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Purpose: Compassion is central to health care. Efforts to promote compassion through educational interventions for health professionals show promise, yet such education has not gained widespread dissemination. Adapting compassion education through technology-enhanced learning may provide an opportunity to enhance the scale and spread of compassion education. However, challenges are inherent in translating such curricula for online delivery. In this study, the authors explored how technology influences the delivery of compassion education for health professionals., Method: Using constructivist grounded theory methodology, the authors conducted semistructured interviews with 13 participants from across Ontario, Canada, from March to October 2019. The sample consisted of individuals who had experience with the design and evaluation of compassion education for health professionals. The interviews were coded and inductively analyzed to identify pertinent themes using constant comparative analysis. The study originated at the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada., Results: Participants provided a range of responses regarding technology and compassion education. While participants revealed concerns about the constraints of technology on human interaction, they also described technology as both inevitable and necessary for the delivery of future compassionate care curricula. Participants also shared ways in which technology may enhance compassion education for health professionals by increasing accessibility and learner comfort with vulnerability. Addressing technological ambivalence, improving facilitation, and maintaining a balance between face-to-face instruction and technology-enhanced learning were identified as elements that could advance compassion education into the future., Conclusions: Compassion education can be enhanced by technology; however, evidence-informed adaptation may require deliberate efforts to maintain some level of face-to-face interaction to ensure that technology does not erode human connection. Further research is required to address the uncertainties surrounding technology and compassion education as identified by participants. These findings provide educators with guidance for adapting compassionate care curricula into a digital domain., (Copyright © 2021 by the Association of American Medical Colleges.)

This article reviews current technologies in nursing education and the impact of technology on learning. The integration of technology into nursing curricula is thought to improve efficiency and enhance student experiences through active learning and interactive learning designs. The following focused questions are explored: (1) What are the current technologies used by university students and faculty in nursing programs? (2) How does that technology influence student learning? The primary themes were student-centered technology, with five subthemes, and faculty-centered technology. Consumers of healthcare (patients) demand quality care and expect highly skilled, compassionate, ethical practitioners; to this end, training and education of future nurses by skilled, qualified nurse educators who are comfortable with technological demands of all aspects of healthcare are fundamental. While it is essential that nurses and nurse educators continue to publish as a mechanism for open discussion and transparency in our teaching and learning approaches, we need higher levels of evidence to strengthen the argument that technology improves the learning environment and student outcomes and has a positive impact on clinical settings and patient care.

Background: Beginning reading skills are often taught using phonics. Research has demonstrated the effectiveness of phonics with typically developing students, but less research has evaluated this method with students with intellectual disabilities., Method: This paper evaluated the computerized phonics-based intervention Headsprout Early Reading ® with eight students aged 7-19 years with severe intellectual disability. Six children were verbal, two were non-verbal. Four students completed Headsprout as it was designed for typically developing children, and four students accessed two adapted version of the intervention. Additional table-top teaching was used to support the intervention for some participants., Results: Verbal students improved in initial sound fluency, nonsense word reading, and word recognition, but did not show improvements in phonemic segmentation, regardless of whether or not they accessed the original or adapted intervention., Conclusions: The findings suggest that Headsprout Early Reading can be used to support the development of reading skills for students with intellectual disability., (© 2019 John Wiley & Sons Ltd.)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Background: Competent cardiac auscultation is a declining skill. Digital stethoscopes and hand-held echocardiography (HHE) are modern devices which may improve the accuracy of heart murmur recognition and diagnosis. Their incremental value compared to conventional examination has not been evaluated in depth., Objectives: Our aim was to quantify the utility of digital stethoscopes and HHE as teaching aids to improve medical students' diagnostic accuracy in the evaluation of heart murmurs using a novel clinically weighted scoring system., Design: This pilot study involved eight medical students and eight patients with heart murmurs. Four patients were examined at 2 sessions, 1 week apart. Medical students were randomised into two groups: the 'intervention group' examined patients with a standard and digital stethoscope, and then received demonstration of the valvular lesion with HHE to illustrate the diagnosis. The 'control group' used a standard stethoscope only and were taught using traditional methods. Students' scores were compared to a 'gold standard' derived from a consensus of auscultation findings of three cardiologists., Results: Overall the mean percent correct of total possible score was 65.4% (SD8.4). Using a mixed models ANOVA approach to repeated measures, the mean [95% CI] increase from training to validation period for the control group was 2.5% [-11.5, 16.5] P (Tukey)  = 0.95 and 15.8% [1.7,29.8] P (Tukey)  = 0.027 for the intervention group. Between the validation and training sessions for both groups, there was an increase of 9.1% [1.82, 16.4] in scores (p = 0.018). The mean [95% CI] difference in scores of the control and intervention groups was 1.9% [-5.4, 9.2] (p = 0.59). The Cohen's effect size estimate was 0.9., Conclusion: Digital stethoscopes and hand-held echo may be useful devices for teaching cardiac auscultation. This pilot study provides a novel study design, a heart murmur grading system, and data that will help develop definitive studies to assess new teaching techniques for cardiac auscultation using digital technology.

