Five hundred eighty doctor of pharmacy (PharmD) students completing ten 4-week APPEs during the final year of the curriculum were asked to document all clinical interventions they made using a Web-based documentation tool. Data were collected over 4 academic years. RESULTS: The total number of interventions made was 59,613, the total dollars saved was $8,583,681, and the average savings per intervention was $148. The top 3 categories of interventions made by students were identifying dosing issues, conducting chart reviews, and recommending appropriate therapy. The top 3 intervention types made by students that resulted in the most dollars saved per intervention were identifying potential allergic reactions, identifying drug interactions, and resolving contraindications. CONCLUSIONS: Pharmacy students made important and cost-effective clinical interventions during their APPEs that resulted in significant savings. Documentation programs can track the number, type, and value of the interventions that pharmacy students are making.

Status of pharmacy practice experience education programs.

OBJECTIVE: To assess financial, personnel, and curricular characteristics of US pharmacy practice experiential education programs and follow-up on results of a similar survey conducted in 2001. METHODS: Experiential education directors at 118 accredited US pharmacy colleges and schools were invited to participate in a blinded, Web-based survey in 2011. Aggregate responses were analyzed using descriptive statistics and combined with data obtained from the American Association of Colleges of Pharmacy to assess program demographics, faculty and administrative organizational structure, and financial support. RESULTS: The number of advanced pharmacy practice experience (APPE) sites had increased by 24% for medium, 50% for large, and 55% for very large colleges and schools. Introductory pharmacy practice experience (IPPE) sites outnumbered APPEs twofold. The average experiential education team included an assistant/associate dean (0.4 full-time equivalent [FTE]), a director (1.0 FTE), assistant/associate director (0.5 FTE), coordinator (0.9 FTE), and multiple administrative assistants (1.3 FTE). Most faculty members (63%-75%) were nontenure track and most coordinators (66%) were staff members. Estimated costs to operate an experiential education program represented a small percentage of the overall expense budget of pharmacy colleges and schools. CONCLUSION: To match enrollment growth, pharmacy practice experiential education administrators have expanded their teams, reorganized responsibilities, and found methods to improve cost efficiency. These benchmarks will assist experiential education administrators to plan strategically for future changes.

A snapshot of the status of problem-based learning (PBL) in Chinese medical schools.

INTRODUCTION: In North America, where it was born, problem-based learning (PBL) has seen dips and rises in its popularity, but its inherent strengths have led to its spread to medical schools all over the world. Although its use at medical schools in some Western countries has already been examined, no one has looked at its status in many other countries, including China. The aim of this study is to determine the number of schools currently using PBL in China, the degree to which they use it, and the reasoning behind such usage. METHODS: We used survey and internet search to examine PBL usage at Chinese medical schools. We were able to collect data from 43 first-class Chinese medical schools that are geographically diverse and thus representative of medical schools all across China. RESULTS: 34 (79.1%) of the 43 medical schools use PBL in the preclinical curriculum. Of the 34, data were collected from 24 (70.6%) medical schools regarding the extent of their PBL usage. Nine (37.5%) schools use PBL for less than 10% of preclinical hours, 14 (58.3%) schools use PBL for 10-50% of preclinical hours, and one (4.2%) school uses PBL for more than 50% of preclinical hours. CONCLUSION: In our sample of Chinese medical institutions, a large majority of schools use PBL, however, most schools use it for less than 50% of total preclinical curricular hours. Our results suggest that schools are interested in increasing the number of curricular hours devoted to PBL but are constrained by resources.

Is running a problem-based learning curriculum more expensive than a traditional Subject-Based Curriculum?

BACKGROUND: Running a problem-based learning (PBL) curriculum has been considered to be more expensive than a traditional Subject-Based Curriculum? This claim has not been well substantiated. AIM: To identify faculty educational activities (FEA) related to PBL, calculate its cost (faculty number and time) and compare it with a traditional Subject-Based Curriculum. METHODS: A structured questionnaire was developed through focused group discussion using a Delphi method to identify FEA and ensure face and content validity. For cost comparison, a hypothetic model was developed based on "what if" the curriculum was traditional subject-based, and running within the frame of the current regulations of University of Sharjah. RESULTS: A total of 23 faculty (16 full-time basic medical sciences and 7 clinical tutors) equal to 19.5 full-time equivalent (FTE) responded to the questionnaire. About five major domains and 26 sub-domains of FEA were identified. The calculated number of faculty needed for the hypothetical Subject-Based Curriculum should have been 19 FTEs. The average FEA hours per faculty per week per student in PBL was 17.41 and for the Subject-Based Curriculum would have been 17.85. CONCLUSION: PBL does not require an increase in number of faculty. The time spent by faculty on educational activities was similar in the two curriculum models. Although the cost of two strategies was similar, but the educational roles and the faculty engagement in education in a PBL curriculum is broader than in the traditional curriculum.

Redesign of a pediatric pharmacotherapy elective course to accommodate budget reductions.

