Applying an instructional design method to serious games - experiences and lessons learned

The ABCDE method, used internationally to treat seriously ill patients, is a complex skill that is commonly trained in face-to-face-courses. In the abcdeSlM game, used as a preparation for these courses, players treat patients in a virtual emergency department. We applied the Four Component Instructional Design theory to redesign the existing game. In this article, we describe how the components of this instructional design theory can be applied to a serious game for medical education

Lean towards learning: connecting Lean Thinking and human resource management in UK higher education

From its origins in the automotive industry, Lean Thinking is increasingly being seen as a solution to problems of efficiency and quality in other industries and sectors. In recent years attempts have been made to transfer Lean principles and practice to the higher education sector with indications of mixed consequences and debate over its suitability. This paper contributes to the debate by drawing evidence from thirty-four interviews conducted across two UK universities that have implemented Lean in some of their activities and we pay particular attention to the role of the HR function in facilitating its introduction. The findings suggest there are problems in understanding, communicating and transferring Lean Thinking in the higher education context; that, despite HR systems being vital facets of Lean, HR professionals are excluded from participation; and that as a consequence the depth and breadth of Lean application in the two institutions is very limited

Business/Culture

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Polymer Crosslinking: a new Strategy to Enhance Mechanical Properties and Structural Stability of Bioactive Glasses

The organic-inorganic hybrids fabricated by the sol-gel method are intrinsically bioactive materials with extensive applications in bone tissue engineering. The brittleness and limited water uptake capacity of these monoliths, however, restrict their applications for engineering the soft tissues and their interfaces with bone. To address these challenges, we developed a unique method in which polymer crosslinking was used to cease the over-condensation of a bioactive glass component and eradicate the formation of brittle structure. In this study, an organosilane-functionalized gelatin methacrylate was covalently bonded to a bioactive glass during the sol-gel process, and the condensation of silica networks was controlled by polymer-crosslinking. The physicochemical properties and mechanical strength of these hybrid hydrogels were then tuned by the incorporation of secondary crosslinking agents such as poly(ethylene glycol diacrylate). The resulting elastic hydrogels displayed tuneable compressive modulus in the range of 42 kPa to 530 kPa. The swelling behaviours of these hybrids and their structural integrities were also favourable for tissue engineering applications. Moreover, these hybrid hydrogels kept their structures for more than 28 days in simulated body fluid. The bioactivity of the constructs due to the presence of silica networks were confirmed by detecting nearly 2-fold increase in the alkaline phosphatase activity of the cultured bone progenitor cells on these hybrid hydrogels within 28 days of in vitro culture. Within the same period, in vivo studies on mice subcutaneous model showed that the hybrid hydrogels were highly biocompatible and well-tolerated. In summary, the bioactivity of the constructs, their tuneable physicochemical properties, the outstanding biocompatibility, and biodegradability of the hybrid hydrogels showed the high potential of the developed technique for fabrication of constructs for a variety of soft and hard tissue regeneration

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Purpose: During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods: European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results: In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion: This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR

Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability

The purpose of this study is to compare the variability of PCT results obtained by automatic selection of the arterial input function (AIF), venous output function (VOF) and symmetry axis versus manual selection. Imaging data from 30 PCT studies obtained as part of standard clinical stroke care at our institution in patients with suspected acute hemispheric ischemic stroke were retrospectively reviewed. Two observers performed the post-processing of 30 CTP datasets. Each observer processed the data twice, the first time employing manual selection of AIF, VOF and symmetry axis, and a second time using automated selection of these same parameters, with the user being allowed to adjust them whenever deemed appropriate. The volumes of infarct core and of total perfusion defect were recorded. The cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and blood-brain barrier permeability (BBBP) values in standardized regions of interest were recorded. Interobserver variability was quantified using the Bland and Altman's approach. Automated post-processing yielded lower coefficients of variation for the volume of the infarct core and the volume of the total perfusion defect (15.7% and 5.8%, respectively) compared to manual post-processing (31.0% and 12.2%, respectively). Automated post-processing yielded lower coefficients of variation for PCT values (11.3% for CBV, 9.7% for CBF, and 9.5% for MTT) compared to manual post-processing (23.7% for CBV, 32.8% for CBF, and 16.7% for MTT). Automated post-processing of PCT data improves interobserver agreement in measurements of CBV, CBF and MTT, as well as volume of infarct core and penumbra

An experimental study on the effects of a simulation game on students’ clinical cognitive skills and motivation

Simulation games are becoming increasingly popular in education, but more insight in their critical design features is needed. This study investigated the effects of fidelity of open patient cases in adjunct to an instructional e-module on students’ cognitive skills and motivation. We set up a three-group randomized post-test-only design: a control group working on an e-module; a cases group, combining the e-module with low-fidelity text-based patient cases, and a game group, combining the e-module with a high-fidelity simulation game with the same cases. Participants completed questionnaires on cognitive load and motivation. After a 4-week study period, blinded assessors rated students’ cognitive emergency care skills in two mannequin-based scenarios. In total 61 students participated and were assessed; 16 control group students, 20 cases students and 25 game students. Learning time was 2 h longer for the cases and game groups than for the control group. Acquired cognitive skills did not differ between groups. The game group experienced higher intrinsic and germane cognitive load than the cases group (p = 0.03 and 0.01) and felt more engaged (p < 0.001). Students did not profit from working on open cases (in adjunct to an e-module), which nonetheless challenged them to study longer. The e-module appeared to be very effective, while the high-fidelity game, although engaging, probably distracted students and impeded learning. Medical educators designing motivating and effective skills training for novices should align case complexity and fidelity with students’ proficiency level. The relation between case-fidelity, motivation and skills development is an important field for further study

Feasibility study of ultrasound-guided resection of tongue cancer with immediate specimen examination to improve margin control - Comparison with conventional treatment

Objectives: Squamous cell carcinoma of the tongue (SCCT) is preferably treated by surgery. Free resection margins (> 5 mm) provide local control and disease-free survival. However, close (1-5 mm) and positive margins (< 1 mm) are frequently encountered. We present our first experience of in-vivo ultrasound (US) guided SCCT resections followed by ex-vivo US control on the resection specimen to obtain free margins. We compare the results with those from a hisorical cohort of 91 conventionally treated SCCT patients. Materials and methods: Ten patients with SCCT were included in a consecutive US-cohort. We aimed for a 5-10 mm margin during surgery, while we visualized the resection plane on US. Ex-vivo US measurements on the resection specimen determined whether there was any need for an immediate re-resection. US measurements were then compared with histopathology. Histopathological margins were compared with a consecutive cohort of 91 patients who had undergone conventional surgery for a SCCT. Results: In the US cohort, 70% of the margins were free. In the conventional cohort, this figure was 17% (P = 0.005). US predicted minimal histopathological margin distance with a mean +/- SD error of 1.9 +/- 1.8 mm. The mean +/- SD of the histopathological overall submucosal/deep margin distance was 7.9 +/- 2.1 mm in the US cohort and 7.0 +/- 2.2 mm in the conventional cohort (P = 0.188). Ex-vivo examination through use of US indicated an immediate re-resection, which prevented local adjuvant treatment. Conclusion: Use of US-guided SCCT resection is feasible and improves margin control