Vaccinations are an important and effective cornerstone of preventive medical care. Growing technologic capabilities and use by both patients and providers present critical opportunities to leverage these tools to improve vaccination rates and public health. We propose the Social Ecological Model as a useful theoretical framework to identify areas in which technology has been or may be leveraged to target undervaccination across the individual, interpersonal, organizational, community, and society levels and the ways in which these levels interact.

Background: A major issue regarding the implementation of blended learning for preregistration health programmes is the analysis of students' perceptions and attitudes towards their learning. It is the extent of the embedding of Technology Enhanced Learning (TEL) into the higher education curriculum that makes this analysis so vital., Objectives: This paper reports on the quantitative results of a UK based study that was set up to respond to the apparent disconnect between technology enhanced education provision and reliable student evaluation of this mode of learning., Design: Employing a mixed methods research design, the research described here was carried to develop a reliable and valid evaluation tool to measure acceptability of and satisfaction with a blended learning approach, specifically designed for a preregistration midwifery module offered at level 4., Methods: Feasibility testing of 46 completed blended learning evaluation questionnaires - Student Midwife Evaluation of Online Learning Effectiveness (SMEOLE) - using descriptive statistics, reliability and internal consistency tests., Results: Standard deviations and mean scores all followed predicted pattern. Results from the reliability and internal consistency testing confirm the feasibility of SMEOLE as an effective tool for measuring student satisfaction with a blended learning approach to preregistration learning., Conclusions: The analysis presented in this paper suggests that we have been successful in our aim to produce an evaluation tool capable of assessing the quality of technology enhanced, University level learning in Midwifery. This work can provide future benchmarking against which midwifery, and other health, blended learning curriculum planning could be structured and evaluated., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Nursing education is facing challenges and a shift in paradigm within the nursing classroom. Educators need to explore innovative strategies that engage students. Clickers are one tool that can enhance participation, protect anonymity, and promote learning of concepts., Methods/data Sources: This mixed methods study evaluated nursing student's perceptions of clicker technology during lecture. This study uses a 9-item questionnaire to explore perceived levels of student perception of the technology of clickers in a nursing classroom., Participants: The sample consisted of ninety-nine sophomore and senior level nursing students. Participants were recruited using convenience sampling., Results: Ninety-one percent of the students agreed or strongly agreed that the use of clickers helped them to develop a better understanding of the subject matter when compared to traditional lecture based class., Conclusion: The findings portray a positive correlation of learning and an enhanced pedagogical approach for nursing students., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: to identify in the scientific literature the educational technologies used in the health education process related to stroke., Method: integrative review, whose eligibility criteria of the articles were: match the keywords "health education" and "stroke"; be a research paper; be in Portuguese, English and Spanish; be available electronically in the databases LILACS, PubMed/Medline, Scopus and CINAHL; year of publication between 2000 and 2016., Results: 24 publications were found. The analysis was carried out by means of analytical and interpretive readings. There were many educational technologies used in the health education process for stroke., Final Considerations: the printed material for general public stood out, aiming to the recognition of alert signs of the disease and the emergency decision-making before suspicious cases of the disease.

Objective: to assess available evidence on educational technologies and practices for prevention of vertical HIV transmission., Method: LILACS, PubMed, Scopus, BDENF, between April and May 2016, with the descriptors: "Vertical Transmission of Infectious Disease", "HIV", "Health Education" and "Technology"., Results: there are 16 articles published between 2000 and 2014, mostly Brazilian and African, Cross-sectional and with low level of evidence. The studies covered the use of hard technologies, through video, radio and telephone, and soft, emphasizing, in particular, counseling., Conclusion: the studies recognize the importance of educational activities as a tool for health promotion in the context of vertical HIV transmission, despite reporting the need for constant training of professionals and urgency in the renewal of educational concepts and practices. Therefore, it is recommended to expand and consolidate health counseling and emphasize the role of nurses as an important actor in this setting.

