Produção Nacional
Revisado por pares
Formative online quiz on hemotherapy from blood physiology to transfusion medicine: a pilot study conducted with Brazilian medical students
2018; American Physical Society; Volume: 42; Issue: 4 Linguagem: Inglês
10.1152/advan.00079.2018
ISSN1522-1229
AutoresMarcella Martins de Vasconcelos Vaena, Luiz Anastácio Alves,
Tópico(s)Simulation-Based Education in Healthcare
ResumoIlluminationsFormative online quiz on hemotherapy from blood physiology to transfusion medicine: a pilot study conducted with Brazilian medical studentsMarcella Martins de Vasconcelos Vaena and Luiz Anastacio AlvesMarcella Martins de Vasconcelos VaenaCellular Communication Laboratory, Graduate Program in Education in Biosciences and Health, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil and Luiz Anastacio AlvesCellular Communication Laboratory, Graduate Program in Education in Biosciences and Health, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, BrazilPublished Online:10 Oct 2018https://doi.org/10.1152/advan.00079.2018MoreSectionsPDF (541 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat INTRODUCTIONThe use of internet-based games has become increasingly common as an educational strategy, and their effectiveness has been indicated in several studies (17, 18). In the health field, educational games have been applied to develop skills, define subject, and verify knowledge on certain themes (6). For the current student generation, digital natives who have grown accustomed to the internet, the use of educational tools that stimulate interactivity and autonomy in learning is important to motivate and maintain student interest (10, 20). In this context, in addition to the competences related to their area of expertise, teachers must also develop technological-digital competences that can facilitate the development of student knowledge (21).Quiz games consist of questions that assess student knowledge on a certain topic and function by applying the concept of formative feedback. In the educational context, this response aims to modify student thinking and behavior, leading to learning. Students receive feedback, so they can recognize their errors and seek to correct them, allowing for gradual knowledge building (22).Transfusion medicine is the medical specialty that uses blood transfusion, blood components, and derivatives as therapy. Blood transfusions are a widely applied procedure that can save lives (13). However, this method presents several patient risks, such as the possibility for the transmission of infectious diseases, transfusion reactions (7), and immunomodulation (5), and the inappropriate use of this therapy unnecessarily exposes patients to these risks.Several studies have pointed out a deficiency regarding medical knowledge in the transfusion medicine area and a need for the expansion and modification of specialty teaching strategies during medical training (8, 9, 11, 16). This problem seems to begin in physiology teaching, since most physiology books do not discuss relevant blood physiology aspects and their applications in clinical situations.In this context, with the aim of creating an auxiliary tool for transfusion medicine teaching and learning, a quiz comprising annotated clinical cases was developed, available on the website entitled "Sciences; an animated way of learning" (http://www.lcc.kftox.com/medical_education.html).The chosen themes were based on an earlier study regarding the evaluation of resident physician knowledge on the subject (24), and the topics were those for which resident physicians presented a lower percentage of correct answers considered essential to the practice.The software was tested by both specialists and medical students, who applied usability criteria, i.e., is the software easy to use, are its contents clear, and also evaluated the possibility of using the tool as an educational resource.METHODSThe quiz.The software was developed following choice of content, planning, prototype development, evaluation, validation and distribution steps (3). The content was based on specialized bibliography and reviewed by six experts, each one with more than 15 yr of experience in the field. The software can be accessed by both desktop (Fig. 1) and mobile devices, such as tablets and smartphones, on both iOS and Android operating systems (Fig. 1).Fig. 1.Desktop and Mobile Quiz Hemotherapy home screens, which are available in English and Portuguese.Download figureDownload PowerPointThe quiz is composed of 10 clinical cases covering hemotherapy topics, such as transfusion reactions, ABO/Rh compatibility, reversal of anticoagulant effects, and indication of platelet use. To answer the questions, knowledge on blood physiology and hemotherapy is required. Each question is composed of five statements, with only one correct choice, single best answer. The order of the options is altered with each move. After selecting the option, the user will receive a congratulatory message if he/she was successful, or an indication of the correct answer if he/she was wrong.Next, the user is directed to a screen with an explanation of the topic. For more extensive topics, a more complete text option with the title "Read more" is available. The sequence is repeated throughout the 10 questions. At the end, bibliographical references and the user's score are available. The option to review the game is then displayed, again showing all questions with the user-marked options and the correct options. If the results will be used for research, a consent form will be made available online that authorizes such use. This tool is planned for the next version. The software is registered as a free software with a 3.0 creative commons license.Software evaluation.Five specialists in transfusion medicine with more than 15 yr of experience in the area, each one from different hemotherapy services, in Rio de Janeiro and 32 undergraduate medical students from a private university in Rio de Janeiro attending their 10th and 11th semesters participated in the quiz evaluation. In Brazil, medical undergraduate schools comprise 12 semesters. The students were already attending their internship, the final practical portion of the medical course, and, therefore, already experience situations or cases like those described in the quiz. All signed a free and informed consent form, and the project was approved by Ethical Committee of Fundação Oswaldo Cruz.To test the software, the methodology reported by Sander et al. (19) was applied, with modifications. An instrument with assertions to be filled out on a five-point Likert scale, ranging from "totally agree" to "totally disagree," was applied in person. The students were also asked if they had received any type of training in transfusion medicine during their undergraduate medical education, and about their perception, if the specialty is important to their practice. In Brazil, students at this point are already practicing under supervision. Questions on