There is currently an international shortage of Audiologists (McIntyre, 2010). Audiology is a professional degree undertaken at a postgraduate level at most universities around the world. Students have training in anatomy and physiology, hearing aids, cochlear implants, electrophysiology and acoustics; combined with a clinical component to the course. The clinical component is undertaken throughout the entirety of the course and involves a mixture of observation and supervised clinical practice in a variety of settings. Clinical training often begins with students crowded around a single piece of equipment, such as an audiometer for testing puretone-hearing thresholds or by pairing up and simulating a hearing loss. This process creates time and access constraints for students as it restricts their ability to practice performing audiometry, particularly if there is a shortage of equipment, and also limits their exposure to a wide variety of hearing loss pathologies. The potential for universities worldwide to use Virtual Reality and Computer Based Simulations to provide Audiology students with basic clinical skills without relying on extensive support from external clinics warrants further investigation. In particular, it needs to be determined whether Audiology students value these simulations as a useful supplement to their clinical training, and whether the use of these simulations translates into measurable improvements in student abilities in real clinical placements. A computer based training program for Audiology students developed at the Human Interface Technology Lab (HITLAB) New Zealand is evaluated in this study as an educational tool at the University of Canterbury, New Zealand. The present study aims to determine if a sample of twelve first year Audiology students felt their interactions with Virtual Patients improved their ability to interact with clients and perform masking which is often part of a basic audiometric assessment for a patient with hearing loss. The study measures the students’ competency in performing masking in puretone audiometry on the Virtual Patient and then on a patient in a real-world setting to see whether the Audiology Simulator training tool improved the student’s basic audiometry skills (a training effect) and whether these skills were maintained after a period of four weeks (a maintenance effect). Statistical analysis is applied to determine any training and maintenance effects. Students also gave subjective feedback on the usefulness of the simulator and suggestions for ways in which it could be improved. Results indicated that there was no statistically significant training effect between students that had used the Audiology Simulator and those that hadn’t. Once all students had used the Virtual Patient there was an overall maintenance effect present in that student’s scores stayed the same or improved even for those students who had not used the Virtual Patient for a period of time. Students overall reported that they found the Virtual Patient to be ‘Moderately Useful’ and had many recommendations for ways in which it could be improved to further assist their learning.The present study indicates that computer based simulation programs like the Virtual Patient are able to present and simulate realistic hearing losses to an acceptable level of complexity for students studying in the field of audiology and that the Audiology Simulator can be a useful and complementary training tool for components of audiological clinical competence, such as puretone audiometry and masking.

Este trabalho tem como objetivo propor um modelo para o uso de ferramentas tecnológicas (em especial simuladores de casos clínicos) como mediadoras do processo de implementação de métodos ativos de aprendizagem no ensino de medicina. A metodologia empregada é a pesquisa-ação, onde o pesquisador é membro ativo da ação e, ao mesmo tempo, a partir da realidade observada, busca na pesquisa soluções para os problemas encontrados. Um estudo teórico sobre métodos ativos de aprendizagem, com ênfase em aprendizagem baseada em problemas e problematização, é apresentado no decorrer do trabalho, seguido de uma revisão sistemática sobre o uso de simuladores no ensino de medicina. O modelo proposto é composto de quatro pilares que lhe dão suporte: metodológicos, organizacionais, tecnológicos e estruturantes. Os pilares metodológicos foram obtidos por meio do estudo teórico sobre métodos ativos de aprendizagem. Os pilares organizacionais são provenientes da revisão sistemática. Quanto aos aspectos tecnológicos, esses foram desenvolvidos abarcando simuladores (SIACC e SimDeCS), banco de imagens médicas, banco de dados e plataformas. Os simuladores foram validados em duas oficinas de formação de professores, e os resultados de um questionário aplicado foram analisados, comparando os dois sistemas e demonstrando os aspectos positivos e os que devem ser melhorados para que possam ser utilizados em sala de aula. Os aspectos estruturantes provêm do estudo de diversas plataformas para disponibilizar os simuladores de paciente