The book publishing industry is going through radical transformations that are driven by recent developments in information systems (IS). E-books are merely one of these developments. Notwithstanding the projections in the growth of e-book use, producers of these products contend with the issue of building user retention and loyalty through continued use. Extending the technology acceptance model (TAM), this study examined the impact of factors of perceived usefulness, perceived ease of use, social influence, and facilitating conditions on e-book continuance intention among users. The subjects of this study were 317 students from five higher institutions of learning in South Africa. Empirical testing of the research model was carried out using structural equation modeling. The results indicate that 42 percent of the variance in e-book users' continuance intention is explained by perceived usefulness, perceived ease of use, and social influence. Interestingly, facilitating conditions have an influence, although indirectly, through perceived usefulness, perceived ease of use, and social influence. The study not only contributes to the existing IS literature by extending the TAM to explain continuance intention in the e-book IS domain in a developing country but also makes recommendations to practitioners who attempt to foster continuous use of this technology.

Objective: To investigate the effects of spectral overlays on reading performance of Brazilian elementary school children., Methods: Sixty-eight children (aged 9-12 years) enrolled in the 5th and 6th grade were included in the study. The Rate of Reading Test (RRT - Brazilian Portuguese version) was used to evaluate reading speed and the Irlen Reading Perceptual Scale was used to allocate the sample according to reading difficulty/discomfort symptoms and to define the optimal spectral overlays., Results: A total of 13% of the children presented an improvement of at least 15% in reading speed with the use of spectral overlays. Pupils with severe reading difficulties tended to have more improvement in RRT with spectral overlays. Children with severe reading discomfort obtained the highest gains in RRT, with an average of 9.6% improvement with intervention, compared to a decrease of -8.2% in the control group. Participants with severe discomfort had an odds ratio of 3.36 to improve reading speed with intervention compared to the control group., Conclusion: The use of spectral overlays can improve reading performance, particularly in those children with severe visual discomfort., (© 2018 S. Karger AG, Basel.)

Aim: The aim of this study was to investigate the differences in the performance and appreciation of students working in a virtual learning environment with two (2D)- or three (3D)-dimensional vision., Material and Methods: One hundred and twenty-four randomly divided first-year dental students performed a manual dexterity exercise on the Simodont dental trainer with an automatic assessment. Group 1 practised in 2D vision and Group 2 in 3D. All of the students practised five times for 45 min and then took a test using the vision they had practised in. After test 1, all of the students switched the type of vision to control for the learning curve: Group 1 practised in 3D and took a test in 3D, whilst Group 2 practised in 2D and took the test in 2D. To pass, three of five exercises had to be successfully completed within a time limit. The students filled out a questionnaire after completing test 2., Results: The results show that students working with 3D vision achieved significantly better results than students who worked in 2D. Ninety-five per cent of the students filled out the questionnaire, and over 90 per cent preferred 3D vision., Conclusion: The use of 3D vision in a virtual learning environment has a significant positive effect on the performance of the students as well as on their appreciation of the environment., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To evaluate the efficacy of robotic-driven handheld laparoscopic instruments for the acquisition and improvement of basic laparoscopic suturing skills., Study Design: A prospective study was carried out on 15 physicians grouped by previous experience. They were evaluated on the completion of basic surgical laparoscopic skills. First, they used traditional non-articulating laparoscopic instruments, and later they used robotic-driven articulating instruments., Results: Significant time reduction was observed in the group of inexperienced physicians when they used robotic-driven instruments for needle loading and placing stitches. An 8.3% time reduction was observed in the same group when considering total times for the completion of all exercises. No significant differences for the experienced groups were found., Conclusions: Robotic-driven handheld instruments could help inexperienced physicians acquire basic skills in laparoscopic techniques. No benefit has been observed when previous laparoscopic experience is present., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The purpose of this study is to describe the construction method of a cost-effective, easy-to-make hemostasis simulator and to compare its effectiveness as a training tool to cadaver training. The simulator is made of materials commonly found in hospitals and clinics. These include a column manometer, a 500-ml saline bag, two intravenous fluid lines, a three-way stopcock, and a 6-mm-diameter Penrose drain. The device was tested on 10 final-year veterinary students. All participants tied 40 knots on the simulator and 40 knots on equine jejunal arteries sourced from a local abattoir. They were then asked to fill out a questionnaire comparing both methods. Participants assigned an overall assessment median score of 8.5/10 to the simulator and of 6.2/10 to cadaver practice. The simulator provided reliable haptic feedback, giving trainees a lifelike feel very close to that experienced when actually closing a blood vessel. In addition, it was effective in objectively evaluating students' ability to place ligatures on vessels. After adequate training, students' skills had significantly improved, alongside their confidence in placing hemostatic sutures. This proves our model is also useful in teaching basic open-surgery skills. Finally, its low production cost makes it ideally suited for self-practice.