their profile regarding the use of the internet were also applied, and a space for suggestions and criticisms was made available. The answers were anonymous, to avoid any kind of embarrassment, leading to bias.Regarding the experts, open questions about the appropriateness of the applied vocabulary, audience, clarity, and timeliness of the content were also asked.RESULTSSpecialist evaluation.The software evaluation by the specialists was positive, as they indicated that the software is easy to understand and that the content is up to date and is clearly expressed. The applied vocabulary was considered appropriate for both medical students and physicians. The quiz was pointed out as an educational tool suitable for use by undergraduate medical students in their fourth or fifth year, by resident physicians, and by physicians in general. The evaluations performed by the experts using the Likert scale are displayed in Fig. 2.Fig. 2.Likert scale to evaluate transfusion medicine specialist perceptions regarding the characteristics and usability of the software as a pedagogical tool.Download figureDownload PowerPointStudent profile.The median age of the undergraduate medical students who participated in the survey was 25.9 yr, with 53% men and 47% women. All participants stated that they used computers and the internet for many different functions, such as sending and receiving e-mails, research, work, and accessing social networks, among others. A total of 78.1% evaluated their computer knowledge as satisfactory or very satisfactory, whereas 75% reported that they used mobile devices more frequently than desktop devices to access the internet.All students considered transfusion medicine as an important part of their clinical practice, while 40.6% perceived their knowledge in the area as insufficient, 50% as basic, and 9.3% as intermediary.Student comments.Most students considered the tool useful as a teaching-learning resource. The main student suggestions were:• To have an options menu to directly access the questions• Create a "read more" button for optional access• Display explanations in the form of videos• Increase the levels of complexity in the addressed topics• Turn the quiz into an app by adding other themesSeveral compliments were received, as follows:• Very good, relevant topics;• Few questions, but well formulated with good explanations.Only two students wrote down negative comments, and both were about the size of the explanatory texts, which they considered to be very extensive. Figure 3 displays the results of the student evaluations using the Likert scale.Fig. 3.Likert-type scale to evaluate student perception involving the characteristics and usefulness of the software as a pedagogical tool.Download figureDownload PowerPointDISCUSSIONIn the internet era, with the immediate availability of a huge amount of information for students, raising their interest to seek and improve knowledge has required changes in educational strategies. In this context, the use of educational software can be a motivating strategy (12).In health education, games have been used to improve the performance of health professionals, by improving their knowledge and skills (15). Although further studies are required to prove their efficiency as an educational strategy, several experiences have demonstrated positive results regarding user acceptance, motivation, and increased interest in the addressed subjects (2).Quiz-type games have already been successfully applied in the medical field for teaching genetics, physiology, and dermatology, among others (4, 14, 23). In transfusion medicine, e-mails with quizzes (Transfusion News, Question of the Day, https://transfusionnews.com/path-questions/) have been applied for the continuing education of professionals in this area in several countries (15). Abney et al. (1) pointed out strategies so that online quizzes can be used in an integrated manner with the traditional curriculum in medical education. These include, for example, examining issues alongside colleagues and aligning educational objectives with the quiz contents.The Quiz Hemotherapy software was well received by both experts and medical students. All experts who evaluated the quiz considered that it brings benefits in understanding the subject and can complement textbook reading and recommended the use of the software to other interested parties. Most students assessed that the software brought benefits to the understanding of the covered topics and liked the method, considering that it could be used to complement traditional methodologies, such as expository classes and/or textbooks. Received suggestions will be considered for improvement in a future software release.The fact that all students perceive transfusion medicine as an important topic for their medical practice, and that 90.6% consider their knowledge in the area as insufficient or basic, reinforces the importance of the development of tools such as the one discussed herein, which can assist in specialty teaching aiming to ultimately broaden the knowledge and possibly improve the transfusion practice for physicians. Teachers and supervisors should be aware of this issue. Future studies are, however, required to assess the impact of the use of this tool on user performance.GRANTSThis study was supported by Fundação de Amparo à Pesquisa do Rio de Janeiro-FAPERJ, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and IOC-Fundação Oswaldo Cruz.DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONSM.M.d.V.V. and L.A.A. conceived and designed research; M.M.d.V.V. performed experiments; M.M.d.V.V. and L.A.A. analyzed data; M.M.d.V.V. and L.A.A. interpreted results of experiments; M.M.d.V.V. prepared figures; M.M.d.V.V. drafted manuscript; M.M.d.V.V. and L.A.A. approved final version of manuscript; L.A.A. edited and revised manuscript.ACKNOWLEDGMENTSThe authors thank Dr. Elizabeth Rose Celso de Souza, Dr. Fernanda Azevedo Silva, Dr. Flavia Miranda Gomes de Constantino Bandeira, Dr. Iara de Jesus Ferreira Motta, Maria Cristina Pessoa dos Santos, and Dr. Selma Magalhães Brito for reviewing the content of the software. 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Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Collections Cited ByEffect of an active learning methodology combined with formative assessments on performance, test anxiety, and stress of university studentsLais Tono Cardozo, Maria Antonia Ramos de Azevedo, Maeline Santos Morais Carvalho, Rafaela Costa, Patricia Oliveira de Lima, and Fernanda Klein Marcondes18 November 2020 | Advances in Physiology Education, Vol. 44, No. 4 More from this issue > Volume 42Issue 4December 2018Pages 644-647 Copyright & PermissionsCopyright © 2018 the American Physiological Societyhttps://doi.org/10.1152/advan.00079.2018PubMed30303413History Received 26 April 2018 Accepted 5 September 2018 Published online 10 October 2018 Published in print 1 December 2018 Metrics
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