Discovering effective pedagogical and evaluation approaches for learning objects in medical education

In 2004 unexplained pedagogical barriers were limiting Learning Object (LO) development. Few reference points existed preventing the formation of specific pedagogical questions as to the nature of these barriers - hence this PhD's rationale. This thesis 'uncovers' the most effective pedagogical and evaluation/assessment* approaches for LO design in Medical Education, and the underlying principles within these approaches - i.e. what is effective, and why. To determine why certain approaches are effective observation/interview/usability studies were performed using grounded theory to generate hypotheses (1A Participants n=57). To verify 1A findings, this process was replicated using different sites/samples in Phase 2(Eastern/Midlands, n=72). To determine what was most effective, systematic reviews using a purpose-built design were undertaken with additional questions on pedagogy and evaluation/assessment• components (1B Studies n=222). Approaches identified as 'effective' according to statistics, SCIE and my own rigor scoring systems were tested blind in two locations (Eastern/Midlands) with different samples under a null hypothesis (i.e. 'Each approach will score no differently to any other', Phase 2 participants n=72). This was further developed by replicating this process via mobile delivery. Section 1A generated over a hundred hypotheses. In Section 1B, two existing approaches scored consistently high. Phase 2 produced the same hypotheses/approaches when submitted to the blinded observation/interview/usability process thus tight theme linkage resulted in rigorous theory and empirical data. The two top-performing 1B approaches scored high resulting in the possible existence of generic principles. When replicating 1A, 1B and Phase 2 for mobile delivery, the existence of generic principles was verified and a possible model for practice formed. In summary, this thesis underlines the importance of learner input and how learners' perceptions form an essential part of the LO learning process. It discovers original generic principles for both desktop and mobile formats, highlights how branch and loop learning systems are necessary for learner customisation, and provides new knowledge verifying Wiley's molecular LO analogy. *In this thesis many types of evaluation approaches are tested. These are called 'evaluation approaches' by the authors that created them. However, in some disciplines the term 'evaluation' is viewed as being interchangeable with the term 'assessment'. For this reason explanatory footnotes will be given throughout where necessary

Discovering effective pedagogical and evaluation approaches for learning objects in medical education

In 2004 unexplained pedagogical barriers were limiting Learning Object (LO) development. Few reference points existed preventing the formation of specific pedagogical questions as to the nature of these barriers - hence this PhD's rationale. This thesis 'uncovers' the most effective pedagogical and evaluation/assessment* approaches for LO design in Medical Education, and the underlying principles within these approaches - i.e. what is effective, and why. To determine why certain approaches are effective observation/interview/usability studies were performed using grounded theory to generate hypotheses (1A Participants n=57). To verify 1A findings, this process was replicated using different sites/samples in Phase 2(Eastern/Midlands, n=72). To determine what was most effective, systematic reviews using a purpose-built design were undertaken with additional questions on pedagogy and evaluation/assessment• components (1B Studies n=222). Approaches identified as 'effective' according to statistics, SCIE and my own rigor scoring systems were tested blind in two locations (Eastern/Midlands) with different samples under a null hypothesis (i.e. 'Each approach will score no differently to any other', Phase 2 participants n=72). This was further developed by replicating this process via mobile delivery. Section 1A generated over a hundred hypotheses. In Section 1B, two existing approaches scored consistently high. Phase 2 produced the same hypotheses/approaches when submitted to the blinded observation/interview/usability process thus tight theme linkage resulted in rigorous theory and empirical data. The two top-performing 1B approaches scored high resulting in the possible existence of generic principles. When replicating 1A, 1B and Phase 2 for mobile delivery, the existence of generic principles was verified and a possible model for practice formed. In summary, this thesis underlines the importance of learner input and how learners' perceptions form an essential part of the LO learning process. It discovers original generic principles for both desktop and mobile formats, highlights how branch and loop learning systems are necessary for learner customisation, and provides new knowledge verifying Wiley's molecular LO analogy. *In this thesis many types of evaluation approaches are tested. These are called 'evaluation approaches' by the authors that created them. However, in some disciplines the term 'evaluation' is viewed as being interchangeable with the term 'assessment'. For this reason explanatory footnotes will be given throughout where necessary.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection.

BACKGROUND: The duration and effectiveness of immunity from infection with and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are relevant to pandemic policy interventions, including the timing of vaccine boosters. METHODS: We investigated the duration and effectiveness of immunity in a prospective cohort of asymptomatic health care workers in the United Kingdom who underwent routine polymerase-chain-reaction (PCR) testing. Vaccine effectiveness (≤10 months after the first dose of vaccine) and infection-acquired immunity were assessed by comparing the time to PCR-confirmed infection in vaccinated persons with that in unvaccinated persons, stratified according to previous infection status. We used a Cox regression model with adjustment for previous SARS-CoV-2 infection status, vaccine type and dosing interval, demographic characteristics, and workplace exposure to SARS-CoV-2. RESULTS: Of 35,768 participants, 27% (9488) had a previous SARS-CoV-2 infection. Vaccine coverage was high: 95% of the participants had received two doses (78% had received BNT162b2 vaccine [Pfizer-BioNTech] with a long interval between doses, 9% BNT162b2 vaccine with a short interval between doses, and 8% ChAdOx1 nCoV-19 vaccine [AstraZeneca]). Between December 7, 2020, and September 21, 2021, a total of 2747 primary infections and 210 reinfections were observed. Among previously uninfected participants who received long-interval BNT162b2 vaccine, adjusted vaccine effectiveness decreased from 85% (95% confidence interval [CI], 72 to 92) 14 to 73 days after the second dose to 51% (95% CI, 22 to 69) at a median of 201 days (interquartile range, 197 to 205) after the second dose; this effectiveness did not differ significantly between the long-interval and short-interval BNT162b2 vaccine recipients. At 14 to 73 days after the second dose, adjusted vaccine effectiveness among ChAdOx1 nCoV-19 vaccine recipients was 58% (95% CI, 23 to 77) - considerably lower than that among BNT162b2 vaccine recipients. Infection-acquired immunity waned after 1 year in unvaccinated participants but remained consistently higher than 90% in those who were subsequently vaccinated, even in persons infected more than 18 months previously. CONCLUSIONS: Two doses of BNT162b2 vaccine were associated with high short-term protection against SARS-CoV-2 infection; this protection waned considerably after 6 months. Infection-acquired immunity boosted with vaccination remained high more than 1 year after infection. (Funded by the U.K. Health Security Agency and others; ISRCTN Registry number, ISRCTN11041050.)