Initially the aim of this article was to discuss and define aging at the intersection point between biology and sociology. However, recent biomedical and technological advances are changing the discourse on aging, and against this background the author of this article argues that current definitions of aging should be improved. The author emphasizes that there is a need to update current definitions of aging, or to formulate new multidisciplinary ones. The author suggests that (besides biology, psychology and sociology) the technological discipline should be included in the integrative gerontology model. Finally, in this article a new definition of aging is put forward. According to the author of this article, human bio-techno-social aging is characterized by: (a) a time-bound process of change including, (b) both reversible and irreversible biological processes, (c) social processes forming an irreversible chain of events, and (d) an increasing use of technological artifacts whose purpose is to support or replace damaged biological functions; and/or an increasing use of technological artifacts whose purpose is to facilitate or enable interaction., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: Currently, a 'pedagogical gap' exists in distributed medical education in that distance educators teach medical students but typically do not have the opportunity to assess them in large-scale examinations such as the objective structured clinical examination (OSCE). We developed a remote examiner OSCE (reOSCE) that was integrated into a traditional OSCE to establish whether remote examination technology may be used to bridge this gap. The purpose of this study was to explore whether remote physician-examiners can replace on-site physician-examiners in an OSCE, and to determine the feasibility of this new examination method., Methods: Forty Year 3 medical students were randomised into six reOSCE stations that were incorporated into two tracks of a 10-station traditional OSCE. For the reOSCE stations, student performance was assessed by both a local examiner (LE) in the room and a remote examiner (RE) who viewed the OSCE encounters from a distance. The primary endpoint was the correlation of scores between LEs and REs across all reOSCE stations. The secondary endpoint was a post-OSCE survey of both REs and students., Results: Statistically significant correlations were found between LE and RE checklist scores for history taking (r = 0.64-r = 0.80), physical examination (r = 0.41-r = 0.54), and management stations (r = 0.78). Correlations between LE and RE global ratings were more varied (r = 0.21-r = 0.77). Correlations on three of the six stations reached significance. Qualitative analysis of feedback from REs and students showed high acceptance of the reOSCE despite technological issues., Conclusions: This preliminary study demonstrated that OSCE ratings by LEs and REs were reasonably comparable when using checklists. Remote examination may be a feasible and acceptable way of assessing students' clinical skills, but further validity evidence will be required before it can be recommended for use in high-stakes examinations., (© 2014 John Wiley & Sons Ltd.)

Objective: Interactive educational tools are thought to convey material effectively. Audience Response Systems (ARSs), in particular, have been shown to improve written test scores in several residency fields but have not been previously reported in psychiatry. Such an approach may prove a valuable tool in improving test performance and medical knowledge., Methods: Psychiatry residents were required to attend 12 90-min review sessions throughout the summer that utilized previous Psychiatry Residency In-Training Exam (PRITE) questions and an ARS to provide immediate feedback and a stimulus for discussion. Preparation for these sessions was either unsupervised (phase I) or involved a personalized reading program for residents who scored below the 50th percentile. Data were evaluated with ANOVA and unpaired 2-tail tests., Results: Overall performance on the PRITE examination improved significantly as compared to pre-intervention controls (change in score 17.0 ± SD 16.6 vs 6.4 ± 12.6, P = 0.0068). The addition of a personalized reading program did not improve raw score performance significantly beyond the improvement seen with ARS alone but did slightly improve percentile rank and STD score., Conclusions: Utilization of the interactive ARS may improve performance on PRITE examination for residents.

The purpose of this report is to describe the general use of clickers as an active learning tool and how they were used in teaching a combined periodontology course for second-year dental and junior dental hygiene students. A survey was used to capture student perceptions following completion of the course. Specific domains were active learning, improved performance, and expectations. The survey response rate was 94.5 percent (121/128). Descriptive analyses showed that, in the domain of active learning, 102 (84.3 percent) agreed/strongly agreed that the use of clickers made the lectures more interactive; sixty-six (54.5 percent) agreed/strongly agreed that the clickers made them focus; and ninety-two (76 percent) agreed/strongly agreed that the clickers encouraged active participation. In the domain regarding improved performance, sixty-three (52 percent) agreed/ strongly agreed that the review sessions utilizing clickers helped them prepare for tests. In the domain of expectations, ninety-three (76.9 percent) had a better idea of what to expect on the examination due to the use of clickers, and seventy-three (60.3 percent) thought that the clickers should be used in future semesters for this class. In addition, faculty members appreciated the greater participation afforded through the use of clickers to obtain a better understanding of the students' grasp of course content. Learning theory suggests that students must actively engage in the learning process in order for meaningful learning in the form of critical thinking and problem-solving to take place. In this study, students confirmed that the use of clicker technology encouraged their active participation in a periodontology course.

