This examine used a non-randomized management group pretest–posttest design to judge dietetic college students’ studying outcomes earlier than and after the scenario-based simulation course. Subjective and goal information have been collected to reinforce the interpretation of the outcomes.
Contributors
We used comfort sampling to enroll 119 third-year dietetic college students from two neighboring universities. These college students have been enrolled in four-year bachelor’s diploma applications in diet at nationally accredited dietetics applications in Taiwan. The entire pattern area consisted of 150 eligible third-year dietetic college students, of whom 119 participated within the examine, yielding a response charge of 79.3%. Each universities supplied a diet counseling course within the semester previous to the examine. Nevertheless, the course primarily centered on theoretical instruction with out sensible communication abilities coaching or associated workouts. A complete of 59 college students have been assigned to the experimental group, whereas 60 college students have been assigned to the management group. Each teams shared comparable coursework and academic backgrounds, guaranteeing comparability of their foundational information and abilities. The experimental group undertook a 12-week scenario-based simulation course, whereas the management group acquired no medical communication abilities intervention. Throughout the examine, 58 college students (98.3%) from the experimental group accomplished the pre-test self-administered questions, the intervention course, two rounds of the Goal Structured Scientific Examination (OSCE), and the post-test self-administered questionnaires. One scholar withdrew from the examine as they dropped out of faculty. Within the management group, solely 51 college students (85%) accomplished the self-administered questionnaires pre-test and post-test. Each teams accomplished the surveys concurrently.
The examine was performed in keeping with the rules laid down within the Declaration of Helsinki, and all procedures involving analysis examine contributors have been permitted by the Nationwide Cheng Kung College Human Analysis Ethics Committee (NCKU HREC-E-110–397-2). All contributors offered knowledgeable consent.
Intervention
The intervention was a 12-week scenario-based simulation course structured round three models: diet evaluation of diabetes, diabetes schooling, and diet schooling for hyperlipidemia. Every unit spanned 4 weeks, with a two-hour weekly session, following a standardized tutorial course of proven within the circulation chart (Fig. 1). The instances and examples within the weekly course content material have been tailor-made to every unit’s theme. This course utilized Jeffries et al.’s simulation framework [11] to design real looking situations with clearly outlined studying aims, incorporating a gradual improve in complexity to facilitate deep studying. The course design integrated various educating strategies throughout 4 sequential steps for every unit:
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Week 1 – Introduction of medical communication abilities through narration and questions & solutions periods to facilitate understanding of the diet counseling course of.
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Week 2 – Statement of video simulations exhibiting incorrect and corrected communication strategies, adopted by small-group discussions to bolster key ideas.
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Week 3 – Palms-on role-play follow with simulated sufferers—senior undergraduate college students of their fourth yr who had accomplished hospital internships and most of their coursework and have been nearing commencement. These college students have been skilled to carry out affected person roles primarily based on structured scripts. These simulated sufferers offered learners with rapid suggestions on their communication abilities following the simulation, enabling college students to mirror and establish areas for enchancment. The researcher (I.J. Lai) and a senior dietitian (Y.C. Lee) noticed these periods, providing further steerage when wanted.
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Week 4 – A diet counseling and schooling take a look at was performed by randomly choosing one scholar from every of the eight teams to play the function of a dietitian and work together with a simulated affected person. On the similar time, the remainder of the category noticed the method. Every unit featured a unique scholar from every group, guaranteeing that a number of college students had the chance to take part within the take a look at all through the intervention. This was adopted by a debriefing session led by a senior dietitian (Lee) to encourage reflection and consolidate studying.
Move chart of a scenario-based simulation course focusing on on enhancing medical communication abilities of dietetic college students
To make sure the course’s relevance, researchers (Lai and Y.T. Huang) and senior dietitians (M.Y. Liu and Lee) with over 15 years of medical experience collaboratively developed the educational supplies. Six specialists, non-members of the analysis workforce, reviewed these supplies for content material validity, and revisions have been made primarily based on their suggestions. The finalized content material was then recorded as three educating movies that includes an actor portraying a dietitian to show right and incorrect medical communication abilities. These movies have been integrated into the curriculum to be used in Week 2 of every unit.
Devices
Goal Structured Scientific Examination (OSCE) Assessing Supplies
The researchers (Lai and Huang) and senior dietitians (Liu and Lee) collaboratively developed 4 validated OSCE assessing supplies masking dietary assessments and schooling for diabetes and hyperlipidemia. Every assessing materials included important elements comparable to goal learners, aims, take a look at gadgets, core competencies, educating content material and supplies, educating analysis, standardized affected person (SP) tips, suggestions kinds, SP scripts, examiner tips, examinee tips (together with process directions posted on the door of the examination room and take a look at questions within the examination room), and scoring checklists for each examinees and SPs. On this examine, the OSCE examination, a suggestions take a look at, utilized the identical assessing materials for each pre-test and post-test. Every take a look at comprised two ten-minute stations. Examiners for the OSCE have been registered dietitians from medical facilities or educating hospitals in South Taiwan, all with OSCE examiner accreditation. Moreover, group members skilled and licensed as SPs have been included to work together with the examinees and supply suggestions at every take a look at station. Earlier than the formal session, consensus and scoring coaching was performed for each SPs and examiners.