OBJECTIVE: To redesign a pediatric elective pharmacotherapy course and determine whether the redesign resulted in changes in outcome measures. DESIGN: Active learning activities were moved to an online format. Prerecorded lectures continued to be used. Peer evaluation was incorporated to give the students more feedback on their performance. ASSESSMENT; Presentation grades, average examination grades, course grades, and evaluation scores from each student who completed University course evaluations were documented for students during the 2 semesters before and the 2 semesters after the course redesign. Although for undetermined reasons a drop in examination grades occurred after the course redesign, no significant differences in presentation grades, final grades, or course evaluation grades occurred. CONCLUSIONS: A strategic course redesign successfully reduced the costs and faculty time required to offer an elective course viewed as essential to the curriculum, allowing the course to be continued in the face of state budget cuts.

Incorporating simulation into a residency curriculum.

The integration of simulation into a medical postgraduate curriculum requires informed implementation in ways that take advantage of simulation's unique ability to facilitate guided application of new knowledge. It requires review of all objectives of the training program to ensure that each of these is mapped to the best possible learning method. To take maximum advantage of the training enhancements made possible by medical simulation, it must be integrated into the learning environment, not simply added on. This requires extensive reorganization of the resident didactic schedule. Simulation planning is supported by clear learning objectives that define the goals of the session, promote learner investment in active participation and allow for structured feedback for individual growth. Teaching to specific objectives using simulation requires an increased time commitment from teaching faculty and careful logistical planning to facilitate flow of learners through a series of simulations in ways that maximize learning. When applied appropriately, simulation offers a unique opportunity for learners to acquire and apply new knowledge under direct supervision in ways that complement the rest of the educational curriculum. In addition, simulation can improve the learning environment and morale of residents, provide additional methods of resident evaluation, and facilitate the introduction of new technologies and procedures into the clinical environment.

Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum.

BACKGROUND: This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse. METHODS: The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U.S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models. RESULTS: This paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice. CONCLUSIONS: Broad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.

Administrative considerations when implementing ACS/APDS Skills Curriculum.

BACKGROUND: With time and cost constraints, implementing an effective, yet efficient, skills curriculum poses significant challenges. Our purpose is to describe a successful curriculum administrative structure that promoted faculty buy-in and accountability, learner responsibility, and acceptable resource usage. METHODS: A total of 14 American College of Surgery (ACS) modules were included in the postgraduate year 1 curriculum. Before arrival, 2 modules were sent to newly matched residents. Remaining modules were administered over a 4-month period, with integrated, independent practice opportunities, as well as 4 mentored and 1 peer practice sessions. A total of 2 verifications of proficiency (VOP) progress exams and 1 final comprehensive VOP were administered. To promote faculty ownership, 1 faculty member was asked to lead each module. Module leaders attended an orientation and development session, and created an instructional management plan. Each module was taught by the leader and 2 additional faculty coinstructors, and evaluated by residents. Equipment, resource costs, and man-hours were tracked. RESULTS: Faculty buy-in was demonstrated by enthusiastic participation, with only 2 absences. Residents gave high ratings to all the modules (range, 4.22-4.89/5). Curriculum costs were approximately $21,500, reduced from potential costs of $187,000 if all simulators would have been purchased new. The estimated budget for year 2 is $17,000. CONCLUSION: It is critical for new curricula to have resident and faculty buy-in, accountability for quality teaching and learning, and reasonable resource use. We provide suggestions for structuring a curriculum to ensure accomplishment of these important drivers.

The use of virtual patients to assess the clinical skills and reasoning of medical students: initial insights on student acceptance.

BACKGROUND: Web-based clinical cases ("virtual patients", VPs) provide the potential for valid, cost-effective teaching and assessment of clinical skills, especially clinical reasoning skills, of medical students. However, medical students must embrace this teaching and assessment modality for it to be adopted widely. METHOD: We examined student acceptance of a web-based VP system, Web-SP, developed for teaching and assessment purposes, in a group of 15 second-year and 12 fourth-year medical students. RESULTS: Student acceptance of this web-based method was high, with greater acceptance in pre-clinical (second-year) compared with clinical (fourth-year) medical students. Students rated VPs as realistic and appropriately challenging; they particularly liked the ability of VPs to show physical abnormalities (such as abnormal heart and lung sounds, skin lesions, and neurological findings), a feature that is absent in standardized patients. CONCLUSIONS: These results document high acceptance of web-based instruction and assessment by medical students. VPs of the complexity used in this study appear to be particularly well suited for learning and assessment purposes in early medical students who have not yet had significant clinical contact.

Comparison of two lecture delivery platforms in a hybrid distance education program.

OBJECTIVE: To compare students' preferences for and academic performance using 2 different distance education course content delivery platforms. METHODS: A randomized, crossover research design was used to compare traditional video with a 4-panel platform among learners on multiple campuses within 1 college of pharmacy.(1) The outcomes were students' preferences for delivery platform and examination scores. Rasch analysis was used to assess unidimensionality and the difficulty of examination items. Hierarchical logistic and multiple regression models were used to assess students' preferences and academic performance. RESULTS: The logistic model predicting preference for the 4-panel or traditional platform was not significant, but African-Americans and Hispanics were more likely to prefer the 4-panel platform than Caucasian and Asian students. The delivery platform did not impact students' academic performance. Students who did well on the semester's previous 2 examinations scored higher on the questions related to schizophrenia. Students with higher Pharmacy College Admission Test (PCAT) scores performed better on the bipolar questions than students who preferred the traditional video platform. CONCLUSION: The additional faculty time, effort, and cost invested in presenting the class material in a 4-panel platform, and the students' extra time and effort spent viewing the 4-panel platform did not produce a comparable benefit in student preference and performance.