Unlabelled: Audience Response Systems (ARS or "clickers") are becoming a popular addition to the college classroom. Instructors are using this educational technology to elicit feedback from students, to determine students' knowledge of content before or during lectures, and to increase participation in the classroom. The purpose of this study was to examine first-year allied health students' perceptions of the impact of clickers on participation during an introductory health professions course., Method: At the mid-point of the course, students completed a survey that assessed their perception of classroom participation. During the second half of the course, clickers were introduced to classroom activities. The survey was re-administered at the end of the course; students also had the opportunity to write a narrative comment., Results: Students felt that clickers increased their level of interaction with the instructor and participation of the class as a whole., Conclusion: Clickers may be a practical way to increase student participation in first-year allied health courses.

Virtual reality dental training simulators, unlike traditional human-based assessment, have the potential to enable consistent and reliable assessment. The purpose of this study was to determine whether a haptic simulator (IDEA Dental(®) ) could provide a reliable and valid assessment of manual dexterity. A total of 106 participants were divided into three groups differing in dental manual dexterity experience: (i) 63 dental students, (ii) 28 dentists, (iii) 14 non-dentists. The groups, which were expected to display various performance levels, were required to perform virtual drilling tasks in different geometric shapes. The following task parameters were registered: (i) Time to completion (ii) accuracy (iii) number of trials to successful completion and (iv) score provided by the simulator. The reliability of the tasks was calculated for each parameter. The simulator and its scoring algorithm showed high reliability in all the parameters measured. The simulator was able to differentiate between non-professionals and dental students or non-professionals and dentists. Our study suggests that for improved construct validity, shorter working times and more difficult tasks should be introduced. The device should also be designed to provide greater sensitivity in measuring the accuracy of the task., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The Fundamentals of Laparoscopic Surgery (FLS) trainer box is now established as a standard for evaluating minimally invasive surgical skills. A particularly simple task in this trainer box is the peg transfer task which is aimed at testing the surgeon's bimanual dexterity, hand-eye coordination, speed, and precision. The Virtual Basic Laparoscopic Skill Trainer (VBLaST) is a virtual version of the FLS tasks which allows automatic scoring and real-time, subjective quantification of performance without the need of a human proctor. In this article we report validation studies of the VBLaST peg transfer (VBLaST-PT) simulator., Methods: Thirty-five subjects with medical background were divided into two groups: experts (PGY 4-5, fellows, and practicing surgeons) and novices (PGY 1-3). The subjects were asked to perform the peg transfer task on both the FLS trainer box and the VBLaST-PT simulator; their performance was evaluated based on established metrics of error and time. A new length of trajectory (LOT) metric has also been introduced for offline analysis. A questionnaire was used to rate the realism of the virtual system on a 5-point Likert scale., Results: Preliminary face validation of the VBLaST-PT with 34 subjects rated on a 5-point Likert scale questionnaire revealed high scores for all aspects of simulation, with 3.53 being the lowest mean score across all questions. A two-tailed Mann-Whitney test performed on the total scores showed significant (p = 0.001) difference between the groups. A similar test performed on the task time (p = 0.002) and the LOT (p = 0.004) separately showed statistically significant differences between the experts and the novices (p < 0.05). The experts appear to be traversing shorter overall trajectories in less time than the novices., Conclusion: VBLaST-PT showed both face and construct validity and has promise as a substitute for the FLS for training peg transfer skills.

Background: There is an increasing need for efficient training simulators to teach advanced laparoscopic skills beyond those imparted by a box trainer. In particular, force-based or haptic skills must be addressed in simulators, especially because a large percentage of surgical errors are caused by the over-application of force. In this work, the efficacy of a novel, salient haptic skills simulator is tested as a training tool for force-based laparoscopic skills., Methods: Thirty novices with no previous laparoscopic experience trained on the simulator using a pre-test-feedback-post-test experiment model. Ten participants were randomly assigned to each of the three salient haptic skills-grasping, probing, and sweeping-on the simulator. Performance was assessed by comparing force performance metrics before and after training on the simulator., Results: Data analysis indicated that absolute error decreased significantly for all three salient skills after training. Participants also generally decreased applied forces after training, especially at lower force levels. Overall, standard deviations also decreased after training, suggesting that participants improved their variability of applied forces., Conclusions: The novel, salient haptic skills simulator improved the precision and accuracy of participants when applying forces with the simulator. These results suggest that the simulator may be a viable tool for laparoscopic force skill training. However, further work must be undertaken to establish full validity. Nevertheless, this work presents important results toward addressing simulator-based force-skills training specifically and surgical skills training in general.

