Content and discontent: a qualitative exploration of obstacles to elearning engagement in medical students

BACKGROUND: Elearning is ubiquitous in healthcare professions education. Its equivalence to ‘traditional’ educational delivery methods is well established. There is a research imperative to clarify when and how to use elearning most effectively to mitigate the potential of it becoming merely a ‘disruptive technology.’ Research has begun to broadly identify challenges encountered by elearning users. In this study, we explore in depth the perceived obstacles to elearning engagement amongst medical students. Sensitising concepts of achievement emotions and the cognitive demands of multi-tasking highlight why students’ deeply emotional responses to elearning may be so important in their learning. METHODS: This study used focus groups as a data collection tool. A purposeful sample of 31 participated. Iterative data gathering and analysis phases employed a constant comparative approach to generate themes firmly grounded in participant experience. RESULTS: Key themes that emerged from the data included a sense of injustice, passivity and a feeling of being ‘lost at sea’. The actual content of the elearning resource provided important context. CONCLUSIONS: The identified themes have strong emotional foundations. These responses, interpreted through the lens of achievement emotions, have not previously been described. Appreciation of their importance is of benefit to educators involved in curriculum development or delivery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12909-016-0710-5) contains supplementary material, which is available to authorized users

Macrocognition in the Health Care Built Environment (m-HCBE): A Focused Ethnographic Study of \u27Neighborhoods\u27 in a Pediatric Intensive Care Unit: A Dissertation

Objectives: The objectives of this research were to describe the interactions (formal and informal) in which macrocognitive functions occur and their location on a pediatric intensive care unit (PICU); describe challenges and facilitators of macrocognition using three constructs of space syntax (openness, connectivity, and visibility); and analyze the health care built environment (HCBE) using those constructs to explicate influences on macrocognition. Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple health care settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “Macrocognition in the Health Care Built Environment” (m-HCBE) addresses this relationship. Methods: A focused ethnographic study was conducted, including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help to advance the m-HCBE theory for improving physical space by designing new spaces or refining existing spaces, or for adapting IPT practices to maximize formal and informal SMI opportunities; this lays the groundwork for future research to improve safety and quality for patient and family care

Self-Tracking by People Living with Multiple Sclerosis: Supporting Experiences of Agency in a Chronic Neurological Condition

Multiple sclerosis is a complex neurological condition. It disrupts the central nervous system leading to an individual range of physical, cognitive, and mental impairments. Research has focused on the tracking of primary disease indicators and disability outcome measures to assess the progression of this condition. However, there is little knowledge on how technologies could support the needs of people with multiple sclerosis (MS) in self-tracking their health and wellbeing. Drawing on qualitative research and design methods this thesis provides two contributions. Firstly, it improves understanding of self-tracking in MS self-management. Interview participants reported regaining a sense of control over MS through intertwining individual self-care practices with different self-tracking tools, including paper notebooks and fitness wearables. They associated experiences of control with their agency to document their health in holistic ways, involving symptom monitoring and life journaling. However, participants criticised that self-tracking apps can impede their capacities, in particular when the user experience is focused on predefined health indicators and the optimisation of health behaviour. These findings highlight the need to support people’s individual self-care intentions and agentive capacities through customisable self- tracking approaches. Secondly, this thesis contributes the design of Trackly, a technology probe that supports people in defining and colouring pictorial trackers, such as body shapes. We identify benefits and challenges of customisable and pictorial self-tracking through a field study of Trackly in MS self-management. Having been able to support their individual self-care intentions with Trackly, participants reported a spectrum of interrelated experiences of agency, including ownership, identity, awareness, mindfulness, and control. Overall, this thesis provides a qualitative account and design perspective that demonstrate how adapting self-tracking technologies to individual care needs supported experiences of agency. These findings are particularly relevant to the design of technologies aimed at leveraging personally meaningful self-care and quality of life

Evaluating Context-Aware Applications Accessed Through Wearable Devices as Assistive Technology for Students with Disabilities

The purpose of these two single subject design studies was to evaluate the use of the wearable and context-aware technologies for college students with intellectual disability and autism as tools to increase independence and vocational skills. There is a compelling need for the development of tools and strategies that will facilitate independence, self-sufficiency, and address poor outcomes in adulthood for students with disabilities. Technology is considered to be a great equalizer for people with disabilities. The proliferation of new technologies allows access to real-time, contextually-based information as a means to compensate for limitations in cognitive functioning and decrease the complexity of prerequisite skills for successful use of previous technologies. Six students participated in two single-subject design studies; three students participate in Study I and three different students participated in Study II. The results of these studies are discussed in the context applying new technology applications to assist and improve individuals with intellectual disability and autism to self-manage technological supports to learn new skills, set reminders, and enhance independence. During Study I, students were successfully taught to use a wearable smartglasses device, which delivered digital auditory and visual information to complete three novel vocational tasks. The results indicated that all students learned all vocational task using the wearable device. Students also continued to use the device beyond the initial training phase to self-direct their learning and self-manage prompts for task completion as needed. During Study II, students were successfully taught to use a wearable smartwatch device to enter novel appointments for the coming week, as well as complete the tasks associated with each appointment. The results indicated that all students were able to self-operate the wearable device to enter appointments, attend all appointments on-time and complete all associated tasks

Program Evaluation of a Specialized Treatment Home for Adults with Severe Challenging Behaviour

Individuals with intellectual and developmental disabilities who engage in severe challenging behaviour comprise 5-10% of the population and experience significant limitations in meaningfully participating in everyday activities due to associated risks (e.g., substantial injury to self and others, extreme property destruction, outward physical aggression targeting others). Unfortunately, research featuring adult participants who engage in severe challenging behaviour is relatively scare compared to child participants. Further, challenging behaviour literature tends to emphasize efficacy (e.g., Does the intervention work?) more often than effectiveness (e.g., Does the intervention work in real world settings?). The current project thus was a systematic program evaluation conducted to evaluate the effectiveness of a comprehensive behavioural treatment package at reducing severe challenging behaviour and generating adaptive skills in adults with intellectual and developmental disabilities. A hybrid nonexperimental consecutive case series design was employed featuring all participants (n = 8) who experienced the treatment package, regardless of their success. The results depicted primarily therapeutic outcomes with a substantial decrease in challenging behaviour from baseline to intervention for majority of participants (n = 5) and an increase in adaptive behaviour (i.e., number of mastered skills targets) for participants (n = 7) across the intervention condition. Treatment fidelity suggests frontline staff were largely implementing the interventions as intended (M = 84%, range 82-90%). Social validity surveys administered to participants, caregivers, and case managers provide support for the acceptability of treatment goals, procedures, and effects. Project limitations, clinical considerations, and future directions are discussed

Exploring the Impact of Mississippi Virtual Community College Academy Professional Development for Online Teaching

As online courses and programs continue to grow in number across Mississippi’s community college system, an examination of the system which trains and supports faculty has gone largely unexamined. The aim of this research was to study the impact of the Mississippi Virtual Community College Academy, the state’s online professional development system, on faculty. Structured interviews were conducted with nine faculty in four community colleges across the state to determine conditions that helped or hindered faculty in their implementation of content learned in online professional development courses on credit-bearing courses they would later teach. Analysis of faculty transcripts indicate faculty have implemented changes due to increased knowledge and confidence, empathy with their students, and being open/flexible to change. Faculty also reported significant challenges for student success attributed to reading comprehension and use of technology