virtual. O modelo foi concluído e validado em suas partes no decorrer da pesquisaação e deverá ser validado na sua completude junto a uma faculdade de Medicina. / This work has as its objective proposing a model for the use of technological tools (especially simulators of clinical cases) as mediators of the implementing process of active methods of learning in the Medicine Teaching. The applied methodology is the research-action one, where the researcher is an active member of the action and at the same time, from the observed reality, searches in the research, solutions to the problems found. A theoretical study about active methods of learning, with emphasis on the learning based on problems and problematization, it is presented throughout the work, followed with a systematic review about the using of simulators in the Medicine Teaching. The proposed model is composed by four pillar bases: methodological, organizational, technological and structural. The methodological pillars were obtained by means of theoretical study about active methods of learning. The organizational pillars come from the systematical review. As for the technological aspects, these ones were developed embracing simulators (SIACC and SimDeCS), medical images bank, data bank and platforms. The simulators were validated in two workshops of teachers’ formation and the results of an applied questionnaire were analyzed, comparing the two systems, displaying the positive aspects and the ones that must be improved to be used in the classroom. The structural aspects come from the study of several platforms to release the simulators of virtual patient. The model was concluded and validated in parts throughout the research-action and it must be validated in its complete in a Medicine Faculty.

Este trabalho tem como objetivo propor um modelo para o uso de ferramentas tecnológicas (em especial simuladores de casos clínicos) como mediadoras do processo de implementação de métodos ativos de aprendizagem no ensino de medicina. A metodologia empregada é a pesquisa-ação, onde o pesquisador é membro ativo da ação e, ao mesmo tempo, a partir da realidade observada, busca na pesquisa soluções para os problemas encontrados. Um estudo teórico sobre métodos ativos de aprendizagem, com ênfase em aprendizagem baseada em problemas e problematização, é apresentado no decorrer do trabalho, seguido de uma revisão sistemática sobre o uso de simuladores no ensino de medicina. O modelo proposto é composto de quatro pilares que lhe dão suporte: metodológicos, organizacionais, tecnológicos e estruturantes. Os pilares metodológicos foram obtidos por meio do estudo teórico sobre métodos ativos de aprendizagem. Os pilares organizacionais são provenientes da revisão sistemática. Quanto aos aspectos tecnológicos, esses foram desenvolvidos abarcando simuladores (SIACC e SimDeCS), banco de imagens médicas, banco de dados e plataformas. Os simuladores foram validados em duas oficinas de formação de professores, e os resultados de um questionário aplicado foram analisados, comparando os dois sistemas e demonstrando os aspectos positivos e os que devem ser melhorados para que possam ser utilizados em sala de aula. Os aspectos estruturantes provêm do estudo de diversas plataformas para disponibilizar os simuladores de paciente virtual. O modelo foi concluído e validado em suas partes no decorrer da pesquisaação e deverá ser validado na sua completude junto a uma faculdade de Medicina. / This work has as its objective proposing a model for the use of technological tools (especially simulators of clinical cases) as mediators of the implementing process of active methods of learning in the Medicine Teaching. The applied methodology is the research-action one, where the researcher is an active member of the action and at the same time, from the observed reality, searches in the research, solutions to the problems found. A theoretical study about active methods of learning, with emphasis on the learning based on problems and problematization, it is presented throughout the work, followed with a systematic review about the using of simulators in the Medicine Teaching. The proposed model is composed by four pillar bases: methodological, organizational, technological and structural. The methodological pillars were obtained by means of theoretical study about active methods of learning. The organizational pillars come from the systematical review. As for the technological aspects, these ones were developed embracing simulators (SIACC and SimDeCS), medical images bank, data bank and platforms. The simulators were validated in two workshops of teachers’ formation and the results of an applied questionnaire were analyzed, comparing the two systems, displaying the positive aspects and the ones that must be improved to be used in the classroom. The structural aspects come from the study of several platforms to release the simulators of virtual patient. The model was concluded and validated in parts throughout the research-action and it must be validated in its complete in a Medicine Faculty.

