Meta-analytic techniques were used to examine the effectiveness of Web-based instruction (WBI) relative to classroom instruction (CI) and to examine moderators of the comparative effectiveness of the 2 delivery media. The overall results indicated WBI was 6% more effective than CI for teaching declarative knowledge, the 2 delivery media were equally effective for teaching procedural knowledge, and trainees were equally satisfied with WBI and CI. However, WBI and CI were equally effective for teaching declarative knowledge when the same instructional methods were used to deliver both WBI and CI, suggesting media effects are spurious and supporting Clark's (1983, 1994) theory. Finally, WBI was 19% more effective than CI for teaching declarative knowledge when Web-based trainees were provided with control, in long courses, and when trainees practiced the training material and received feedback during training. Study limitations and directions for future research are discussed.

The comparative effectiveness of web-based and classroom instruction: a meta-analysis

Meta-analytictechniqueswereusedtoexaminetheeffectivenessofWebbased instruction (WBI) relative to classroom instruction (CI) and to examine moderators of the comparative effectiveness of the 2 delivery media.TheoverallresultsindicatedWBIwas6%moreeffectivethanCI for teaching declarative knowledge, the 2 delivery media were equally effective for teaching procedural knowledge, and trainees were equally satisfied with WBI and CI. However, WBI and CI were equally effective for teaching declarative knowledge when the same instructional methods were used to deliver both WBI and CI, suggesting media effects are spurious and supporting Clark’s (1983, 1994) theory. Finally, WBI was 19% more effective than CI for teaching declarative knowledge when Web-based trainees were provided with control, in long courses, and when trainees practiced the training material and received feedback during training. Study limitations and directions for future research are discussed.

The comparative effectiveness of web-based and classroom instruction:

Background: Blended learning, defined as the combination of traditional face-to-face learning and asynchronous or synchronous e-learning, has grown rapidly and is now widely used in education. Concerns about the effectiveness of blended learning have led to an increasing number of studies on this topic. However, there has yet to be a quantitative synthesis evaluating the effectiveness of blended learning on knowledge acquisition in health professions. Objective: We aimed to assess the effectiveness of blended learning for health professional learners compared with no intervention and with nonblended learning. We also aimed to explore factors that could explain differences in learning effects across study designs, participants, country socioeconomic status, intervention durations, randomization, and quality score for each of these questions. Methods: We conducted a search of citations in Medline, CINAHL, Science Direct, Ovid Embase, Web of Science, CENTRAL, and ERIC through September 2014. Studies in any language that compared blended learning with no intervention or nonblended learning among health professional learners and assessed knowledge acquisition were included. Two reviewers independently evaluated study quality and abstracted information including characteristics of learners and intervention (study design, exercises, interactivity, peer discussion, and outcome assessment). Results: We identified 56 eligible articles. Heterogeneity across studies was large (I 2 ≥93.3) in all analyses. For studies comparing knowledge gained from blended learning versus no intervention, the pooled effect size was 1.40 (95% CI 1.04-1.77; P< .001; n=20 interventions) with no significant publication bias, and exclusion of any single study did not change the overall result. For studies comparing blended learning with nonblended learning (pure e-learning or pure traditional face-to-face learning), the pooled effect size was 0.81 (95% CI 0.57-1.05; P< .001; n=56 interventions), and exclusion of any single study did not change the overall result. Although significant publication bias was found, the trim and fill method showed that the effect size changed to 0.26 (95% CI -0.01 to 0.54) after adjustment. In the subgroup analyses, pre-posttest study design, presence of exercises, and objective outcome assessment yielded larger effect sizes. Conclusions: Blended learning appears to have a consistent positive effect in comparison with no intervention, and to be more effective than or at least as effective as nonblended instruction for knowledge acquisition in health professions. Due to the large heterogeneity, the conclusion should be treated with caution. [J Med Internet Res 2016;18(1):e2]

