How neurosurgeons maintain and update their professional knowledge in a self-directed learning context.

BACKGROUND Given the changes in the current learning environment health professionals are facing major challenges to keep up with current and updated information with the rapidly growing clinical and scientific knowledge base. Being able to identify relevant, high-quality articles, adapt or adopt to new learning strategies with an already intense workload are just a few of the main challenges. Self-directed learning is a key skill of competent health professionals and describes the process by which individuals evaluate their learning needs, goals and the resources needed for learning, however the emerging problems for professionals practicing SDL are manifold. DESIGN A qualitative, exploratory approach based on four research questions was used to understand how skilled neurosurgeons maintain and update their professional knowledge. Twenty-six neurosurgeons within the University Hospital of Bern completed a semi-structured interview. RESULTS One of the main findings concerns the differences between neurosurgeons regarding the SDL strategies they employ, which is compounded by their level of experience. All participants recognized that new or alternative learning approaches are necessary to manage the learning landscape, and for many this concerned their use of learning digital tools. Many, however, were unsure how to change their current behavior. CONCLUSION The results highlight that positive factors influencing SDL in the workplace include learning leadership and support in identifying new or alternative strategies, an internal culture committed to learning as well as digital learning tools and networks. All are vital in managing the continuously evolving learning environment

SEMPER: A Web-Based Support System for Patient Self-Management

The paper discusses an eHealth project which is currently developing an interactive web-based platform that assists patients to self-manage work-related disorders and alcoholism. The focus is on motivating long-term behaviour change. This is supported by an online assessment component based on the technique of motivational interviewing and a feedback component which visualizes actual behaviour in relation to intended behaviour. Disease-specific information is provided through an information portal that utilizes lightweight ontologies (associative networks) in combination with text mining. Emotional support is provided via virtual communities. The paper discusses the design rationales underlying the approach taken and outlines some implementational aspects. The paper also briefly outlines how the effectiveness of the self-management tool will be measured based on an outcome model particularly suited for health promotion

Pre-licensure medical students’ knowledge and views on interprofessional learning: A qualitative concept analysis based on real-world data

Background: The several definitions of Interprofessional Education (IPE) allow for different interpretations and interchangeable terms. This study aims to determine the characteristics and attributes of the definition of IPE. Materials and methods: In November 2019, 31 medical students (64.5% female) from a single institution took part in nine semi-structured interviews. We created a deductive three-level code system followed by an inductive code system based on several known IPE definitions. We extracted the main entities of the concept of IPE according to both code systems to create a framework. We used MaxQDA software for qualitative analysis. Verification of codes and categories was attained through sequential peer-debrief. Results: Participants correctly named the WHO’s definition of IPE, and outlined its four main dimensions according to the Interprofessional Education Collaborative report. We found new IPE attributes and demonstrated the weight of communication and role recognition. Two-thirds of medical students mentioned IPE activities that we classified as a contrary model (without collaboration or patient-centeredness) and a minimum weight was given to the importance of patient-centeredness. Conclusion: Medical students’ understanding of the concept of IPE is coherent. We deepened the understanding of previously identified definitions of IPE, and we identified new attributes of the concept. Finally, we added “well-being” as a component of interprofessionality

Trajectories of learning approaches during a full medical curriculum: impact on clinical learning outcomes.

Background No consensus exists on whether medical students develop towards more deep (DA) or surface learning approaches (SA) during medical training and how this impacts learning outcomes. We investigated whether subgroups with different trajectories of learning approaches in a medical students’ population show different long-term learning outcomes. Methods Person-oriented growth curve analyses on a prospective cohort of 269 medical students (Mage=21years, 59 % females) traced subgroups according to their longitudinal DA/SA profile across academic years 1, 2, 3 and 5. Post-hoc analyses tested differences in academic performance between subgroups throughout the 6-year curriculum until the national high-stakes licensing exam certifying the undergraduate medical training. Results Two longitudinal trajectories emerged: surface-oriented (n = 157; 58 %), with higher and increasing levels of SA and lower and decreasing levels of DA; and deep-oriented (n = 112; 42 %), with lower and stable levels of SA and higher but slightly decreasing levels of DA. Post hoc analyses showed that from the beginning of clinical training, deep-oriented students diverged towards better learning outcomes in comparison with surface-oriented students. Conclusions Medical students follow different trajectories of learning approaches during a 6-year medical curriculum. Deep-oriented students are likely to achieve better clinical learning outcomes than surface-oriented students