Background: In the Peg Transfer task in the Fundamentals of Laparoscopic Surgery (FLS) curriculum, six peg objects are sequentially transferred in a bimanual fashion using laparoscopic instruments across a pegboard and back. There are over 268 trillion ways of completing this task. In the setting of many possibilities, the traveling salesman problem is one where the objective is to solve for the shortest distance traveled through a fixed number of points. The goal of this study is to apply the traveling salesman problem to find the shortest two-dimensional path length for this task., Methods: A database platform was used with permutation application output to generate all of the single-direction solutions of the FLS Peg Transfer task. A brute-force search was performed using nested Boolean operators and database equations to calculate the overall two-dimensional distances for the efficient and inefficient solutions. The solutions were found by evaluating peg object transfer distances and distances between transfers for the nondominant and dominant hands., Results: For the 518,400 unique single-direction permutations, the mean total two-dimensional peg object travel distance was 33.3 ± 1.4 cm. The range in distances was from 30.3 to 36.5 cm. There were 1,440 (0.28 %) of 518,400 efficient solutions with the minimized peg object travel distance of 30.3 cm. There were 8 (0.0015 %) of 518,400 solutions in the final solution set that minimized the distance of peg object transfer and minimized the distance traveled between peg transfers. Peg objects moved 12.7 cm (17.4 %) less in the efficient solutions compared to the inefficient solutions., Conclusions: The traveling salesman problem can be applied to find efficient solutions for surgical tasks. The eight solutions to the FLS Peg Transfer task are important for any examinee taking the FLS curriculum and for certification by the American Board of Surgery.

Advances in digital technologies are dramatically altering the texts and tools available to teachers and students. These technological advances have created excitement among many for their potential to be used as instructional tools for literacy education. Yet with the promise of these advances come issues that can exacerbate the literacy challenges identified in the other articles in this issue. In this article Gina Biancarosa and Gina Griffiths characterize how literacy demands have changed in the digital age and how challenges identified in other articles in the issue intersect with these new demands. Rather than seeing technology as something to be fit into an already crowded education agenda, Biancarosa and Griffiths argue that technology can be conceptualized as affording tools that teachers can deploy in their quest to create young readers who possess the higher levels of literacy skills and background knowledge demanded by today's information-based society. Biancarosa and Griffiths draw on research to highlight some of the ways technology has been used to build the skills and knowledge needed both by children who are learning to read and by those who have progressed to reading to learn. In their review of the research, Biancarosa and Griffiths focus on the hardware and software used to display and interface with digital text, or what they term e-reading technology. Drawing on studies of e-reading technology and computer technology more broadly, they also reflect on the very real, practical challenges to optimal use of e-reading technology. The authors conclude by presenting four recommendations to help schools and school systems meet some of the challenges that come with investing in e-reading technology: use only technologies that support Universal Design for Learning; choose evidence-based tools; provide technology users with systemic supports; and capitalize on the data capacities and volume of information that technology provides.

Objective: To explore whether laryngopharyngeal simulator teaching can improve the quality of clinical operation compared with traditional preclinical teaching program., Method: Sixty-five surgical interns were randomly divided into two groups. Experimental group was given traditional clinical practice together with simulator for laryngopharyngeal training, while control group received traditional clinical practice only. The teaching effect were compared through the operation assessment., Result: After simulation training, the performance of experimental group was superior to that of the control group, and the difference was statistically significant (P < 0.05)., Conclusion: Simulator can improve the quality of teaching. It is recommended for teaching hospital and doctor's training base and deserves further promotion.

To transform undergraduate biology education, faculty need to provide opportunities for students to engage in the process of science. The rise of research approaches using next-generation (NextGen) sequencing has been impressive, but incorporation of such approaches into the undergraduate curriculum remains a major challenge. In this paper, we report proceedings of a National Science Foundation-funded workshop held July 11-14, 2011, at Juniata College. The purpose of the workshop was to develop a regional research coordination network for undergraduate biology education (RCN/UBE). The network is collaborating with a genome-sequencing core facility located at Pennsylvania State University (University Park) to enable undergraduate students and faculty at small colleges to access state-of-the-art sequencing technology. We aim to create a database of references, protocols, and raw data related to NextGen sequencing, and to find innovative ways to reduce costs related to sequencing and bioinformatics analysis. It was agreed that our regional network for NextGen sequencing could operate more effectively if it were partnered with the Genome Consortium for Active Teaching (GCAT) as a new arm of that consortium, entitled GCAT-SEEK(quence). This step would also permit the approach to be replicated elsewhere.

Classroom response systems, or clickers, have become pedagogical staples of the undergraduate science curriculum at many universities. In this study, the effectiveness of clickers in promoting problem-solving skills in a genetics class was investigated. Students were presented with problems requiring application of concepts covered in lecture and were polled for the correct answer. A histogram of class responses was displayed, and students were encouraged to discuss the problem, which enabled them to better understand the correct answer. Students were then presented with a similar problem and were again polled. My results indicate that those students who were initially unable to solve the problem were then able to figure out how to solve similar types of problems through a combination of trial and error and class discussion. This was reflected in student performance on exams, where there was a statistically significant positive correlation between grades and the percentage of clicker questions answered. Interestingly, there was no clear correlation between exam grades and the percentage of clicker questions answered correctly. These results suggest that students who attempt to solve problems in class are better equipped to solve problems on exams.

