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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 2 | Issue 2
Page Nos. 51-114

Online since Tuesday, November 5, 2019

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METHODOLOGY  

Analyzing educational interventions without random assignment p. 51
Samuel C Karpen
DOI:10.4103/EHP.EHP_21_19  
Since educational researchers rarely have the luxury of random assignment, confounding variables are a common concern. This manuscript introduces readers to methods for statistically controlling confounding variables, namely propensity score matching, propensity score weighting, and doubly robust estimation. These techniques allow researchers to accurately estimate the effect of an intervention (e.g. a new teaching method's effect on course grades) even when the groups being compared differ on other relevant variables (e.g. one group has a higher pre-DVM GPA than the other). Example analysis are included to aid researchers hoping to conduct their own analyses.
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SHORT RESEARCH REPORT Top

Building and validating a predictive model for DVM academic performance p. 55
Samuel C Karpen, Scott A Brown
DOI:10.4103/EHP.EHP_20_19  
Background: Predicting success in the veterinary curriculum with admissions variables is a longstanding interest of veterinary faculty. As linear models have consistently outperformed experts' opinions when making quantitative estimates, integrating them into admissions could both improve the outcome and reduce the burden of the admissions process. Aims and Objectives: To build and test linear models for predicting first year grade point average (GPA) and practice readiness in the Doctor of Veterinary Medicine (DVM) program. Materials and Methods: The authors built and validated models for predicting first year GPA and clinical rotation performance using data from the college's application management system and internal records. Lasso regression was used to select the subset of variables that best predicted both first year GPA and clinical faculty's ratings of practice readiness. Results: Validated models indicated no application variables reliably predicted practice readiness. Only total undergraduate GPA, GRE verbal/quantitate score, reference letter positivity, and number of unexplained course withdrawals reliably predicted first year GPA. Conclusion: Selecting applicants who will be successful in the first year of the veterinary curriculum is an important objective, particularly given the challenges many students face during this part of the veterinary curriculum. The overarching goal of a veterinary curriculum, however, is to produce practice ready veterinarians, thus additional work must be done to improve our ability to identify applicants who will be poised for success upon graduation.
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ORIGINAL RESEARCH Top