abstract: Virtual Patient Simulations (VPS) are web-based exercises involving simulated patients in virtual environments. This study investigates the utility of VPS for increasing medical student clinical reasoning skills, collaboration, and engagement. Many studies indicate that VPS provide medical students with essential practice in clinical decision making before they encounter real life patients. The utility of a recursive, inductive VPS for increasing clinical decision-making skills, collaboration, or engagement is unknown. Following a design-based methodology, VPS were implemented in two phases with two different cohorts of first year medical students: spring and fall of 2013. Participants were 108 medical students and six of their clinical faculty tutors. Students collaborated in teams of three to complete a series of virtual patient cases, submitting a ballpark diagnosis at the conclusion of each session. Student participants subsequently completed an electronic, 28-item Exit Survey. Finally, students participated in a randomized controlled trial comparing traditional (tutor-led) and VPS case instruction methods. This sequence of activities rendered quantitative and qualitative data that were triangulated during data analysis to increase the validity of findings. After practicing through four VPS cases, student triad teams selected accurate ballpark diagnosis 92 percent of the time. Pre-post test results revealed that PPT was significantly more effective than VPS after 20 minutes of instruction. PPT instruction resulted in significantly higher learning gains, but both modalities supported significant learning gains in clinical reasoning. Students collaborated well and held rich clinical discussions; the central phenomenon that emerged was "synthesizing evidence inductively to make clinical decisions." Using an inductive process, student teams collaborated to analyze patient data, and in nearly all instances successfully solved the case, while remaining cognitively engaged. This is the first design-based study regarding virtual patient simulation, reporting iterative phases of implementation and design improvement, culminating in local theories (petite generalizations) about VPS design. A thick, rich description of environment, process, and findings may benefit other researchers and institutions in designing and implementing effective VPS. / Dissertation/Thesis / Ed.D. Educational Leadership and Policy Studies 2014

Este trabalho tem como objetivo propor um modelo para o uso de ferramentas tecnológicas (em especial simuladores de casos clínicos) como mediadoras do processo de implementação de métodos ativos de aprendizagem no ensino de medicina. A metodologia empregada é a pesquisa-ação, onde o pesquisador é membro ativo da ação e, ao mesmo tempo, a partir da realidade observada, busca na pesquisa soluções para os problemas encontrados. Um estudo teórico sobre métodos ativos de aprendizagem, com ênfase em aprendizagem baseada em problemas e problematização, é apresentado no decorrer do trabalho, seguido de uma revisão sistemática sobre o uso de simuladores no ensino de medicina. O modelo proposto é composto de quatro pilares que lhe dão suporte: metodológicos, organizacionais, tecnológicos e estruturantes. Os pilares metodológicos foram obtidos por meio do estudo teórico sobre métodos ativos de aprendizagem. Os pilares organizacionais são provenientes da revisão sistemática. Quanto aos aspectos tecnológicos, esses foram desenvolvidos abarcando simuladores (SIACC e SimDeCS), banco de imagens médicas, banco de dados e plataformas. Os simuladores foram validados em duas oficinas de formação de professores, e os resultados de um questionário aplicado foram analisados, comparando os dois sistemas e demonstrando os aspectos positivos e os que devem ser melhorados para que possam ser utilizados em sala de aula. Os aspectos estruturantes provêm do estudo de diversas plataformas para disponibilizar os simuladores de paciente virtual. O modelo foi concluído e validado em suas partes no decorrer da pesquisaação e deverá ser validado na sua completude junto a uma faculdade de Medicina. / This work has as its objective proposing a model for the use of technological tools (especially simulators of clinical cases) as mediators of the implementing process of active methods of learning in the Medicine Teaching. The applied methodology is the research-action one, where the researcher is an active member of the action and at the same time, from the observed