Self-directed learning among general practitioners in the German-speaking part of Switzerland: a qualitative study using semi-structured interviews.

AIMS OF THE STUDY This research aimed to investigate the self-directed learning (SDL) habits of Swiss general practitioners from the German-speaking part of Switzerland, understanding how they acquire new knowledge, exploring the impact of the COVID-19 pandemic on these habits and identifying optimisation strategies for their future self-directed learning. METHODS We employed a qualitative study design, conducting semi-structured interviews with 16 general practitioners from 30 May 2022 to 06 July 2022. Thematic analysis based on a mixed deductive/inductive approach was used to gain insight into the learning activities and self-directed learning practices of the practitioners. RESULTS The interviewed general practitioners demonstrated a versatile approach to self-directed learning, where peer communication emerged as the most predominant learning method. It is noteworthy that the younger generation in particular showed a strong inclination for peer learning and is well prepared for the integration of advanced digital solutions for peer communication. Furthermore, a significant shift was observed in media-based self-directed learning, especially since the COVID-19 pandemic. Digital platforms and repositories for practical learning were mentioned as educational mainstays by many interviewees, reflecting a profound technological shift observed over the past 25 years and especially since the pandemic. The primary motivation for pursuing new knowledge remains patient care, although personal development and staying up-to-date with medical and technological advancements are also key motivators. Although the pandemic has undeniably accelerated the transition towards digital learning, it has also brought with it challenges such as information overload and technical difficulties. There was an evident decline in formal learning venues and physical presence during the pandemic, yet the reported value of in-person interactions remains high. Suggestions for optimising self-directed learning included enhancing digital offerings, fostering stronger peer networks and integrating more practical content. CONCLUSIONS The COVID-19 pandemic has catalysed a transformation in the self-directed learning practices of general practitioners in the German-speaking part of Switzerland, underlining the importance of a balanced approach between digital and traditional learning methods. As the digital realm of self-directed learning grows, it is essential to address existing challenges and capitalise on potential advantages. Both individual networking efforts like general practitioner quality circles and initiatives from official authorities like informal self-test opportunities can play pivotal roles in refining self-directed learning practices. The findings from this study offer valuable insights for enhancing learning resources and environments that align with general practitioners' needs and preferences. Future research should investigate the ongoing impact of advanced digital technologies on self-directed learning to understand the evolving landscape in a post-pandemic world

From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial.

BACKGROUND Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. METHODS In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances. DISCUSSION Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. TRIAL REGISTRATION ClinicalTrials.gov (NCT05037318), September 8, 2021

