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Self-directed learning and portfolio development for nurses: developing workbooks as a facilitative tool.

Workbooks are often used for discipline-specific learning in academic institutions but there is growing recognition of their potential usefulness in the clinical setting to promote learning and professional development. The purpose of this paper is to share some tips/guidelines for those clinical staff interested in developing self-directed learning programs using a workbook approach. Combined with skilled facilitation, custom designed workbooks based on adult learning theories can enhance skills and encourage portfolio development in the clinical setting. This cost and time effective approach utilises existing resources to cater to diverse needs and topics, building sustainable collaborations. This paper will argue that the proposed program has the potential to contribute to healthcare improvement by promoting skill development amongst staff and contributing to evidence-based practice.

Clinical Competence↗

Codman Award Paper: self-efficacy of staff nurses for health promotion counselling of patients at risk for stroke.

The effect of nurses' confidence to counsel patients at risk of stroke in selected health promotion areas: smoking cessation, exercise and nutrition was examined. Bandura's (1986) self-efficacy and Knowles' adult learning theories provided the theoretical underpinnings for the study. This was a quasi-experimental design in which neuroscience nurses (N = 23) from a quaternary hospital completed questionnaires prior to, immediately after, and 2 months post completion of a self-directed learning manual (SDL). The researcher-designed manual was designed to enhance learning about the risk factors for stroke and the importance of stroke prevention. Along with reflective activities and pre-post test, strategies for counseling high-risk, stroke-prone individuals in the areas of smoking cessation, exercise, and nutrition were also integrated. The Health Promotion Counseling Self-Efficacy Scale (Tresolini, Saluja, and Stritter, 1995), consisting of 10 self-efficacy subscales relating to self-confidence in knowledge and ability to counsel in health promotion areas, was used to capture the nurses' self-report of self-efficacy. Using a 5-point Likert Scale, nurses also rated their amount of agreement or disagreement about health promotion counseling in practice. Overall, self-efficacy levels for both knowledge and counseling increased significantly (p < .01) from pre-to immediately post completion of the manual, and decreased slightly at two-month follow-up. This pattern was evident in all health promotion areas measured except for knowledge in exercise (p = .015). Nurses' attitudes about aspects of health promotion practices correlated significantly (p < 05) at two-month follow-up with all health promotion areas. Results of this study support the usefulness of a self-directed learning manual as a teaching strategy for health promotion counseling of individuals at risk of stroke.

Adult↗

Learning modules as a supplement to existing audiovisual aids.

The development and use of supplementary learning modules for audiovisual aids designed for wider audiences was found to be a feasible approach for the education of family practice residents. This approach allows programs to direct learner attention to areas of greatest interest in family practice. It was not excessively time consuming to develop the two modules and extensive technical expertise with media was not required. It was found that the modules were adaptable to individual or group use. This teaching method appears to be an excellent learning tool for residents. Supplementary learning modules may be useful for medical students and other health-care providers in family practice. Further economy of time and other innovations using this basic approach could result from recruiting family practice residents and other students to develop their own learning modules on topics of individual interest.

Audiovisual Aids↗

The asthma files: evaluation of a multimedia package for children's asthma education.

Children's knowledge of asthma triggers and the impact on children's knowledge of using 'The Asthma Files', an interactive, educational computer program, were evaluated in this pilot study. Thirty-one children aged between seven and 14 years and diagnosed with asthma were recruited to the study. Ten boys participated in evaluating the triggers section and a questionnaire was used to determine their feelings about the program and retention of information. Children enjoyed using the package and knowledge about asthma triggers increased significantly. 'The Asthma Files' shows promise as an additional tool to augment existing education.

Adolescent↗

Structured packs for independent learning: a comparison of learning outcome and acceptability with conventional teaching.

