MOOC learners' engagement with two variants of virtual patients : a randomised trial

Introduction: Massive Open Online Courses (MOOCs) are an increasingly popular form of education in health professional education. VPs have been introduced in MOOCs to increase interactivity. There is a lack of research in understanding the reasons behind high dropout rates in MOOCs. We explored how learners interact with VPs and compared the significance of different VP designs on dropout rates. Methods: RCT of 378 participants split into two groups to interact with two VPs using different design: branching and linear. Data on node progression and VP attempts was analysed using descriptive and quantitative analysis. Results: Eight groups of learner interaction patterns were identified. The majority of learners completed the VP in a linear path in one attempt. A significant number either completed the case in a loop path in one attempt, completed in a linear path in multiple attempts or dropped out without attempting the case. VP design has a significant effect on dropout rates of learners. There is a higher dropout rate from a branched VP compared to linear VP. Discussion: Prior research showed that branched VPs are more engaging and promote greater learning compared to linear VPs. However, our results indicate that branched VPs had greater dropout compared to VPs that require less time to be solved. Conclusions: We conclude that branching had a negative effect on completion of the VP activity in the MOOC. Moreover, we believe that more complex VPs require more effort on task and this might not be a design that facilitates the interaction in a MOOC audience, where the participants might wish to acquire the basic medical knowledge offered by the course

The Practice of Thresholds: Autonomy in Clinical Education Explored Through Variation Theory and the Threshold Concepts Framework

This paper demonstrates a practical dimension to the discussion about threshold concepts. Threshold concepts have thus far mostly been acknowledged to elucidate learning processes mainly connected to theoretical concepts. By exploring situations that prompted experiences of autonomy and authenticity in clinical learning, findings showed how a practical experience could have the same power to transform thinking and identity as theoretical thresholds and serve as a trigger for transformational learning, therefore making the discussion about ‘practical thresholds' or thresholds in practice possible. The present study explores situations that prompted autonomy and authenticity, and offers context for and substance to these situations by adopting variation theory and the threshold concept framework. In order to learn more about situations that prompt experiences of autonomy and authenticity, and create prerequisites for such experiences, this paper examines how students discern and interpret these situations by analysing them through variation theory and the threshold concept framework

Standards in semen examination:publishing reproducible and reliable data based on high-quality methodology

Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen, and the International Standard ISO 23162:2021. With these tools, we propose that authors should be instructed to follow these laboratory methods in order to publish studies in peer-reviewed journals, preferable by using a checklist as suggested in an Appendix to this article.Peer reviewe

Improving the situation of urinary bladder cancer survivors treated with radical surgery or radical radiotherapy

In this thesis we investigated whether the situation of urinary bladder cancer survivors can be improved. To do this, it is necessary to acquire a more specific knowledge of longterm distressing symptoms, symptom characteristics (nature, occurrence, intensity and duration), and of the corresponding symptom-induced distress, as well as the effect on wellbeing and the quality of life (VI). This more exact information can also be used in the pretherapeutic situation to "tailor", as far as possible. the method of treatment for the individual. Well-being is statistically significantly lower in patients having undergone cystectomy and urostomy, both non-continent and continent, as compared to a matched control population (I). Patients treated with radical radiotherapy for urinary bladder cancer report the same lowered level of well-being (II) in contrast to patients treated with cystectomy and an orthotopic neobladder connected to the urethra; they reported well-being and a subjective quality of life as good as that of the matched control population (M). One reason for the discordance might be the feeling of reduced attractiveness in urostomy patients, a 5-fold increase in feeling unattractive being reported among them (I) as compared to no increase at all in cystectomised patients with a neobladder (III). The 6- fold increase of the feeling of reduced attractiveness in the irradiated patients as compared to matched controls might be an effect due to the increased risk for bowel symptoms. A 9-fold increased risk for defecation urgency and an 11-fold increased risk for faecal leakage was reported by the irradiated patients as compared to the matched controls (II). The risk of being affected by these symptoms was also increased in cystectomised patients with a urostomy, and a 7-fold increase of defecation urgency and faecal leakage was seen compared to matched controls (I). The risk of symptomatic urinary tract infections was increased 3-fold among the operated patients with a urostomy, i.e. 25% had at least one urinary tract infection requiring treatment during the past year (I). Virtually all men operated on were affected by sexual dysfunction, particularly erectile dysfunction, a symptom causing much distress among the affected (I+III, IV). A lower prevalence of erectile dysfunction was seen among the irradiated patients, i.e. 75% (II). Symptoms of sexual dysfunction were the most distressing kinds of symptom among urinary bladder cancer patients (IV). The prevalence of distressing symptoms was lowest for surgical patients with orthotopic neobladder substitution. The occurrence of distressing symptoms does not increase with follow-up time, but an increased symptom burden was strongly correlated with decreased well-being (V). A majority of urinary bladder cancer patients give priority to optimal survival over a reduced symptom burden (I- III). If we refine the surgical technique during radical cystectomy and preserve (autonomic?) nerves in the pelvis, possibly the distressful bowel symptoms and the faecal leakage seen in patients operated in Sweden but not among those operated at Herlev University Hospital in Copenhagen can be eliminated. The high incidence of urinary tract infections in bladder cancer survivors possibly can be diminished by preventive measures. An orthotopic neobladder substitution and preservation of erectile nerves during surgery are further means to improve quality of life in urinary bladder cancer survivors. For those giving high priority to preserved sexual function, radical radiotherapy can be an option. During radiotherapy, diminishing the dose to the anal sphincter and rectum probably can increase quality of life in the patients that are cured. Our studies have identified additional factors that may improve the situation for urinary bladder cancer survivors, and 1 conclude that quality of life of urinary bladder cancer survivors probably can be improved considerably

Video analysis in basic skills training : a way to expand the value and use of BlackBox training?