/pdf/the-effectiveness-of-blended-learning-in-health-professions-3cygdj8ewb.pdf

The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis

CONTEXT The opposing forces of increased training expectations and reduced training resources have greatly impacted health professions education. Virtual patients (VPs), which take the form of interactive computer-based clinical scenarios, may help to reconcile this paradox. METHODS We summarise research on VPs, highlight the spectrum of potential variation and identify an agenda for future research. We also critically consider the role of VPs in the educational armamentarium. RESULTS We propose that VPs' most unique and cost-effective function is to facilitate and assess the development of clinical reasoning. Clinical reasoning in experts involves a non-analytical process that matures through deliberate practice with multiple and varied clinical cases. Virtual patients are ideally suited to this task. Virtual patients can also be used in learner assessment, but scoring rubrics should emphasise non-analytical clinical reasoning rather than completeness of information or algorithmic approaches. Potential variations in VP design are practically limitless, yet few studies have rigorously explored design issues. More research is needed to inform instructional design and curricular integration. CONCLUSIONS Virtual patients should be designed and used to promote clinical reasoning skills. More research is needed to inform how to effectively use VPs.

Virtual patients: a critical literature review and proposed next steps.

Determining semantic similarity between texts is important in many tasks in information retrieval such as search, query suggestion, automatic summarization and image finding. Many approaches have been suggested, based on lexical matching, handcrafted patterns, syntactic parse trees, external sources of structured semantic knowledge and distributional semantics. However, lexical features, like string matching, do not capture semantic similarity beyond a trivial level. Furthermore, handcrafted patterns and external sources of structured semantic knowledge cannot be assumed to be available in all circumstances and for all domains. Lastly, approaches depending on parse trees are restricted to syntactically well-formed texts, typically of one sentence in length. We investigate whether determining short text similarity is possible using only semantic features---where by semantic we mean, pertaining to a representation of meaning---rather than relying on similarity in lexical or syntactic representations. We use word embeddings, vector representations of terms, computed from unlabelled data, that represent terms in a semantic space in which proximity of vectors can be interpreted as semantic similarity. We propose to go from word-level to text-level semantics by combining insights from methods based on external sources of semantic knowledge with word embeddings. A novel feature of our approach is that an arbitrary number of word embedding sets can be incorporated. We derive multiple types of meta-features from the comparison of the word vectors for short text pairs, and from the vector means of their respective word embeddings. The features representing labelled short text pairs are used to train a supervised learning algorithm. We use the trained model at testing time to predict the semantic similarity of new, unlabelled pairs of short texts We show on a publicly available evaluation set commonly used for the task of semantic similarity that our method outperforms baseline methods that work under the same conditions.

/pdf/short-text-similarity-with-word-embeddings-1h71ossbvq.pdf

Short Text Similarity with Word Embeddings

Background: Bioethics education often focuses on lectures and discussions to set a foundation for ethical decision making. Our goal was to bridge the gap between classroom learning and bedside competence through computer-assisted instruction. This article assesses the efficacy of MedEthEx Online, a computer-based learning program as part of a required Bioethics course. Description: Of 173 American medical students, 89 in Section 1 attended 8 bioethics lectures and 8 small-group discussions. Eighty-four in Section 2 had a similar course, although two group discussions were replaced with computerized learning. We compared (a) final exam scores, (b) topic-specific question scores, (c) performance with standardized patients, (d) self-assessments, and (e) course evaluations. Evaluation: Exam scores were comparable, although computerized-learning students scored higher in specific exam areas, felt somewhat more clinically prepared, and rated the course slightly better. Standardized patient interactions differed...

MedEthEx Online: a computer-based learning program in medical ethics and communication skills.