Creating measurable, practice-relevant day-1 competencies for swine veterinary education p. 59
Perle E Zhitnitskiy, Thomas W Molitor, Montserrat Torremorell, Laura K Molgaard
DOI:10.4103/EHP.EHP_23_19  
Background: Veterinary education (VE) is increasingly transitioning toward a competency-based model with a focus on educational outcomes. The American Association of Veterinary Medical Colleges published a framework of competencybased veterinary education (CBVE) to provide guidance to veterinary educators in creating a curriculum that would graduate proficient veterinarians, capable of carrying out activities central to the profession, without supervision. Aims and Objectives: Swine Faculty at a Midwest Institution aimed to create a subset of competencies anchored in the CBVE framework for graduates aspiring to practice swine medicine. Methods: Using the Delphi process and the collaboration of swine practitioners and educators around the country, the team developed a list of 109 competencies divided into nine domains and three levels of expertise. Results: The list was designed as an online, interactive, savable tool, available at http://z.umn.edu/SwineCompetencies. Conclusion: Following this work, the swine faculty plans to evaluate the swine curriculum at the college level with the intent to incorporate additional opportunities for the students to practice and be assessed on the activities listed.
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What constitutes excellent teaching: A survey of the perceptions of AAVMC distinguished veterinary teacher award winners p. 65
Kenneth D Royal, Todd Zakrajsek, Keven Flammer
DOI:10.4103/EHP.EHP_6_18  
Background: Although researchers have attempted to discern the characteristics of good teachers and good teaching, no one has attempted to solicit the perspectives of instructors recognized for their teaching effectiveness in veterinary medicine. Thus, the purpose of this study was to survey national award-winning educators, namely recipients of the AAVMC Distinguished Veterinary Teacher Award, in an effort to gain insights about the beliefs, characteristics and behaviors of proven, outstanding educators. Methods: This mixed-methods study utilized survey and grounded theory methodologies to analyze quantitative and qualitative data. Results: Although most award-winning educators did not possess any formal training in education, each demonstrated a high-level understanding of modern learning theory and effective pedagogical techniques. Although opinions varied on some issues, there was virtually a consensus on the importance of issues such as emphasizing clinical relevance, focusing on core concepts, avoiding minutiae, offering opportunities for application, and illustrating how concepts are related. Further, most educators embraced backward design principles and were highly intrinsically motivated to perform their instructional duties well. Award-winning educators tend to believe developing expertise in teaching is just as important as developing expertise in one's academic discipline/content area. Conclusion: Continual and increasing efforts to promote faculty development are warranted in veterinary medical education.
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Applied teaching model for veterinary junior surgery laboratory p. 72
Andrea Kalei Herndon Erickson, Andrew B West, Margaret K Bruner, Dean A Hendrickson, Catriona M MacPhail
DOI:10.4103/EHP.EHP_15_19  
Objective: To assess perceived veterinary student confidence and surgical skill set following a live animal, nonrecovery porcine surgical laboratory and to assess veterinary alumni long-term surgical confidence benefits from this laboratory during their first few years in practice. Sample Population: Four hundred students pre- and post-laboratory self-assessment surveys were analyzed from veterinary students participating in the junior surgery laboratory (JSL) from 2009 to 2018. One hundred and fifty veterinary alumni surveys were analyzed from JSL participants graduating between 2014 and 2018. Materials and Methods : Procedures performed on swine culled from food production included wound closure, abdominal exploratory, abdominal closure, splenectomy, nephrectomy, gastrostomy, intestinal anastomosis, and cystotomy. Procedures performed aimed to facilitate development of atraumatic tissue handling, vessel ligation, and hollow organ surgery. Results: All participants demonstrated significant self-evaluation improvement (P < 0.001) in all categories to include prepping and draping, scrubbing, gowning and gloving, sterile technique, instrument handling, gentle tissue handling, knowledge of abdominal surgery, abdominal surgical exploration, skin incisions, vessel ligation, handling and suturing of abdominal viscera, comfort in a surgical setting, perceived surgical ability, and knowledge of abdominal surgical procedures. Surveyed Professional veterinary medicine (PVM) alumni agree that JSL contributed to their perceived confidence and surgical skills. Conclusions and Clinical Relevance: Authors believe that the skills-oriented teaching method and deliberate practice using a combination of bench models, cadavers, and live animal procedures build perceived student surgical skills and confidence. The majority of surveyed PVM alumni support this statement and report long-term perceived surgical skill and confidence benefits gained from the JSL during their 1st year of practice.
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Part I: Perceptions of clinical experience in the veterinary teaching hospital: Views of students, staff, house officers, and faculty in veterinary medicine clinical education p. 81
Candice Stefanou, Juan Samper, Marina McConkey, Hailey Carter
DOI:10.4103/EHP.EHP_18_19  
Background: The clinical portion of the education of health professionals occurs through the combined efforts of staff, interns, residents, and faculty in the teaching hospital. Exposure to the clinical environment is an essential element in shaping the emerging medical professional's development as a competent practitioner for their 1st day of independent practice. Although high value is placed on clinical education by students and educators alike, the expectations of what educational activities will occur, and the value of each to professional development varies. Thus, this study sought to explore the perceptions of students, faculty, and staff in clinical veterinary medical education regarding their expectations about what students would experience during clinical training and how important those experiences are believed to be. Methods: This study utilized survey research methods. Results: The results reveal a complex picture of competing expectations and experiences that differ based on the status of the respondent as a student, veterinary technician, resident, or clinical faculty. Conclusion: Varied perspectives speak to the complexities of clinical education in the authentic environment of the hospital.
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Part II: Observations of clinical teaching in the veterinary teaching hospital p. 91
Candice Stefanou, Kelly Moore, Juan Samper, Bobbi Conner, Marina McConkey, Michael Aherne
DOI:10.4103/EHP.EHP_19_19  
Background: Clinical education is uniformly considered an essential phase of training in all health professions, yet our understanding of the nature of clinical teaching is limited, including how teaching responsibilities are distributed among various teaching staff available. This study documents variety of teaching techniques used in the clinics of a veterinary teaching hospital and explores the teaching roles that are assumed by the clinical staff. Methods: Nearly 115 h of structured observations of clinical teaching in 11 different clinical services was evaluated. Results: Faculty and residents engaged in different but complementary teaching behaviors with the students. House officers were most likely to demonstrate their clinical reasoning for the students and respond to student questions. Faculty, on the other hand, primarily asked students questions. Providing opportunities for students to observe professionals demonstrating clinical problem-solving and decision-making and questioning and answering questions were the dominant teaching techniques. All teachers took opportunities to extend student learning by taking advantage of the “teaching moment” as the fourth most frequent teaching technique observed. Conclusion: Results suggest that, while a variety of valuable teaching techniques are utilized, there could be more opportunities for students to practice decision-making under the supervision of seasoned professionals.
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Team-based learning in postgraduate midwifery education: A descriptive qualitative study p. 98
Nusrat Bano, Jennifer de Beer, Tagwa Y Omer
DOI:10.4103/EHP.EHP_17_19  
Background: Pharmacology is perceived as a difficult course by nursing students who find it difficult to retain drug names and complex pharmacokinetic and pharmacodynamics processes. Team-based learning is a student-centered instructional design associated with improved academic outcomes. Purpose: To explore experiences of postgraduate nursing students with team-based learning in clinical pharmacology course. Methods: A descriptive qualitative design comprising of in-depth interviews was used. Study sample comprised of post graduate midwifery nursing students enrolled in clinical pharmacology course conducted with team-based learning. Content analysis following Graneheimian inductive approach was used to yield themes and subthemes. Results: Two themes emerged as 'Learning environment' and 'Intellectual process', comprising of 3-4 subthemes. Students absorbed concepts in a relaxed yet challenging environment. Intellectual process showcased improvements in knowledge retention, grasping concepts, confidence and thinking. Conclusion: Postgraduate midwifery nursing students had positive learning experiences in clinical pharmacology course conducted with team-based learning.
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Knowledge, attitude, and practice regarding preventive dentistry among dental students in Tamil Nadu, India p. 103
Sangeeta Chavan, S Lavanya Rahavi, K Umesh, Muthu Karuppaiah, Palanivel Pandian
DOI:10.4103/EHP.EHP_13_19  
Purpose: This study aimed to assess the knowledge, attitude, and practice of preventive dentistry among dental students. Materials and Methods: It is a cross-sectional study conducted among dental students in Tamil Nadu, India. Seven dental colleges were randomly selected. Final-year students, interns, and postgraduates were selected at random. The survey was conducted in the month of July–September 2018. A 17-item, structured, self-administered questionnaire consisting of demographic information and questions which were based on the knowledge, attitude, and practices of preventive dentistry was used to collect data from the study participants. Ethical clearance and informed consent were obtained. Results: Nearly 93.1% of final-year students, 98.4% of interns, and 45.7% of postgraduates were knowledgeable of preventive dentistry. Majority of the dental students responded that regular dental checkup is important in preventing oral diseases and nearly 67% of final-year students, 62.9% of interns, and 80.2% of postgraduates reported that they feel competent in performing preventive dental procedures. More than 50% of the respondents expressed a need for some changes in the dental curriculum. Conclusion: Results indicate that even though students have knowledge regarding preventive dentistry, the emphasis on practicing it is not adequate. Hence, there is a need a need for change to improve to improve knowledge, attitude, and practice regarding preventive dentistry in undergraduate students.
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FACULTY DEVELOPMENT Top