reality, searches in the research, solutions to the problems found. A theoretical study about active methods of learning, with emphasis on the learning based on problems and problematization, it is presented throughout the work, followed with a systematic review about the using of simulators in the Medicine Teaching. The proposed model is composed by four pillar bases: methodological, organizational, technological and structural. The methodological pillars were obtained by means of theoretical study about active methods of learning. The organizational pillars come from the systematical review. As for the technological aspects, these ones were developed embracing simulators (SIACC and SimDeCS), medical images bank, data bank and platforms. The simulators were validated in two workshops of teachers’ formation and the results of an applied questionnaire were analyzed, comparing the two systems, displaying the positive aspects and the ones that must be improved to be used in the classroom. The structural aspects come from the study of several platforms to release the simulators of virtual patient. The model was concluded and validated in parts throughout the research-action and it must be validated in its complete in a Medicine Faculty.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objetivo: desenvolver e avaliar a ferramenta do paciente virtual, PharmaVP Software, no ensino de competências para a prática da Atenção Farmacêutica (AtenFar). Métodos: Inicialmente, foi realizado um estudo quasi-experimental, longitudinal e prospectivo, no qual foi avaliado o impacto de um programa piloto de AtenFar nos resultados clínicos e na qualidade de vida de pacientes reais com Diabetes Mellitus tipo 2 (DM), no período de fevereiro a novembro de 2009. A amostra deste estudo foi obtida por conveniência, composta por idosos com faixa etária entre 60 e 75 anos, de ambos os gêneros. Neste estudo, foram avaliados os dados sócio-demográficos, farmacoterapêuticos e clínicos (Hemoglobina Glicosilada HbA1c, Glicemia Capilar, Pressão Arterial PA, Índice de Massa Corporal IMC, e Circunferência da Cintura) dos pacientes. A avaliação da qualidade de vida foi realizada por um instrumento genérico denominado Medical Outcomes Studies 36 - item Short Form - SF36®. Logo após, com base no banco de dados obtidos do programa piloto de AtenFar, foram realizados dois estudos de desenvolvimento metodológico, no período de fevereiro de 2010 a dezembro de 2012: desenvolvimento do sistema piloto e da segunda versão do Software PharmaVP. O software foi aplicado na população de estudantes da disciplina de AtenFar do Curso de Farmácia da Universidade Federal de Sergipe - Brasil e avaliado quanti-qualitativamente pelos desenvolvedores, mentores e usuários do sistema, por meio de instrumentos baseados na literatura. Resultados: No total, 34 pacientes completaram o programa de Atenfar. A média de idade dos idosos foi 65.94 ± 4,73 anos. Houve diferença significativa das medidas de HbA1c, Glicemia Capilar, PA (sistólica e diastólica) e Circunferência da Cintura, antes depois das intervenções farmacêuticas (p < 0,05). Seis dos oito domínios da qualidade de vida tiveram diferença significativa entre a linha de base e avaliação final. Somados, o sistema piloto e a segunda versão do PharmaVP Software foram desenvolvidos e avaliados no período de 20 meses e 63 estudantes utilizaram o software. Após as avaliações, a funcionalidade, confiabilidade e usabilidade do sistema piloto obtiveram resultados satisfatórios. No entanto, a eficiência, manutenibilidade e portabilidade apresentou necessidade de ajustes. Na avaliação da satisfação do software piloto, os estudantes concordaram que a experiência foi fundamental para o aprendizado da AtenFar. Após a avaliação da segunda versão do PharmaVP Software, o sistema mostrou-se funcional, operacional, atrativo, eficaz, produtivo e satisfatório. Além disso, demonstrou resultados positivos quanto à aceitação, o uso e o aprendizado dos estudantes. Esses resultados foram corroborados pelos depoimentos dos estudantes obtidos na análise qualitativa. Conclusão: o programa piloto de AtenFar apresentou impacto positivo nos resultados clínicos e humanísticos do grupo de idosos portadores de DM e serviu de base para a elaboração da ferramenta educativa do pacientes virtual. O PharmaVP Software foi desenvolvido e avaliado satisfatoriamente e demonstrou que pode ser um método efetivo e complementar para o desenvolvimento das competências necessárias para a prática da AtenFar.

