a multicentre cohort study of nursing and medical students

Funding Information: The authors would like to thank Daniela Abreu, MSc who established contact with the participating institutions and was responsible for implementation of the study protocol. They also wish to thank the following faculty who assisted with study implementation: University of Rzeszow: Paweł Więch, PhD, DSc, Grzegorz Kucaba, PhD, EMT-P; Jacek Szczygielski, PhD, MD; Izabela Sałacińska, PhD, CRNA; Dariusz Bazaliński, PhD, DSc; Marzena Domino, MA; Cadi Ayyad University: Abdelhamid Hachimi, MD; Houssam Rebahi, MD; Mohamed Bouskraoui, MD; University of South-Eastern Norway: Guro-Marie Eiken, MScN, RN, NP; Porto Nursing School: Paulo Machado, RN, PhD; UNITEC: Doany Gutierrez, MD; Juan Carlos Triminio MD; Karina Varela MD; Sonia Escoto MD, MSc; Lía Mineros MD, MSc; Ely Ramírez MD; Guimel Peralta MD; Odessa Henríquez MD, PhD; David Tvildiani Medical University: Sergo Tabagari, MD, PhD; Tamar Talakvadze, MD, PhD; Paata Tsagareishvili, MD; Rusudan Agladze, MD, PhD; Ketevan Kapanadze, MD; Nino Gakhokidze, MD; Red Cross Higher School of Health: Ana Sofia Jesus, Paediatric RN; NOVA Medical School: Maria Teresa Neto, MD, PhD; Catarina Limbert, MD, PhD; Rui Domingues, MD; Filipa Marujo, MD; Guilherme Lourenço, MD; Beatriz Ferreira, Medical Student; and Guangxi Medical College: Lu Zhhenzhi, NS. Funding Information: André Mestre was supported by Centro 2020, PT2020 and European Union research grant nº 41388 to Take the Wind Ltd, developers of the Body Interact™ Virtual Patient Simulator. No other investigators or participants received compensation for their role in the study. Funding Information: A.Mestre was supported by Centro 2020, PT2020 and European Union research grant nº 41388 to Take the Wind Ltd, developers of the Body InteractTM Virtual Patient Simulator. No other investigators or participants received compensation for their role in the study. The authors had access to all study data and sole responsibility for data analysis and the writing of the manuscript. All other authors have no competing interest to declare . Publisher Copyright: © 2022, The Author(s).Background: The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students. Methods: We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience. Results: Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students. Conclusions: In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.publishersversionpublishe

Revitalizing physical assessment in undergraduate nursing education - what skills are important to learn, and how are these skills applied during clinical rotation? A Cohort Study

Background:The preparedness of newly graduated registered nurses for a demanding work environment and carepractices takes form during nursing education. Norwegian nursing education at one university has implemented aselection of basic physical assessment skills (B-PAS) in the nursing curriculum in order to prepare nursing studentsfor a demanding work environment post-graduation.Methods:A mixed-method cohort design. We evaluated nursing students’self-reported use of B-PAS during theirclinical rotation using the“Survey of Examination Techniques Performed by Nurses”questionnaire (30 items). Inaddition, two focus group interviews elicited factors that hinder or facilitate the actual use of B-PAS during clinicalrotation. We recruited students from a bachelor’s degree programme for nursing at a Norwegian university. Threehundred and sixty-three of 453 eligible nursing students in the first, second, and third year of the bachelor’s degreeprogramme participated in the study (80%).Results:ANOVA showed a significant progression (p< 0.016) in students’self-reported use of B-PAS. Auscultationand percussion skills were graded below the median score of 3, which indicates that these skills were less usedthroughout the programme. The nursing students highlighted contextual factors for their use of B-PAS when inclinical rotation. Preceptors are important gatekeepers for successful implementation, and there is a need for closecollaboration between the university and clinical practice.Conclusion:Despite the reduced PAS taught in the curricula, there is still a lack of application of such skills in clinicalrotations. This study highlights that research should explore how different work environments influence the utilisationof learned skills, and which learning strategies are appropriate or most successful for stimulating clinical reasoning andthe extensive use of physical assessmen

Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach

Background: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor’s degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. Objective: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. Methods: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. Results: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. Conclusions: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students’ perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts

Reflection on actions: Identifying facilitators of and barriers to using physical assessment in clinical practice

Current research suggests that nursing students do not apply all sets of physical assessment skills (PAS) learned in their nursing education. The aim of this study was to evaluate third-year nursing students’ process of clinical judgment using PAS in clinical rotation. Specific focus was on how the process of clinical judgment affected when the nursing students performed physical assessment, and which types of knowledge were implied in their practice. Ten nursing students performed PAS independently while in clinical rotation; these performances were audiotaped and observed. Shortly after, individual semi-structured stimulated recall interviews (SRI) took place. Regardless of the nursing students’ stated level of PAS utilization, self-efficacy or scientific knowledge, clinical judgment was primarily based on contextual factors and personal prerequisites. This study contributes to indepth knowledge about how nursing students perform physical assessment, how they describe their clinical judgment process and their strategies towards systematically and confidently using PAS. We conclude the paper with pedagogical strategies and learning activities that can facilitate reflection-in-action and reflection-on-action

Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach

Background: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor’s degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. Objective: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. Methods: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. Results: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. Conclusions: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students’ perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts

Reflection on actions: Identifying facilitators of and barriers to using physical assessment in clinical practice

Physical assessment skills (PAS) learned in their nursing education. The aim of this study was to evaluate third-year nursing students' process of clinical judgment using PAS in clinical rotation. Specific focus was on how the process of clinical judgment affected when the nursing students performed physical assessment, and which types of knowledge were implied in their practice. Ten nursing students performed PAS independently while in clinical rotation; these performances were audiotaped and observed. Shortly after, individual semi-structured stimulated recall interviews (SRI) took place. Regardless of the nursing students’ stated level of PAS utilization, self-efficacy or scientific knowledge, clinical judgment was primarily based on contextual factors and personal prerequisites. This study contributes to in-depth knowledge about how nursing students perform physical assessment, how they describe their clinical judgment process and their strategies towards systematically and confidently using PAS. We conclude the paper with pedagogical strategies and learning activities that can facilitate reflection-in-action and reflection-on-action