The role of metacognition in teaching clinical reasoning: Theory to practice p. 108
Ken Kosior, Tracy Wall, Sarah Ferrero
DOI:10.4103/EHP.EHP_14_19  
The ability to think critically in an uncertain and complex health-care environment is a paramount skill needed for health profession students to transition to clinical practice. Experts and educators in health profession education have unintentionally created confusion regarding operationalizing critical thinking, clinical reasoning, and clinical decision-making. In the purest form, health profession educators are referencing the cognitive abilities of a clinician to transfer thinking skills from an academic to a clinical setting. The problem with teaching clinical reasoning in health professions is that the ability to transfer knowledge and skill to patient care is often inefficient. Metacognitive awareness provides a theoretical and practical construct to make previously unconscious cognitive processes overt. The benefit of integrating and scaffolding pedagogical practices to emphasize explicit student knowledge and regulation of cognition may benefit health profession educators in teaching future clinicians how to handle cognitively complex problems. Making clinical reasoning overt through metacognitive awareness provides health profession educators a framework which helps to teach and assess cognitive strategies associated with clinical reasoning. Metacognitive awareness operationalizes a complex construct to allow a definitive way for health profession educators to instruct the cognitive system, resulting in enhanced clinical reasoning. Learning the components of metacognitive awareness is essential to a solid foundation for students and faculty. As students receive further instruction and feedback on cognitive strategies, the potential exists to improve metacognitive judgments. Case-based learning, simulated and standardized patient interactions, and experiential learning all provide pedagogical tools to promote metacognitive awareness in health profession students. Through serial assessment of metacognitive awareness, health profession educators may also gain valuable insight into how students develop cognitive strategies for future clinical reasoning. The increased ability to plan and evaluate cognitive processes may aid health profession students and educators in attaining more meaningful thinking for complex problem-solving in clinical practice.
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