OBJECTIVES: The GMC recommends that students become independent learners, while tutor time is an increasingly precious resource. A set of structured learning materials requiring students to undertake and reflect on practical tasks in five learning areas was developed. DESIGN: The study used a randomized control trial to evaluate the effectiveness of using these structured learning materials in place of conventional teaching for 228 third-year undergraduate students and 55 teachers, on both hospital and community based medical and general practice firms. Evaluation involved assessing student performance on an examination question and a writing task, together with a student and tutor satisfaction questionnaire. SETTING: King's College School of Medicine and Dentistry, London. SUBJECTS: Third-year medical (first-year clinical) undergraduates. RESULTS: No significant difference in learning outcome was found for students on community- and hospital-based medical and general practice firms between students who had used the structured materials and those who had had conventional teaching on the same topic. The packs were acceptable to tutors and students. CONCLUSIONS: Such resources represent a mid-point between formal didactic teaching and self-directed learning. They may be particularly suitable for promoting independent learning for students on traditional medical courses. They offer an appropriate way to cover certain topics in the clinical curriculum and help to protect tutor time for topics which cannot be effectively taught in other ways.

Clinical Medicine↗

Self-directed learning and continuing professional development.

This is the first of a series of articles on topics that will be relevant to radiologists planning personal learning projects and continuing professional development (CPD) activities for the Maintenance of Certification Program. Topics of future articles include: program development, needs assessment, small-group learning, problem-based learning and evidence-based radiology.

Canada↗

Oral cancer education training methods: a comparison of self-study and didactic approaches.

BACKGROUND: Dentists' competence and comfort level in detecting oral cancer may be strongly influenced by their dental school training. The purpose of this study was to compare the demonstrated knowledge of oral cancer topics among students receiving lectures and those learning the material through self-instruction at two dental schools. METHODS: Students at School 1 received 17 hours of lectures on various topics in oral cancer, including epidemiology, etiologic factors, histopathology, clinical appearance, clinical management and treatment, and oral complications. Lecture topics reflected material in the assigned text. Students at School 2 received only an introductory lecture, followed by a ten-week self-paced course using the same text used in School 1. At the end of the courses, the students at the two schools received identical 50-item final examinations. RESULTS: The students who had received the lectures and assigned readings scored significantly higher than did those assigned self-instruction alone (mean score of 91.2% vs 81.3%; p < 0.0001). This difference remained after statistical adjustment for entering grade-point average and Dental Aptitude Test score. CONCLUSIONS: Self-study of assigned readings may result in lower levels of knowledge of oral cancer topics than more traditional lecture-based teaching. The impact of this difference on clinical performance has not yet been demonstrated.

Analysis of Variance↗

Developing a clinical education program from the clinician's perspective.

As the number of physical therapy programs increases, more physical therapy departments will be developing clinical education programs. A guide for clinicians who are developing clinical education programs is presented. Suggestions are made for developing a philosophy of clinical education and for structuring the program. Topics discussed include guidelines for clinical instructors and students, learning contracts, negotiable time, and program evaluation. Examples adapted from the clinical education materials developed at Massachusetts Rehabilitation Hospital are included.

Philosophy, Medical↗

Three methods of oral health education in secondary schools.

In 1990, three methods of oral health education (OHE) were implemented in three secondary schools in the city of Pori, Finland, one method in each school. The traditional OHE consisted of a lecture given by a dentist with the aid of transparencies and slides. The peer OHE consisted of a lecture given by six pupils from the upper grades. These pupils used transparencies and extracts of video films and had a classroom exhibition with pictures, slogans, and dental aids and instruments. The self-teaching OHE was based on an exhibition from which the pupils searched for the information themselves. After the programs, the pupils' opinions about the method itself, its contents and implementation, knowledge about certain oral health issues, and the possible effect of the method were determined by a questionnaire. The attitudes and opinions were most positive in the peer OHE group. The traditional OHE was quite well accepted, but the self-teaching method was not very successful. The participants in the traditional OHE more often felt that they had been encouraged to pursue good oral health habits. In all groups, the topic considered to be the most boring was tooth brushing. Peer OHE can be recommended for Finnish secondary schools. The issue of tooth brushing should be played down, however, as too frequent repetition of the topic may cause more negative attitudes towards oral health education and practices.

Adolescent↗

Randomized clinical trials: alternatives to conventional randomization.

