Development and validation of a measurement scale to assess nursing students’ readiness for the flipped classroom in Sri Lanka

Purpose The aim of this study was to develop and validate a scale to measure nursing students’ readiness for the flipped classroom in Sri Lanka. Methods A literature review provided the theoretical framework for developing the Nursing Students’ Readiness for Flipped Classroom (NSR-FC) questionnaire. Five content experts evaluated the NSR-FC, and content validity indices (CVI) were calculated. Cross-sectional surveys among 355 undergraduate nursing students from 3 state universities in Sri Lanka were carried out to assess the psychometric properties of the NSR-FC. Principal component analysis (PCA, n=265), internal consistency (using the Cronbach α coefficient, n=265), and confirmatory factor analysis (CFA, n=90) were done to test construct validity and reliability. Results Thirty-seven items were included in the NSR-FC for content validation, resulting in an average scale CVI of 0.94. Two items received item level CVI of less than 0.78. The factor structures of the 35 items were explored through PCA with orthogonal factor rotation, culminating in the identification of 5 factors. These factors were classified as technological readiness, environmental readiness, personal readiness, pedagogical readiness, and interpersonal readiness. The NSR-FC also showed an overall acceptable level of internal consistency (Cronbach α=0.9). CFA verified a 4-factor model (excluding the interpersonal readiness factor) and 20 items that achieved acceptable fit (standardized root mean square residual=0.08, root mean square error of approximation=0.08, comparative fit index=0.87, and χ2/degrees of freedom=1.57). Conclusion The NSR-FC, as a 4-factor model, is an acceptable measurement scale for assessing nursing students’ readiness for the flipped classroom in terms of its construct validity and reliability

Developing and Implementing a Framework for System Level Measures: lessons from New Zealand

Background: Measuring performance is now the norm in health systems. System Level Measures (SLMs), implemented at New Zealand’s Counties Manukau Health (CMH) are designed to support quality improvement activities undertaken across the health system using only a small set of measures. While the healthcare and performance measurement literature contains information regarding the facilitators and barriers to quality improvement initiatives, there is an absence of studies into whether these factors are germane to the establishment and implementation of a SLM framework. Methods: A purposive sample of thirteen senior managers and clinicians involved in the construction and implementation of SLMs were invited to participate. Semi-structured telephone interviews were completed and recordings transcribed verbatim. Transcriptions were thematically analysed using a general inductive approach. Findings: In total, ten interviews took place. Six facilitative themes were identified including: dispersed and focused leadership; communication; data; alignment of the measures with organisational strategic data; alignment of the measures with organisational strategic plans and values; stakeholder engagement; and a dedicated project team. Conversely, five themes were identified that hindered the process. These were: reaching consensus; perfection versus pragmatism; duplication and process burden; achieving buy-in and workload. Discussion: The factors that facilitate and hinder establishing and implementing a framework of SLMs are common to other quality improvement approaches. However, this study demonstrated that these factors were also germane to SLMs. These findings are of particular relevance as researchers and policy makers elsewhere increasingly aim to adopt measurement arrangements for health systems that address equity, safety, quality, access and cost. Abbreviations: CMH – Counties Manukau Health; DHB – District Health Board; IHI – Institute for Healthcare Improvement; QI – Quality Improvement; SLM – System Level Measure

Investigating Predictors of Psychological Distress for Healthcare Workers in a Major Saudi COVID-19 Center.

This study investigated the relationship between fear of COVID-19, previous exposure to COVID-19, perceived vulnerability to disease, sleep quality, and psychological distress among healthcare workers (HCWs) in Taif city in Saudi Arabia, which has a population of 702,000 people. A cross-sectional study design was adopted. HCWs (n = 202) completed a survey containing the Fear of COVID-19 Scale (FCV-19S), Perceived Vulnerability to Disease (PVD), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety, and Stress Scale (DASS-21). FCV-19S and sleep quality were significant predictors for psychological distress. Female gender was a significant predictor for depression and stress. Single, divorced, and widowed marital status were predictive for anxiety. FCV-19S was weakly correlated with PVD but moderately with depression, anxiety, and stress. Of the two PVD subscales, perceived infectability was weakly correlated with psychological distress. PVD and previous experience with COVID-19 were not significant predictors. Sleep quality and FCV-19S were major predictors of psychological distress. Findings indicated that poor sleep quality was strongly associated with psychological distress, while fear of COVID-19 had a moderate association. Such results support the need to design and implement psychological programs to assist HCWs in dealing with the psychological impact of this ongoing pandemic

Assess the feasibility of flipped classroom pedagogy in undergraduate nursing education in Sri Lanka: A mixed-methods study

BACKGROUND: The nursing education system has evolved with an increased emphasis on student-centred education, such as implementing flipped classroom pedagogy. Given the promising positive educational outcomes, the trend of using flipped classroom pedagogy has become increasingly popular in undergraduate nursing education. However, little is known about how these flipped classroom methods impact on nursing educational practices in limited-resource settings situated in South Asia. OBJECTIVE: To assess the feasibility of implementing flipped classroom pedagogy in undergraduate nursing education from the nursing students’ perspective. METHODS: This mixed-methods study employed a quantitative survey and six focus group discussions conducted in three state universities in Sri Lanka. The Nursing Students’ Readiness for Flipped Classroom (NSR-FC) questionnaire was used to collect quantitative data. The semi-structured focus group discussions were conducted by using 18 reflective and open-ended questions. Descriptive statistics and multivariate analysis of variance methods were employed when analysing quantitative data. An inductive thematic analysis approach was used to summarize the focus group discussions. RESULTS: The questionnaire survey revealed that nursing students reported high levels of personal, technical, and pedagogical readiness across all three universities, while environmental readiness was perceived as low. The inductive thematic analysis identified three themes, namely: enablers, challenges, and benefits. Specifically, nursing students valued the student-centred approach. They were ready to utilize their own devices to overcome limited technological provision; however, a short training session about how to engage in the flipped classroom was desirable. Also, their exposure to basic educational technology was perceived as adequate and they were aware of the positive outcomes of flipped classroom pedagogy. CONCLUSION: Nursing students were ready to enrol in a flipped classroom programme. The provision of technological resources in the education environment was identified as a great challenge for flipped classroom implementation. Overall, the findings indicate there are promising feasibilities for the flipped classroom implementation

