Defining Appropriate Resources for Nursing Homes to Reduce Potentially Avoidable Transfers After a Fall

Falls are common in nursing home (NH) residents and are the predominant reason for an emergency department (ED) transfer. Falls are responsible for 25% - 87% of ED transfers, a proportion of which are potentially avoidable. INTERCARE – an implementation science study reducing unplanned hospitalizations (2018 – 2020) – involved experts to identify potentially avoidable fall-related transfers. Focus group and stakeholder survey enabled identification of resources to safely manage some falls in NHs. 25.9% of fall-related transfers were potentially avoidable based on using root-cause analysis and discharge reports. Avoidability was associated to ED visit, compared to hospitalizations. Appropriate resources identified by stakeholders included timely access to outpatient services for diagnostic imaging (e.g., X-Ray) and clinical skills’ training in suturing and wound care for registered or specialist nurses. Although NHs are striving for a home-like environment, better access to basic diagnostic and treatment services within NHs should be possible.

COVID-19 Pandemic and Challenges for Dental Education

The COVID-19 pandemic has a different impact on everyone. The impact is not only on mortality and morbidity in infected people but also on the mental health of uninfected people.1,2 Apart from the health side, other sectors that may also be affected include the industrial sector, tourism, and education.3 The COVID-19 pandemic poses enormous challenges to all stakeholders in the educational field such as lecturers, students, and leaders and staff of institutions.1 Learning that was previously delivered in-person in the classroom has shifted to an online platform. The trend for all elements in learning today is towards the digital arena. One solution in the world of education is the use of asynchronous learning, which allows learning to be carried out at different times. It gives lecturers the flexibility to prepare learning materials and allow students to adjust to the demands of home and study. This system creates flexibility in learning without compromising competency. In the field of dentistry, in addition to learning in the classroom to obtain cognitive abilities, learning to achieve psychomotor abilities is also important. This psychomotor ability in dental education can be done through a simulation laboratory and clinical skills training. These aspects are challenging. Several countries have implemented the use of virtual reality (VR) in simulation laboratories to get the sensation of practice on the simulation model. However, this has not yet been fully adapted to all dental education institutions because the facilities owned by the institution still do not fully support this technology.4-6 The high risk of transmission through aerosols is a major challenge in dental education based on clinical skills training.7 The use of tele-dentistry, an electronic-based dentistry medical consultation facility, is an alternative.8,9 This facility can shorten dental treatment visits that have a high risk of transmission. In addition, in emergency dental care and other dental treatments, the use of adequate personal protective equipment (PPE) can reduce the risk of infection transmission. Finally, dental education innovations in cognitive and psychomotor aspects are urgently needed today in the era of the COVID-19 pandemic to achieve optimal student competencies. Dr. Agung Sosiawan, drg., M.H., M.Kes. Dean Faculty of Dental Medicine Universitas Airlangga REFERENCES Daniel J. Education and the COVID-19 pandemic. Prospects. 2020 Oct;49(1):91-6. Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med. 2020 Aug 6; 383(6):510-2. Khanna RC, Cicinelli MV, Gilbert SS, Honavar SG, Murthy GV. COVID-19 pandemic: lessons learned and future directions. Indian J Ophthalmol. 2020 May; 68(5):703. Chang TY, Hong G, Paganelli C, Phantumvanit P, Chang WJ, Shieh YS, Hsu ML. Innovation of dental education during COVID-19 pandemic. J Dent Sci. 2021 Jan 1; 16(1):15-20. Desai BK. Clinical implications of the COVID‐19 pandemic on dental education. J Dent Educ. 2020 May; 84(5):512. Alzahrani SB, Alrusayes AA, Aldossary MS. Impact of COVID-19 pandemic on dental education, research, and students. Int J Health Sci Res. 2020 Jun; 10:207-12. Deery C. The COVID-19 pandemic: implications for dental education. Evidence-based Dentistry. 2020 Jun; 21(2):46-7. Machado RA, Bonan PR, Perez DE, MARTELLI H. COVID-19 pandemic and the impact on dental education: discussing current and future perspectives. Braz Oral Res. 2020 Jun 29;34. Machado RA, Souza NL, Oliveira RM, Martelli Júnior H, Bonan PR. Social media and telemedicine for oral diagnosis and counselling in the COVID-19 era. Oral Oncol. 2020 Jun; 105:104685.

Challenges of peer assisted learning in online clinical skills training of ophthalmology module