Background: Basic skills training in laparoscopic high-fidelity simulators (LHFS) improves laparoscopic skills. However, since LHFS are expensive, their availability is limited. The aim of this study was to assess whether automated video analysis of low-cost BlackBox laparoscopic training could provide an alternative to LHFS in basic skills training. Methods: Medical students volunteered to participate during their surgical semester at the Karolinska University Hospital. After written informed consent, they performed two laparoscopic tasks (PEG-transfer and precision-cutting) on a BlackBox trainer. All tasks were videotaped and sent to MPLSC for automated video analysis, generating two parameters (Pl and Prtcl_tot) that assess the total motion activity. The students then carried out final tests on the MIST-VR simulator. This study was a European collaboration among two simulation centers, located in Sweden and Greece, within the framework of ACS-AEI. Results: 31 students (19 females and 12 males), mean age of 26.2 +/- 0.8 years, participated in the study. However, since two of the students completed only one of the three MIST-VR tasks, they were excluded. The three MIST-VR scores showed significant positive correlations to both the Pl variable in the automated video analysis of the PEG-transfer (RSquare 0.48, P < 0.0001; 0.34, P = 0.0009; 0.45, P < 0.0001, respectively) as well as to the Prtcl_tot variable in that same exercise (RSquare 0.42, P = 0.0002; 0.29, P = 0.0024; 0.45, P < 0.0001). However, the correlations were exclusively shown in the group with less PC gaming experience as well as in the female group. Conclusion: Automated video analysis provides accurate results in line with those of the validated MIST-VR. We believe that a more frequent use of automated video analysis could provide an extended value to cost-efficient laparoscopic BlackBox training. However, since there are gender-specific as well as PC gaming experience differences, this should be taken in account regarding the value of automated video analysis

Ablative or Surgical Treatment for Small Renal Masses (T1a): A Single-Center Comparison of Perioperative Morbidity and Complications

The purpose of this study is to evaluate the treatment safety of thermal ablation compared to surgical treatment of T1a tumors (small renal masses) at a high-volume center. We conducted an observational single-center study based on data collected form the National Swedish Kidney Cancer Register (NSKCR) between 2015 and 2021. In total, 444 treatments of T1a tumors were included. Patients underwent surgery (partial or total nephrectomy) or ablative treatment—radiofrequency ablation (RFA) or microwave ablation (MWA). Patient characteristics were retrieved from patient records, and tumor complexity was estimated from pre-interventional CT scans. The odds ratio (OR) of suffering from a severe surgical complication following ablative treatment was estimated using a logistic regression model adjusted for age, BMI, ASA physical status classification, smoking status and RENAL nephrometry score. The frequency of severe surgical complications was 6.3% (16/256 treatments) after surgical intervention and 2.1% (4/188 treatments) following ablative treatment. Our primary hypothesis that ablative treatment is associated with a lower risk of severe surgical complications is supported by the results (OR 0.39; 0.19–0.79; p = 0.013). When adjusting for age, smoking status, ASA score, BMI score and RENAL nephrometry score, we see an even greater difference between the two groups (OR 0.34; 0.17–0.68; p = 0.002). Our study was limited by the differences in patient and tumor characteristics between the two compared groups and the study design. If oncological outcomes are found to be comparable, ablative treatment should be considered as a first-line treatment for all small renal masses

Undergraduate Education for Urology in Europe. Where Do We Stand?

Regardless of career intentions, junior doctors will meet patients with urological problems. There are no studies on the status of undergraduate education for urology in Europe. We designed an 18-item online survey using the platform www.surveymonkey.com to assess the current status of undergraduate education in urology. A total of 347 medical students, trainees, and urologists responded to the survey. Medical students' exposure to urology during their undergraduate career was heterogeneous. Although the quality of urology education was valued from moderate to high, urology as a speciality did not influence their future training decision making. Decision making in relation to residency training correlated with the number of hours spent on practical training, duration of urology rotation, and year of medical school in which urological exposure was introduced. The current European exposure to urology at undergraduate level is heterogeneous, with various factors influencing future decisions regarding training and specialisation. A uniform undergraduate curriculum would eliminate such heterogeneous exposure and facilitate a workforce fit for the future urological needs. PATIENT SUMMARY: Junior doctors will meet patients with urological problems in the wards, emergency departments, and primary care. Institutions should work together for a urological curriculum that fits the future clinical requirements.status: publishe