Investigating stable and dynamic aspects of student motivation using generalizability theory

Background The Academic Motivation Scale (AMS) is a commonly used 28‐item measure of motivation orientation. However, the scale has not been examined using methods to distinguish between state and trait aspects of motivation. We applied Generalizability Theory to appraise the psychometric properties of the AMS and to differentiate items measuring state or trait motivation within the AMS. Methods One hundred and thirty medical students completed the 28‐item AMS at three time points. Generalizability Theory was applied to examine the generalizability of the AMS (total and sub‐scales) and to estimate state and trait aspects of student motivation. Results The overall AMS showed high generalizability (G = .93) in assessing student motivation across student populations and occasions, whereas the AMS subscales demonstrated low levels of generalizability. The majority of the AMS items scored high for the state component index suggesting movement between motivational priorities while maintaining the overall stability of the individual motivation levels. Conclusions The total AMS is suitable as a reliable measurement of motivation among student populations with high generalizability of scores across students and assessment occasions. Measuring trait motivation using the total AMS score instead of subscale scores reduces measurement error and optimises instrument reliability

Applying Rasch analysis to evaluate and enhance the Academic Motivation Scale

Objective The 28-item Academic Motivation Scale (AMS) is a widely used measure of students’ motivation to learn but it has the common limitations of an ordinal scale such as low precision and unsuitability for parametric statistics. The current study aimed to evaluate the psychometric properties of the AMS using Rasch methodology and enhance the precision of the scale using ordinal-to-interval transformation. Method The Partial Credit Rash model was used to analyze responses of 429 New Zealand medical students who completed the scale in English. Results The initial poor fit of the AMS to the Rasch model was improved by creating four super-items combining dependent subscales/items that displayed higher residual correlations with each other. These modifications resulted in the best fit to the Rasch model with no significant deviations of scale parameters from the model expectations (χ2 (24) = 19.79, p = 0.71), invariance across sex, age and ethnic groups, unidimensionality and high reliability (PSI = 0.81). Conclusions This study supported the robust psychometric properties of the AMS and produced conversion tables to transform the ordinal AMS scores into interval-level data to enhance the precision of the scale and enable use of parametric statistics without altering the original scale structure. KEY POINTS What is already known about this topic: (1) The Academic Motivation Scale (AMS) was developed to measure academic motivation which is important in higher education settings to evaluate students’ motivation to learn. (2) The AMS is an ordinal scale which is not suitable for parametric statistical tests and has other limitations of an ordinal measure, such as low precision. (3) The full-scale AMS is the most reliable according to the recent evidence, while the individual subscales of the AMS have low generalisability across student population and response occasions. What this topic adds: (1) Using Rasch methodology provides a powerful tool to evaluate and enhance the psychometric properties of an ordinal scale such as the AMS. (2) Rasch model fit indicates that the AMS complies with fundamental principles of measurement, such as unidimensionality, invariance, and interval scale metrics. (3) This study produced ordinal-to-interval conversion tables to transform ordinal responses to the AMS into interval level data that increases precision of the instrument and its suitability for parametric statistic

Preventing burnout in undergraduate and postgraduate students studying medicine

In this chapter, the definition and measurement of burnout will be discussed, followed by an exploration of the factors which contribute to burnout in medical trainees along with the likely consequences. Many interventions have been used to prevent and manage burnout, including building resilience in individuals and within organizations. The effectiveness of some of these interventions will be reviewed, with a focus on educational management strategies. The chapter concludes with examples of specific interventions which are being used to prevent and manage burnout in New Zealand medical trainees. In the chapter, the term ‘medical trainees’ will be used to refer to both undergraduates (medical students) and post-graduates (junior doctors in a training programme)

The Impact of a Revised Curriculum on Academic Motivation, Burnout, and Quality of Life Among Medical Students

Objective: The purpose of this study was to determine the impact of a revised curriculum on medical student academic motivation, burnout, and quality of life. Methods: This cross-sectional comparative study involved 2 medical school cohorts of second year and fourth year medical students at The University of Auckland: a cohort under a traditional curriculum (n = 437) and a cohort under a revised curriculum (n = 446). Participants completed self-reported questionnaires measuring academic motivation, burnout, and quality of life. Two multivariate analyses of covariance (MANCOVAs) were conducted. Results: The response rate was 48%. No statistically significant differences were found between curriculum cohorts for mean scores of academic motivation, personal burnout, and quality of life. However, differences were found when comparing preclinical medical students and students in their clinical years of training. In comparison with Year 2 medical students, the MANCOVA for Year 4 students showed a significant main effect for the revised curriculum with respect to both physical and environmental quality of life. Conclusions: A revised medical curriculum had a differential effect on quality of life for Year 4 students in the latter years of medical school who are based in a clinical learning environment