Background Online communication has taken over in the last 2 years due to the frequent lockdowns because of the COVID-19 pandemic. Overburdened physicians in this pandemic are struggling to get enough time to teach clinical skills online to the students. Also, due to student’s safety issues, the students cannot fully attend the clinics. Therefore, in this scenario, online PAL (Peer Assisted Learning) sessions for clinical skill teaching and learning can be an effective alternative for undergraduate medical students. The academic limitations caused by the COVID-19 related lockdown however can have a pleasurable outcome if certain challenges, related to online PAL, are overcome. Therefore, the present study aims to identify the challenges of Peer Assisted Learning (PAL) sessions during online clinical skills training in the Ophthalmology module of undergraduate medical students. Methods This qualitative exploratory study, utilizing online focus group discussions to explore the challenges of online PAL in training and learning of clinical skills were carried at the Ophthalmology department of Batterjee Medical College, Jeddah; Saudi Arabia. A purposive convenient sampling technique was used to collect data. Data were transcribed and analyzed using thematic analysis. Results The study identified six themes that were further divided into smaller subthemes. The subthemes derived from the collected data were organized under the following major themes; infrastructure, learning environment, psychological problems, interaction deficit, learning desires, and desire for feedback on performance. The major challenge reported by the medical student during online PAL sessions was infrastructure in terms of network connection, scheduling, and timing of the session. The unprofessional learning environment, psychological problems in terms of behavioral issues and personality changes, interaction deficit with peers, tutor, and patient, learning desires, and desire for feedback on performance were the other important challenges faced by the students. Conclusion The challenges explored by our study can be used by the medical educators to incorporate online PAL as an effective, efficient, and alternative teaching and learning modality in the curriculum especially in compromised circumstances like the current COVID-19 pandemic.

EFFECTIVENESS OF INSTRUCTIONAL DESIGN FRAMEWORK BASED ON COGNITIVE LOAD THEORY FOR CLINICAL SKILLS TRAINING

Purpose: Cognitive load theory (CLT) is receiving increased recognition in medical education and it was cited as an important theoretical framework for simulation-based medical education. Simulated learning environments can place a high demand on the cognitive resources of the learners, hence, we aimed to design an instructional framework to optimise the total cognitive load imposed on the medical students during their clinical skills training in the clinical skills laboratory. Method: This study is a quasi-experimental post-test design. The sampling technique was purposive sampling, which included year 2 students at the Faculty of Medicine-Suez Canal University population. The study was conducted in the clinical skills and simulation laboratory. The intervention group received a developed instructional design framework based on CLT. The control group learned with the ordinary teaching method without any intervention. The cognitive load was measured using the Cognitive Load Inventory (CLI) immediately after the training session for both groups. Furthermore, students’ achievement in the clinical skill laboratory was compared in both groups. Findings: The total cognitive load is lower in the group that received the developed instructional design than that of the control group, and this result was statistically significant. Also, the performance of the intervention group is higher than in the control group. Implications for research and practice: The developed instructional design framework is a potentially useful guide for managing students' cognitive load in the clinical skills training session.

ENHANCING STUDENTS’ MOTIVATION: THE EFFECT OF A STRUCTURED ORAL EXAMINATION IN BASIC CLINICAL SKILLS TRAINING

Background: Basic Clinical Skills (BCS) is one of the learning methods in medical education that acts as an intermediary bridge to apply procedural knowledge and clinical competency for medical students. Medical educators have successfully used many ways to assess students’ abilities, both oral and written. Oral examinations have vast advantages compared to other assessment methods. However, no standardization of questions to be tested becomes an essential issue in the assessment process. A structured oral examination may increase students’ motivation to prepare themselves better to study the material before following BCS training. This study aimed to determine the effect of a structured oral examination on students’ motivation and identify students’ motivation. Methods: This quasi-experimental research used a pretest-posttest design to assess the effect of applying the structured oral examination on students’ motivation. The subject of this study was the third-year medical students that amounted to 109 students. Sample selection was made by total sampling. In this study, the authors used SMQ-II questionnaires to measure the students’ motivation. Results: This research showed significant differences between student motivation on pretest and posttest (p-value of 0,000) after the students were given the structured oral examination at the beginning of basic clinical skills training. It means the structured oral examination affected students’ motivation. Conclusion: The structured oral examination administered for students before entering BCS learning processes had a significant impact on the students’ motivation. The preparation and the regulation of the structured oral examination on the BCS learning processes should be reinforced to motivate the students and make them more skillful

Final Year 5 Students’ Exit Evaluation of the Asia Metropolitan University MBBS Program

Introduction: An exit evaluation study by the final year graduating students was done Just prior to the completion of the third batch of the MBBS program at Asia Metropolitan University (AMU).Objective: (1) To determine whether the MBBS program had enabled the students to (a)attain the eight Program Learning outcomes (PLO); (b)to achieve the eight major competency areas expected upon completion of the program; and (2) To look into the strengths and weaknesses of the program from the graduating final year students’ perspectives.Methods: A descriptive study was done among 18 medical students who were doing senior clerkship posting. A self-administered questionnaire including one open ended question was used for the study. Informed consent was obtained from the participants, assuring them on confidentiality. Data gathered were analysed using SPSS version 23.Results: Most of the students (77%) feel that the program had enabled them to attain each one of the eight Program Learning Outcomes(PLO); between 60-78% achieved competencies in each one of the eight major areas expected at the end of course. The strengths included experienced lecturers, smooth implementation of the program, well designed curriculum while weakness was deficiency in clinical skills, training facilities, number of lecturers, case mix and adequacy of clinical exposure. The weaknesses include readiness to be a self-directed learner.Conclusion: Majority of the students attained each of the eight (PLO) competencies. The strengths were identified and discussed. The study has paved the way for a more detailed indepth study with more samples among the future graduating batches.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S12