Indiana University-Purdue University Indianapolis (IUPUI) / There is a critical need for faculty, a shortage of clinical sites, and an emphasis on quality and safety initiatives that drive increasing use of simulation in nursing education. Debriefing is an essential component of simulation, yet faculty are not consistently prepared to facilitate it such that meaningful learning, demonstrated through clinical reasoning, occurs from the experience. The purpose of this exploratory, quasi-experimental, pre-test-post-test study was to discover the effect of the use of a simulation teaching strategy, Debriefing for Meaningful Learning (DML), on the development of clinical reasoning in nursing students. Clinical reasoning was measured in 238 participant students from a Midwestern university school of nursing taking an adult health course that uses simulation. Participants were assigned to either the experimental or control group where the DML was compared to customary debriefing using the Health Sciences Reasoning Test (HSRT) before and after the debriefing experience, and the Debriefing Assessment for Simulation in Healthcare©–Student Version (DASH©–SV) with four supplemental questions about the DML (DMLSQ) process, during the post-debriefing assessment. This research sought to understand if the DML debriefing strategy positively influenced the development of clinical reasoning skills in undergraduate nursing students, as compared to usual and customary debriefing. The data revealed that there was a statistical difference between total mean test scores measured by the HSRT. There was, additionally, statistical significance in the change in scores between pre-test and post-test for those who used the DML as compared to the control. There was also a difference in the student’s perception of the quality of the debriefing measured by the DASH©–SV with the DML rated statistically higher than usual debriefing. Finally, there was a significant correlation, demonstrated through regression analysis, between the change in HSRT scores and students’ perception of quality debriefing and the use of the DML. This study contributes to the growing body of knowledge about simulation pedagogy, provides tools for use in debriefing, and informs faculty on best practices in debriefing.

A comparative analysis was undertaken using descriptive survey and cross-sectional design to explore the effects of two curricular approaches ( Problem-based learning and traditional) used in Comprehensive basic nursing programme on the development of, clinical reasoning abilities of nursing students was undertaken, Triple Jump Exercise as the data collection instrument was used to evaluate students' abilities, in clinical reasoning, Using quota sampling technique, a convenience sample of 87 subjects was selected from two nursing institutions using these two approaches, These were student nurses in their 1st, 2nd and 4th year levels of study, Using individual interviews, subjects were required to think aloud and verbalize their clinical reasoning after being presented with a clinical scenario, Subjects' verbalizations were quantified, based on the criteria specified in the evaluation form of the data collecting instrument, and total scores were obtained, Analysis using computer software package (SAS) was done to provide for descriptive and statistical summarisation, Though descriptive analysis through mean scores of clinical reasoning showed slight differences resulting from the curricular approaches used. this was not confirmed statistically as the two factor ANOVA and Tukey's method revealed no significant differences by approaches nor their interaction with level of study, Only levels of study had significant differences at p=O,OOO I, with senior levels outperforming their juniors, These findings therefore conclude that PBL and the traditional approach perfonn on a similar level in clinical reasoning. Nurse educators are therefore challenged to identify effective strategies to enhance and nurture clinical reasoning, One strategy, which this study recommends, is the use of case-based approaches in CBNP. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Indiana University-Purdue University Indianapolis (IUPUI) / It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students’ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students’ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students’ perceptions of clinical reasoning. Students who were older and had previous healthcare experience had higher scores, as well as students in the AS program, indicating larger changes in students’ perceptions of clinical reasoning abilities from Baseline to Time 2. Timing of HPS, mid or end of semester, had no effect on Difference scores, and thus students’ perceptions of clinical reasoning abilities.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Esta dissertação pretende realizar um estudo de caso, investigar como a proposta teórica da Psicologia Médica aplicou se em uma instituição de ensino e assistência, a Universidade do Estado do Rio de Janeiro (UERJ). O eixo central da análise consiste em demonstrar como os pressupostos iniciais deste campo tinham uma vertente subversiva em relação a prática médica. Fundamentalmente, questionavam-se os padrões universalizantes da ciência nos quais a medicina moderna se estruturou. Havia o objetivo de refundá-la, a partir de bases que não fosse as ditadas pela racionalidade cientifica moderna. A inserção da Psicologia Médica na UERJ retrata uma trajetória marcada por dificuldades e lutas políticas, que implicaram em uma gradual modificação de seu propósito de origem. A disciplina perde seu caráter crítico, de contestação à medicina, para transformar-se em mais uma especialidade médica. / This dissertation intends to conduct a case study to investigate how the theoretical proposal of Medical Psychology applied in an educational institution and assistance, the Universidadey do Estado do Rio de Janeiro (UERJ). The core of the analysis is to demonstrate how the initial assumptions of this field had a subversive aspect in relation to medical practice. Fundamentally questioned is the universalizing science standards in which modern medicine was structured. Had the objective of refounds it from bases that were not dictated by the modern scientific rationality. The insertion of Medical Psychology at UERJ portrays a trajectory marked by difficulties and political struggles, which resulted in a gradual modification of its original purpose. The discipline loses its critical character, the challenge to medicine, to become more of a medical specialty.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Esta dissertação pretende realizar um estudo de caso, investigar como a proposta teórica da Psicologia Médica aplicou se em uma instituição de ensino e assistência, a Universidade do Estado do Rio de Janeiro (UERJ). O eixo central da análise consiste em demonstrar como os pressupostos iniciais deste campo tinham uma vertente subversiva em relação a prática médica. Fundamentalmente, questionavam-se os padrões universalizantes da ciência nos quais a medicina moderna se estruturou. Havia o objetivo de refundá-la, a partir de bases que não fosse as ditadas pela racionalidade cientifica moderna. A inserção da Psicologia Médica na UERJ retrata uma trajetória marcada por dificuldades e lutas políticas, que implicaram em uma gradual modificação de seu propósito de origem. A disciplina perde seu caráter crítico, de contestação à medicina, para transformar-se em mais uma especialidade médica. / This dissertation intends to conduct a case study to investigate how the theoretical proposal of Medical Psychology applied in an educational institution and assistance, the Universidadey do Estado do Rio de Janeiro (UERJ). The core of the analysis is to demonstrate how the initial assumptions of this field had a subversive aspect in relation to medical practice. Fundamentally questioned is the universalizing science standards in which modern medicine was structured. Had the objective of refounds it from bases that were not dictated by the modern scientific rationality. The insertion of Medical Psychology at UERJ portrays a trajectory marked by difficulties and political struggles, which resulted in a gradual modification of its original purpose. The discipline loses its critical character, the challenge to medicine, to become more of a medical specialty.