Healthcare systems in aging societies need to find new solutions in the provision of care and treatment of older people. Gerotechnologies play a crucial role in the "aging-in-place" process. This article offers a critical overview of gerotechnological studies and will suggest a new approach in the study of the relationship between aging and technologies. Some trajectories of analysis and theoretical models are presented to underline the different perspectives in the discipline. Critical positions highlight the lack of theoretical analysis, mainly in relation to the complex social phenomenon of aging related to technology. Conclusions outline a relational approach to gerotechnologies: an analysis of the interactions between technological artifacts, users, and the context in which technologies are used. This approach expands the view from the technical potential of the technology to the way elderly people use technology, and suggests innovative care and cure strategies for aging., (© 2011 Blackwell Publishing Asia Pty Ltd.)

This article describes an undergraduate lab exercise that demonstrates the importance of students thinking critically about what they see through a microscope. The students are given growth data from tip-growing organisms that suggest the cells grow in a pulsatile manner. The students then critique this data in several exercises that incorporate aspects of a problem-based learning approach, envisaging growth not just in two dimensions, but in three dimensions. For some cells, what appears to be pulsatile growth could also be explained by growth at a constant rate up and down in the z-axis. Depending on the diffraction pattern generated by the tip of the cell, this movement in the z-axis could go undetected. This raises the possibility that pulsatile growth seen in some species may be an artifact generated by the limitations of the light microscope. Students were subsequently asked to rate their awareness of the need to think critically about what they see through a microscope, using a scale of 1 (unaware) to 5 (very much aware). Prior to doing the lab exercise, the mean rating was 2.7; this increased to 4.4 after the lab. The students also indicated a likelihood of being more critical in their thinking in other aspects of their biology curriculum.

Biology student mastery regarding the mechanisms of diffusion and osmosis is difficult to achieve. To monitor comprehension of these processes among students at a large public university, we developed and validated an 18-item Osmosis and Diffusion Conceptual Assessment (ODCA). This assessment includes two-tiered items, some adopted or modified from the previously published Diffusion and Osmosis Diagnostic Test (DODT) and some newly developed items. The ODCA, a validated instrument containing fewer items than the DODT and emphasizing different content areas within the realm of osmosis and diffusion, better aligns with our curriculum. Creation of the ODCA involved removal of six DODT item pairs, modification of another six DODT item pairs, and development of three new item pairs addressing basic osmosis and diffusion concepts. Responses to ODCA items testing the same concepts as the DODT were remarkably similar to responses to the DODT collected from students 15 yr earlier, suggesting that student mastery regarding the mechanisms of diffusion and osmosis remains elusive.

Learner participation and engagement has proven effective and essential across educational settings. Clickers, also known as classroom response systems (CRS), are widely used across disciplines, and their effectiveness has been demonstrated in higher education. However, few studies have been conducted on clicker use in nursing education. The purpose of this article is to examine the literature on how clickers can best be used to promote learner engagement among undergraduate nursing students and to better classroom education. This literature review addresses three key characteristics of clicker use in nursing, medical, pharmacy, and paramedic education found in fifteen empirical studies: interactivity and participation; satisfaction and learning outcomes; and formative assessment and contingent teaching. Nurse educators must take advantage of the latest technology such as clickers to provide more effective and efficient education., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The goal of this study was to explore whether the ability of precise mirror-inverted movements can be learned and improved with the device Mirroprep and whether practice success can be transferred to the clinical situation. Three groups of students at different levels of dental study and different achievement levels were asked to perform a drawing exercise with indirect vision using Mirroprep. Further, the group of most senior students were asked whether the motor skills learned with this device were helpful in clinical tooth preparations by use of the dental mirror. According to the test results, we were able to show that mirror-inverted motor functions can be learned and improved by practice and that it is also helpful for performing tooth preparations. Because of this, it is deemed reasonable for students to start practicing with the training device during their preclinical studies and to have their skills tested.

Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article describes one process in which a group of Geriatric Research, Education, and Clinical Center educators identified an area where important new information accrued, their development of a new clinical and teaching tool for imparting the new information, the initial dissemination of the tool to a preliminary target audience, and the initial evaluation of the new tool to determine how to improve its distribution and use beyond the original target audience.