Physiological measures as indices of moods during human-computer interaction

Emotions are an important factor in human-computer interaction. One of the challenges in building emotionally intelligent systems is the automatic recognition of affective states. We are developing and evaluating a method for measuring user affect that incorporates psychological, behavioral, and physiological measures. During affective stimulation, breathing parameters, skin conductance level (SCL) and corrugator EMG activity correlate with self-reported levels of valence and arousal. Valence, at the level of subjective experience, summarizes how well one is doing, whereas arousal refers to a sense of energy. A stimulus activates appetitive or defensive motivation (the valence dimension) with some degree of energy mobilization (the arousal dimension). In the laboratory, moods are induced using different procedures. Only few studies have investigated the critical question of how long induced moods actually last. Further, knowledge concerning the persistence of physiological responding, when the stimuli are withdrawn, remains spare. The goals of this study were first, to assess the somato-physiological activity during affective stimulation (film clip viewing) and its relation to valence and arousal, and second, to determine if the response patterns persist, dissipate or otherwise change when the stimuli are withdrawn and the subjects perform a computer task. Seventy-six participants viewed a neutral film clip (an educational program) and completed immediately afterward the task (control condition). Then, they viewed either a positive high-arousal clip (sport scenes), a positive low-arousal clip (takes from landscapes), a negative high-arousal clip (scene depicting captives forced to play Russian roulette) or a negative low-arousal clip (a documentary about a slum in Belgium) and completed the task a second time (experimental condition). The task required participants to shop on an e-commerce website for office supplies. After each clip and each task, the participants rated their current mood. We tested valence and arousal effects during the last 90 s of the films, the first and last 90 s of the task of the experimental condition. Viewing of the selected film clips resulted in increasing defensive and appetitive activation in the expected ways both subjectively and physiologically. Corrugator EMG activity was higher at the end of the negative clips than the positive clips, and minute ventilation and SCL were higher for the arousing clips than for the less arousing clips. After the approximately 9-minute task, people who viewed the negative clips still reported more negative valence than those who viewed the positive clips. On the contrary, there were no differences in the arousal ratings. The valence effect in the mood state was paralleled by valence effects in the somato-physiological measures during the task. Increased facial frowning at the end of the negative clips was maintained during the task indicating persistence of defensive activation. SCL was lower for the negative film groups, especially at the end of the task, suggesting that sympathetic activation was lowered in subjects in the negative mood as compared with subjects in the positive mood. The findings of this study have several implications. First, they enrich our knowledge concerning the relationships between subjective feelings and their physiological correlates. Second, they inform us about the effectiveness of film clips as a mood induction instrument. Third, they suggest that induced changes in arousal are quickly overridden by the degree of activation "imposed" by the cognitive task, whereas induced changes in valence are more resistant and thus likely to impact the execution of the task. Finally, they show which physiological measures may be useful in tracking mood states during human-computer interaction (i.e., corrugator EMG activity and SCL). Feedback from these parameters could be used by computers to recognize mood states in the user

Attitude towards and Readiness for Interprofessional Education in Medical and Nursing Students of Bern

Objectives: Interprofessional collaboration is becoming increasingly important in health care for various reasons. Interprofessional Education (IPE) can provide a basis for this. The aim of our study was to find out how medical (MS) and nursing students (NS) think about their own and other professions, what they know about each other, how strong their willingness to embrace IPE is, and what forms of IPE they deem useful. Methodology: Seven IPE experts rated the two measuring instruments, Readiness for Interprofessional Learning Scale RIPLS, and Interdisciplinary Education Perception Scale IEPS in terms of relevance of the items, and the quality of translation into German. Nine RIPLS items and 13 IEPS items were considered content-valid. All MS of the University of Bern and NS of the two Bernese educational institutions for nursing were invited to the online survey in the fall of 2014 by email. Results: 498 (254 MS, 244 NS) of the 2374 invited students completely filled in the questionnaire (21%). The results of the reduced RIPLS allowed no conclusive statements. When assessing their own occupational group in the IEPS, the MS attributed "competence and autonomy" to themselves significantly more frequently, while to the NS, the same was true for the item, "actual cooperation". MS know significantly less about the training of other health professionals. NS show a significantly higher willingness to embrace IPE. Teaching ethics, communication, team training, and clinical skills are deemed suitable for IPE by both groups. From the comments it appears that in both groups a majority welcomes IPE; however, the various arguments had different prevalence in both groups. Both groups fear that IPE leads to heightened stress during the study. A subgroup of MS fears a lowering of academic level. Conclusion: The results of this survey of Bernese MS and NS concerning IPE provide important information for the planning and implementation of IPE. Important steps in the introduction of IPE will be a clear justification and the definition of its objectives. These must be explicitly communicated to all students