L’observance, qui décrit à quel degré le patient suit la prescription, est un facteur essentiel pour que le traitement réussisse. Les observances des patients varient beaucoup et l’efficacité du médicament varie parallèlement. Par conséquent, il faut avoir des paramètres sensibles et fiables pour mesurer l’observance. Dans la littérature, on trouve beaucoup de paramètres pour évaluer l’observance mais leurs avantages, limites et inconvénients, en ce qui concerne l’évaluation de l’impact de l’observance sur les effets des médicaments n’ont pas encore été étudiés en profondeur. L’évaluation de ces paramètres nécessite de les tester dans différentes situations. Comme les données disponibles sur l’observance ne concernent pas un ensemble exhaustif de situations, le recours à la simulation, en s’inspirant des cas réels ou plausibles, est très pertinent. On a ainsi réussi à développer un modèle dont les paramètres sont simples et compréhensibles et qui est pratique et flexible pour simuler les différents cas et même les cas extrêmes de l’observance. On a proposé de nouveaux paramètres pour mesurer l’impact biopharmaceutique de l’observance. Ensuite, on a comparé la performance, en termes de sensibilité et la fiabilité, des paramètres proposés et celles de paramètres déjà utilisés. En conclusion, on peut souligner qu’il n’y a pas de paramètre parfait étant donné que chacun a ses propres limites. Par exemple, pour les médicaments dont les effets sont directement liés aux leurs concentrations plasmatiques, le pourcentage des doses prises, qui est le paramètre le plus utilisé, offre la pire performance; par contre, le pourcentage des doses correctes nettes qui est un nouveau paramètre possède une bonne performance et des avantages prometteurs. / Compliance, which refers to the degree of the conformity to the prescription, is an essential factor for a successful treatment. The compliances of patients vary widely and the effectiveness of medication varies in parallel. Therefore, we need to have reliable and sensible parameters to measure it. In literature, there are many parameters to describe it, but their advantages, disadvantages and limitations regarding the assessment of the impact of compliance on drug have not yet been studied in depth. The evaluation of these parameters requires testing them in different situations. As available compliance data are not exhaustive, the use of the simulation, based on real or plausible cases, is very relevant. We succeeded to develop a model whose parameters are simple and understandable and which is convenient and flexible to simulate the different cases and even the extreme cases of compliance. We proposed new parameters for measuring the biopharmaceutical impact of compliance. Then, we compared the performance, in terms of sensibility and reliability, of these parameters and those already used to assess compliance and discussed their performances and limitations. In conclusion, we can emphasize that there is no ideal parameter since each one has its own limitations. For example, for drugs whose effects are directly related to their plasma concentrations, the percentage of taken doses, which is the most used parameter, has the worst performance, on the other hand, the percentage of the weighted correct doses, which is a new parameter, possesses a good performance and promising advantages.

No description available.

