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      Simulation based virtual learning environment in medical genetics counseling: an example of bridging the gap between theory and practice in medical education

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          Abstract

          Background

          Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based learning environments increase students’ knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making.

          Methods

          An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major in medicine, received a 2-h training session in a simulation based learning environment. The main outcomes were pre- to post- changes in knowledge, intrinsic motivation, and self-efficacy, together with post-intervention evaluation of the effect of the simulation on student understanding of everyday clinical practice were demonstrated.

          Results

          Knowledge (Cohen’s d = 0.73), intrinsic motivation ( d = 0.24), and self-efficacy ( d = 0.46) significantly increased from the pre- to post-test. Low knowledge students showed the greatest increases in knowledge ( d = 3.35) and self-efficacy ( d = 0.61), but a non-significant increase in intrinsic motivation ( d = 0.22). The medium and high knowledge students showed significant increases in knowledge ( d = 1.45 and 0.36, respectively), motivation ( d = 0.22 and 0.31), and self-efficacy ( d = 0.36 and 0.52, respectively). Additionally, 90 % of students reported a greater understanding of medical genetics, 82 % thought that medical genetics was more interesting, 93 % indicated that they were more interested and motivated, and had gained confidence by having experienced working on a case story that resembled the real working situation of a doctor, and 78 % indicated that they would feel more confident counseling a patient after the simulation.

          Conclusions

          The simulation based learning environment increased students’ learning, intrinsic motivation, and self-efficacy (although the strength of these effects differed depending on their pre-test knowledge), and increased the perceived relevance of medical educational activities. The results suggest that simulations can help future generations of doctors transfer new understanding of disease mechanisms gained in virtual laboratory settings into everyday clinical practice.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12909-016-0620-6) contains supplementary material, which is available to authorized users.

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          Most cited references26

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          Self-Efficacy: An Essential Motive to Learn.

          During the past two decades, self-efficacy has emerged as a highly effective predictor of students' motivation and learning. As a performance-based measure of perceived capability, self-efficacy differs conceptually and psychometrically from related motivational constructs, such as outcome expectations, self-concept, or locus of control. Researchers have succeeded in verifying its discriminant validity as well as convergent validity in predicting common motivational outcomes, such as students' activity choices, effort, persistence, and emotional reactions. Self-efficacy beliefs have been found to be sensitive to subtle changes in students' performance context, to interact with self-regulated learning processes, and to mediate students' academic achievement. Copyright 2000 Academic Press.
            • Record: found
            • Abstract: found
            • Article: not found

            Hard evidence on soft skills.

            This paper summarizes recent evidence on what achievement tests measure; how achievement tests relate to other measures of "cognitive ability" like IQ and grades; the important skills that achievement tests miss or mismeasure, and how much these skills matter in life. Achievement tests miss, or perhaps more accurately, do not adequately capture, soft skills-personality traits, goals, motivations, and preferences that are valued in the labor market, in school, and in many other domains. The larger message of this paper is that soft skills predict success in life, that they causally produce that success, and that programs that enhance soft skills have an important place in an effective portfolio of public policies.
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              • Abstract: found
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              Computerized virtual patients in health professions education: a systematic review and meta-analysis.

              Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design. The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model. Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes. Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.

                Author and article information

                Contributors
                (45)51432444 , gmakransky@health.sdu.dk
                mads@labster.com
                jwulff@health.sdu.dk
                jw@nordicmetrics.com
                michelle.hood@griffith.edu.au
                p.creed@griffith.edu.au
                ibache@sund.ku.dk
                asli@sund.ku.dk
                annenoe@sund.ku.dk
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                25 March 2016
                25 March 2016
                2016
                : 16
                : 98
                Affiliations
                [ ]Department of Psychology, University of Southern Denmark, Odense, Denmark
                [ ]Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
                [ ]Department of Education, University of Aarhus, Aarhus, Denmark
                [ ]School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
                [ ]Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
                [ ]Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
                Article
                620
                10.1186/s12909-016-0620-6
                4807545
                27012245
                ea5430b1-3ed3-46df-865d-45ea1f973c45
                © Makransky et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 October 2015
                : 19 March 2016
                Funding
                Funded by: Innovation fund Denmark
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Education
                learning simulations,virtual laboratory,medical genetics education,cytogenetics,e-learning

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