The main hallmarks of the novel problem-based curriculum are self-directed, student-centred learning, clinical reasoning, small group tutorials and the facilitation of learning in an integrated way. These features differ significantly from the traditional curriculum which is teacher-centred, discipline-based and more content orientated. The innovative programme was implemented at the University of Transkei with a view to improving medical education. In this study, the perceptions of second year medical students regarding the implemention of and transition to the new curriculum, was assessed, as part of the evaluation of the curriculum. The results showed that students had grievances about the overwhelming volume of information they had to cover, time constraints, examination methods and bias of tutors towards their own subjects. Nevertheless, they considered the innovation to be favourable, exciting, relevant to life and to future tasks, and more motivating than the traditional curriculum. / Educational Studies / M. Ed. (Didactics)

The main hallmarks of the novel problem-based curriculum are self-directed, student-centred learning, clinical reasoning, small group tutorials and the facilitation of learning in an integrated way. These features differ significantly from the traditional curriculum which is teacher-centred, discipline-based and more content orientated. The innovative programme was implemented at the University of Transkei with a view to improving medical education. In this study, the perceptions of second year medical students regarding the implemention of and transition to the new curriculum, was assessed, as part of the evaluation of the curriculum. The results showed that students had grievances about the overwhelming volume of information they had to cover, time constraints, examination methods and bias of tutors towards their own subjects. Nevertheless, they considered the innovation to be favourable, exciting, relevant to life and to future tasks, and more motivating than the traditional curriculum. / Educational Studies / M. Ed. (Didactics)

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: Script concordance tests (SCTs) are assessments purported to measure clinical data interpretation. The aims of this research were to (1) test the psychometric properties of SCT items, (2) directly examine the construct validity of SCTs, and (3) explore the concurrent validity of six SCT scoring methods while also considering validity at the item difficulty and item type levels. Methods: SCT scores from a problem solving SCT (SCT-PS; n=522) and emergency medicine SCT (SCT-EM; n=1040) were used to investigate the aims of this research. An item analysis was conducted to optimize the SCT datasets, to categorize items into levels of difficulty and type, and to test for gender biases. A confirmatory factor analysis tested whether SCT scores conformed to a theorized unidimensional factor structure. Exploratory factor analyses examined the effects of six SCT scoring methods on construct validity. The concurrent validity of each scoring method was also tested via a one-way multivariate analysis of variance (MANOVA) and Pearson’s product moment correlations. Repeated measures analysis of variance (ANOVA) and one-way ANOVA tested the discriminatory power of the SCTs according to item difficulty and type. Results: Item analysis identified no gender biases. A combination of moderate model-fit indices and poor factor loadings from the confirmatory factor analysis suggested that the SCTs under investigation did not conform to a unidimensional factor structure. Exploratory factor analyses of six different scoring methods repeatedly revealed weak factor loadings, and extracted factors consistently explained only a small portion of the total variance. Results of the concurrent validity study showed that all six scoring methods discriminated between medical training levels in spite of lower reliability coefficients on 3-point scoring methods. In addition, examinees as MS4s significantly (p<0.001) outperformed their MS2 SCT scores in all difficulty categories. Cross-sectional analysis of SCT-EM data reported significant differences (p<0.001) between experienced EM physicians, EM residents, and MS4s at each level of difficulty. When considering item type, diagnostic and therapeutic items differentiated between all three training levels, while investigational items could not readily distinguish between MS4s and EM residents. Conclusions: The results of this research contest the assertion that SCTs measure a single common construct. These findings raise questions about the latent constructs measured by SCTs and challenge the overall utility of SCT scores. The outcomes of the concurrent validity study provide evidence that multiple scoring methods reasonably differentiate between medical training levels. Concurrent validity was also observed when considering item difficulty and item type.