Alice is a seventy-year-old woman with metastatic breast cancer undergoing monthly chemotherapy treatments. Although she lives alone, her granddaughter, Louise, visits her several times a week and helps her do things she can no longer do for herself. Louise usually shops for Alice, washes her clothes, and cleans the house. In addition, she takes Alice to all her appointments. As Alice's treatments continue, Louise finds that Alice requires more frequent help of every kind. Alice seems to have increasing difficulty moving about her house and needs more help with her personal hygiene. Louise discusses with Alice the possibility of hiring someone to look after her and stay with her during the day and some evenings while Louise goes to work. Alice refuses to entertain the suggestion, insisting she is capable of taking care of herself. Just before a routine office visit Louise tells the nurse, Rebecca, that Alice appears increasingly weak and has difficulty bathing, getting in and out of her wheelchair, and fixing her own meals. Louise explains that she works as a musician in a nearby city and keeps very irregular hours, which makes it difficult for her to help Alice with more than a few simple routine daily activities. She worries constantly that Alice will fall and injure herself. Other family members or friends are either unwilling or physically unable to share the responsibility of Alice's care. Louise's constant worrying and exhaustion have begun to affect her job performance and she occasionally misses rehearsals on days when Alice needs extra help. Rebecca agrees that Louise must have help taking care of Alice, at least until Alice completes these aggressive treatments. She suggests they approach the doctor about their concern. The two women explain the predicament to Dr. Ramsey, the oncologist caring for Alice, and ask him to order a consult for a home health nurse and/or meals-on-wheels. Alice immediately protests, "No, absolutely not. I feel well enough to take care of myself. Louise should go to rehearsals and not worry about me. If I fall, it's my problem, not Louise's." Dr. Ramsey asks Alice if she feels positive that she can manage by herself. Alice replies, "I certainly can. I don't want to hear another word about it." Continuing to address Alice, Dr. Ramsey says, "Well, if you say no to home health care the answer is no. My patients have the right to make their own decisions." Despite Alice's wish to hear no more about this, Louise urges Dr. Ramsey to reconsider, emphasizing that Alice could easily fall and break her hip if left alone, which would set her health back tremendously and force Louise to leave her job to take over Alice's care full time. Dr. Ramsey replies, "I am sorry about your situation, but I cannot, in good conscience, try to persuade a patient to accept a service she clearly does not want." Louise tries to urge Dr. Ramsey again but he ignores her and only acknowledges comments from Alice. Rebecca tries to support Louise's concerns, but the doctor ignores her as well. Later, after Alice and Louise leave the office, Rebecca tells Dr. Ramsey how frustrated she felt when he would not listen to their concerns about Alice. He reiterates that Alice is competent to make her own decisions and that she has a right to refuse home health care. He says he felt the need to focus on his patient rather than Rebecca or Louise because they seemed to be talking about the patient as if she were a child: leaving her out of the discussion. He says, "Someone in that room needed to show Alice that they recognize she is still in control of her affairs." Rebecca tells Dr. Ramsey that at the very least, he should document Alice's refusal of home health care in the chart in case Alice does injure herself. Is Dr. Ramsey right to see this decision as belonging solely to Alice? Commentary Dr. Ramsey is very intent on doing the right thing for his patient. …

Don't I count?

Informed decision making and refusal of treatment

The goal of this paper is two-fold. First, I begin by reviewing several of themajor points of emphasis among health educatorsas they begin to incorporate multiculturalissues into healthcare education. I thenconsider the role of moral relativism, which iscurrently being endorsed by some healtheducators, as the foundation for resolvingcross-cultural conflicts in healthcare. Iargue that moral relativism is ultimatelyinconsistent with the stated goals inmulticultural curricular proposals and fails toprovide an effective framework for consideringmoral conflicts in cross-cultural settings. Instead, I propose that those methods seekingto establish a common morality, built uponmutually shared values, offer the mostpromising means of resolving cross-culturalconflicts. This leads to my second goal, tocompare recent work in moral pragmatism withwhat is now widely known in bioethics as moral``principlism.'' I argue that while proponentsof principlism and pragmatism each seek toestablish a common foundation for moraldeliberation, they fail to appreciatesignificant similarities between theirrespective approaches. Instead of offeringtwo completely unique and independent methodsof moral deliberation, I suggest thatprinciplism and pragmatism embrace commonthemes that point us in a positive direction,providing an effective framework useful forconsidering cross-cultural conflicts inhealthcare.

A moral framework for multicultural education in healthcare.

Parents, lies, and videotape: covert video surveillance in pediatric care.

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