L’observance, qui décrit à quel degré le patient suit la prescription, est un facteur essentiel pour que le traitement réussisse. Les observances des patients varient beaucoup et l’efficacité du médicament varie parallèlement. Par conséquent, il faut avoir des paramètres sensibles et fiables pour mesurer l’observance. Dans la littérature, on trouve beaucoup de paramètres pour évaluer l’observance mais leurs avantages, limites et inconvénients, en ce qui concerne l’évaluation de l’impact de l’observance sur les effets des médicaments n’ont pas encore été étudiés en profondeur. L’évaluation de ces paramètres nécessite de les tester dans différentes situations. Comme les données disponibles sur l’observance ne concernent pas un ensemble exhaustif de situations, le recours à la simulation, en s’inspirant des cas réels ou plausibles, est très pertinent. On a ainsi réussi à développer un modèle dont les paramètres sont simples et compréhensibles et qui est pratique et flexible pour simuler les différents cas et même les cas extrêmes de l’observance. On a proposé de nouveaux paramètres pour mesurer l’impact biopharmaceutique de l’observance. Ensuite, on a comparé la performance, en termes de sensibilité et la fiabilité, des paramètres proposés et celles de paramètres déjà utilisés. En conclusion, on peut souligner qu’il n’y a pas de paramètre parfait étant donné que chacun a ses propres limites. Par exemple, pour les médicaments dont les effets sont directement liés aux leurs concentrations plasmatiques, le pourcentage des doses prises, qui est le paramètre le plus utilisé, offre la pire performance; par contre, le pourcentage des doses correctes nettes qui est un nouveau paramètre possède une bonne performance et des avantages prometteurs. / Compliance, which refers to the degree of the conformity to the prescription, is an essential factor for a successful treatment. The compliances of patients vary widely and the effectiveness of medication varies in parallel. Therefore, we need to have reliable and sensible parameters to measure it. In literature, there are many parameters to describe it, but their advantages, disadvantages and limitations regarding the assessment of the impact of compliance on drug have not yet been studied in depth. The evaluation of these parameters requires testing them in different situations. As available compliance data are not exhaustive, the use of the simulation, based on real or plausible cases, is very relevant. We succeeded to develop a model whose parameters are simple and understandable and which is convenient and flexible to simulate the different cases and even the extreme cases of compliance. We proposed new parameters for measuring the biopharmaceutical impact of compliance. Then, we compared the performance, in terms of sensibility and reliability, of these parameters and those already used to assess compliance and discussed their performances and limitations. In conclusion, we can emphasize that there is no ideal parameter since each one has its own limitations. For example, for drugs whose effects are directly related to their plasma concentrations, the percentage of taken doses, which is the most used parameter, has the worst performance, on the other hand, the percentage of the weighted correct doses, which is a new parameter, possesses a good performance and promising advantages.

Rationale: Audiology student training in New Zealand faces many difficulties with a limited number of qualified instructors and suitable external placements. With a continued shortage of audiologists in New Zealand, new methods of training need to be introduced and implemented. One solution is through the use of realistic, computer-based virtual patient simulators (VPS). HIT Lab New Zealand in conjunction with the University of Canterbury has designed a VPS for New Zealand audiology students. A speech audiometry component is to be developed based on best practice recommendations, and needs to be validated. Method: Two studies, one with 18 Master of Audiology (“expert”) and another with 18 (“novice”) undergraduate students, were evenly divided into simulator and non-simulator user groups. Simulator users had to complete 5 virtual patient cases in addition to the non-simulator users’ requirement to refer to provided lecture notes and speech audiometry protocols. Novice students were assessed on declarative, procedural and retained knowledge of speech audiometry; expert students were additionally assessed on training transfer. The intervention period was set at two weeks, and the retention assessment at four weeks post-intervention.   Results: Expert students who used the simulator significantly improved their training transfer skills. No significant differences were found between and within groups for declarative knowledge and procedural knowledge. Training transfer and procedural knowledge were retained for both groups, but only non-simulator users retained declarative knowledge. Novice students who used the simulator significantly increased their declarative knowledge. Both groups’ procedural knowledge significantly regressed post-intervention. Declarative and procedural knowledge were retained for both groups. Implications: Simulator use appears to accelerate learning outcomes otherwise achievable through traditional learning methods, and does depend on the users’ existing knowledge base. Regular use may be necessary to retain desired learning outcomes. Improvements (e.g., more detailed feedback systems) are to be incorporated into the simulator, and sole reliance on the simulator for learning is not recommended. Future research into more holistic aspects of virtual patient use within the field of audiology and allied health care is warranted.