The Department of Veterans Affairs (VA) has found distance education to be particularly valuable as a means to disseminate information to large numbers of busy learners in geographically diverse settings. Specifically, Geriatric Research, Education and Clinical Centers (GRECCs) of the VA have used various forms of distance learning to provide geriatrics-focused education to diverse health care providers. Such formats allow programs to be available to audiences regardless of distance or time. Although the distance-learning format has clear benefits, there are also some barriers that have hindered its wider adoption, including technical difficulties and ease of use. Organizers of distance education programs are challenged to overcome these barriers to provide a quality learning experience for the audience. The GRECCs will likely continue to be leaders in exploring innovative distance-learning strategies to accomplish their mission of quality geriatric education.

The technological complexity and richness of a child's environment today is far beyond what any adults today experienced when they were growing up. For example, no adult today knows what it is like to be a four-year-old using his or her first iPhone app or Webkinz account. Therefore, we seek ways to understand what children need in today's new technologies even without ourselves being children. Since 1999, young people ages seven to eleven have been the author's partners in codesigning new educational technologies at the University of Maryland's Human-Computer Interaction Lab. This work has helped inform who children are--what matters to them, what technologies need to be changed, and what needs to be built for the future. This work uses cooperative inquiry, a set of codesign methods that can enable adults and children to share their ideas while minimizing the differences in age and communication styles. This article describes low-tech methods for brainstorming, offering feedback, and supporting creative change in technology prototype designs. Examples of technologies are discussed and insights from children shared.

"Educational technology" is often equated in the popular imagination with "computers in the schools." But technology is much more than merely computers, and education is much more than mere schooling. The landscape of child-accessible technologies is blossoming in all sorts of directions: tools for communication, for physical construction and fabrication, and for human-computer interaction. These new systems and artifacts allow educational designers to think much more creatively about when and where learning takes place in children's lives, both within and outside the classroom.

Recent advances in technology are transforming our lives, but in many cases they are also limiting the way children are exposed to local communities and physical spaces. Technology can help young people actively connect with their neighborhoods, but doing that requires different methods and tools from the ones typically available in schools, homes, and youth centers. This article introduces a theoretical framework describing the technical and nontechnical elements that must be considered in the implementation of technology initiatives for youth participation and local community engagement. The article then describes the application of the framework in two multiyear initiatives.

Unlabelled: Authors have claimed that Internet-based instruction promotes greater learning efficiency than non-computer methods., Objectives: determine, through a systematic synthesis of evidence in health professions education, how Internet-based instruction compares with non-computer instruction in time spent learning, and what features of Internet-based instruction are associated with improved learning efficiency., Data Sources: we searched databases including MEDLINE, CINAHL, EMBASE, and ERIC from 1990 through November 2008. STUDY SELECTION AND DATA ABSTRACTION we included all studies quantifying learning time for Internet-based instruction for health professionals, compared with other instruction. Reviewers worked independently, in duplicate, to abstract information on interventions, outcomes, and study design., Results: we identified 20 eligible studies. Random effects meta-analysis of 8 studies comparing Internet-based with non-Internet instruction (positive numbers indicating Internet longer) revealed pooled effect size (ES) for time -0.10 (p = 0.63). Among comparisons of two Internet-based interventions, providing feedback adds time (ES 0.67, p =0.003, two studies), and greater interactivity generally takes longer (ES 0.25, p = 0.089, five studies). One study demonstrated that adapting to learner prior knowledge saves time without significantly affecting knowledge scores. Other studies revealed that audio narration, video clips, interactive models, and animations increase learning time but also facilitate higher knowledge and/or satisfaction. Across all studies, time correlated positively with knowledge outcomes (r = 0.53, p = 0.021)., Conclusions: on average, Internet-based instruction and non-computer instruction require similar time. Instructional strategies to enhance feedback and interactivity typically prolong learning time, but in many cases also enhance learning outcomes. Isolated examples suggest potential for improving efficiency in Internet-based instruction.

Objective: To determine if patients hospitalized for angioplasty could learn about symptoms, risk factors, and care-seeking behaviors before and after discharge and to assess patient acceptability of the intervention., Methods: Thirty-two women and 32 men were randomly assigned to groups and completed an intervention pretest. The experimental group viewed the Know & Go! slide presentation at baseline and 2 and 4 months after discharge. A satisfaction survey was mailed to patients in the experimental group., Results: There were no significant differences between groups in clinical or sociodemographic characteristics. The experimental group scored significantly higher on an intervention posttest at study completion (F = 15.21; P < .001). Patients were highly satisfied with the program and computer technology (range 0-12, M = 9.57 ± 1.83)., Conclusion: The Know & Go! intervention was safe, effective, and acceptable to patients in pilot testing. Results support refinement and further testing of the intervention for patients diagnosed with coronary heart disease., (Copyright © 2010 Elsevier Inc. All rights reserved.)