The randomized allocation format remains an exceedingly powerful tool for clinical research. Because humans are the subjects in clinical research, this area of scientific study must operate within the limits dictated by such basic principles as individual autonomy, justice, and beneficence. As randomized studies have become more common in clinical research, it has become apparent that there is often need for modification of the basic randomized format or for alternatives. The most widespread modification is the use of sequential analyses to monitor the progress of a trial and ensure early identification of either unanticipated adverse effects or more pronounced differences than expected. Although this modification does not affect the basic randomized allocation format, it does provide a protection that is lacking in the conventional trial and should be utilized whenever feasible. Modifications that do affect the basic structure of the randomized trial include adaptive allocation and pre-randomization. The former is attractive and useful but limited to studies in which results from early enrollees are known before late enrollees are allocated. The greater the linkage between preceding subject results and subsequent assignments, the greater is the protection afforded by such a format. Pre-randomization, more universally applicable than adaptive allocation, suffers from pronounced cross-over potential and has been criticized on ethical grounds, a combination of weaknesses that raises questions of whether pre-randomization truly offers advantages to conventional randomized formats. True alternatives to the randomized format include the self-controlled study and the historical control design. Both possess significant ethical advantages over the simple randomized study. Unfortunately, both are at some methodological disadvantage when the same comparison is made. The self-controlled study is limited to the study of conditions sufficiently stable or recurrent that they permit two or more treatment courses in a single patient. In emergency medicine and critical care, this description fits only a small proportion of the illness spectrum. This design is underutilized in clinical research focused on less severe problems of the type seen in ambulatory and primary-care settings. Such problems can be suitable topics for research by emergency medicine specialists. Historical control studies are eminently applicable in the emergency and critical-care setting.(ABSTRACT TRUNCATED AT 400 WORDS)

Antihypertensive Agents↗

The development of a computer assisted instruction and assessment system in pharmacology.

We describe the construction of a computer based system for instruction and assessment in pharmacology, utilizing a large bank of multiple choice questions. Items were collected from many sources, edited and coded for student suitability, topic, taxonomy and difficulty and text references. Students reserve a time during the day, specify the type of test desired and questions are presented randomly from the subset satisfying their criteria. Answers are scored after each question and a summary given at the end of every test; details on item performance are recorded automatically. The biggest hurdle in implementation was the assembly, review, classification and editing of items, while the programming was relatively straight-forward. A number of modifications had to be made to the initial plans and changes will undoubtedly continue with further experience. When fully operational the system will possess a number of advantages including: elimination of test preparation, editing and marking; facilitated item review opportunities; increased objectivity, feedback, flexibility and descreased anxiety in students.

Anxiety↗

Enhancing the dental histology curriculum using computer technology.

The predominant difference between the histology offered to dental students and that taken by other health care professionals is the emphasis placed on the oral tissues. The oral histology component of the dental curriculum is commonly handled in one of three ways, all delivering far more detailed information than the often less than one hour that a typical medical histology course spends on the oral cavity and its component tissues. Overall, three general curricular styles can be defined: 1) dental histology is taught by medical or dental faculty as a separate course, the oral histology component being a separate course taught by either faculty group; 2) medical and dental students take histology together in a single class with the oral histology component taught separately by faculty from either college; and 3) both basic and oral histology is taught within a single semester, the format used at the University of Kentucky College of Dentistry. The oral histology topics are similar in all of the course formats, regardless of whether they occur as a stand-alone course or are merged with basic histology. The main portion of this paper will describe a self-study, non-microscope-based laboratory experience designed to complement this fused topic course. Self-study labs using digital media are becoming more popular across both medical and dental histology curricula, specifically with the oral histology component where the histological skills for preparing these tissues are rapidly disappearing from many schools. This paper describes a typical syllabus for a fused course, outlining the topics for basic and oral histology, and demonstrates how the laboratory portion has been enhanced using digital technology.

CD-ROM↗

Investigating the effectiveness of self-learning packages in staff development.

The nursing shortage and high patient acuity levels make it difficult for nurses to attend traditional inservice programs. Time and financial constraints affect the staff educator's ability to teach needed topics to large numbers of nursing staff. This study suggests that the use of self-learning packages can be a viable alternative or adjunct to traditional inservice programs for nursing staff development.

Educational Measurement↗