The SP’s suggestions kind, tailored from Schirmer et al. [12], consisted of 4 questions rated on a Likert scale with scores starting from 1 = “dangerous” to five = “glorious” to judge college students’ communication abilities. An instance query is, “When explaining, do you are feeling the scholars show knowledgeable perspective?” The checklists for examinees, accomplished by examiners, have been developed utilizing the size by Joyce et al. [13] to judge college students’ medical communication abilities when interacting with SPs. These 4 checklists contained 6 ~ 9 questions, scored from 1 = “not executed” to three = “utterly executed,” with a complete rating starting from 6 to 27 factors. Greater scores point out higher medical communication abilities. Questions on college students’ communication abilities and affected person interviewing inquired in regards to the (1) capability to verify the affected person’s identification, politely tackle the affected person, and introduce oneself, (2) use of language the affected person can perceive (non-medical phrases), and (3) talking in a peaceful and regular tone that conveys knowledgeable perspective. Moreover, the ultimate query in these checklists used an ordinary Likert scale from 1 = “poor” to five = “glorious” to judge college students’ total medical communication abilities.
Self-administered questionnaire
The questionnaire included 5 elements:
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Basic Data: Pupil ID, age, intercourse, native language, the common grade within the second yr of college, and whether or not contributors have taken (or are at the moment taking) a course in Vitamin Counseling and Training.
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Scientific Communication Confidence Scale: This self-assessment kind was tailored from the communication self-confidence scales utilized by Fallowfield et al. [14] and Huang et al. [15]. It consists of ten gadgets evaluating numerous facets of communication, together with the power to supply affected person info on dietary take care of ailments, deal with affected person feelings, and talk with sufferers with out feeling careworn. The dimensions is designed to measure college students’ rapid emotional readiness in medical communication. The next is an instance: I’m assured in conducting diet consultations comfortably with sufferers I meet for the primary time. Contributors rated every merchandise on a Likert scale starting from 1 = “strongly disagree” to five = “strongly agree”. The entire rating ranged from 10 to 50 factors, with larger scores indicating larger confidence in medical communication amongst college students.
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Scientific Communication Self-efficacy Scale. These things have been tailored from the unique scale developed by Ammentorp et al. [16]. It contains 15 gadgets rated on a ten-point Likert scale starting from 0 (not assured in any respect) to 10 (very assured). The entire rating ranged from 0 to 150 factors, with larger scores indicating larger medical communication self-efficacy. In contrast to the boldness scale, this self-efficacy scale focuses on college students’ perception of their functionality to realize particular communication targets and carry out efficiently in actual medical duties. The next is an instance: I can reply nutrition-related questions regarding the affected person’s situation.
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Scientific Communication Competence Scale: This scale, tailored from Hsu et al. [17], consisting of 16 gadgets rated on a five-point Likert scale starting from 1 (unable to realize) to five (wholly achieved). The entire rating ranges from 16 to 80 factors, with larger scores indicating higher medical communication abilities. The next is an instance merchandise: I can introduce myself in a non-threatening or acceptable tone and perceive the aim of the affected person’s diet session.
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Satisfaction Scale for the State of affairs-based Simulation Course: This scale, tailored from Huang et al. [15], was completely administered to the experimental group within the post-test. It comprised 11 closed-ended and two open-ended questions. The closed-ended questions have been rated on a five-point Likert scale starting from 1 (very dissatisfied) to five (very glad). The entire rating ranged from 11 to 55 factors, with larger scores indicating larger scholar satisfaction with course studying. The next is an instance merchandise: the design of this course helps me establish my studying challenges in medical communication abilities. The open-ended questions allowed college students to supply suggestions and options on probably the most impactful facets of the course and their most memorable experiences after participating.
Reliability and validity
Six specialists from the fields of diet schooling and diet remedy have been invited to look at the validity of the intervention tutorial designs, OSCE assessing supplies, and a self-administered questionnaire concerning the appropriateness of the educational designs, examined ideas, and readability of the questionnaire statements. The SP’s suggestions kind, the checklists for examinees, and the self-administered questionnaire have been developed primarily based on each English and Chinese language reference supplies (as described within the Instrument part). A Chinese language draft tailor-made to the examine’s aims was developed and validated by the six specialists. The finalized devices used within the examine have been in Chinese language, with English translations offered as dietary supplements for reference.
To evaluate the reliability of those supplies, thirty third-year dietetic college students (non-study contributors) have been invited to take part within the pilot examine on February 6, 2022. The content material validity indices of the questionnaire ranged from 0.93 to 0.99, whereas Cronbach’s alpha values, indicating the interior consistency of the subscales, ranged from 0.93 to 0.97. These processes ensured that the examine supplies have been each legitimate and dependable to be used on this analysis.
Information assortment
The self-administered questionnaire, distributed as an internet kind, was designed to gather subjective information from each the experimental and management teams earlier than and after the course intervention. The questionnaire hyperlink was shared by on-line teams, permitting college students to resolve whether or not to take part. To proceed, the contributors had to supply their consent on the primary web page of the shape; in any other case, the webpage robotically exited. Solely the experimental group participated within the OSCE, which occurred one week earlier than and after the course intervention. The experimental group, consisting of 59 people, was divided into 4 subgroups: two within the morning and two within the afternoon. Every group needed to undergo two examination stations, together with one dietary evaluation and one dietary schooling station, for each diabetes and hyperlipidemia illness situations mixed. 4 examiners and 4 SPs participated on this examine all through the day. Throughout the OSCE, the examiners used “The Guidelines for Examinees” to judge every scholar’s medical efficiency. On the similar time, SPs stuffed out the “SP Suggestions Type” to supply their views on the scholars’ interactions. The scholars have been invited to finish a Google Type for qualitative suggestions after every OSCE.
Statistical evaluation
Quantitative information have been analyzed utilizing SPSS 18.0. Descriptive statistics have been employed to look at sociodemographic information, studying satisfaction, uncooked scores, and complete scores for every scale merchandise. Categorical variables are frequencies and percentages, whereas steady variables are represented as means and commonplace deviations. Nonparametric measures comparable to medians and ranges have been included to focus on the variety of evaluations amongst contributors for the end result variables of communication confidence, self-efficacy, and competence. Paired t-tests examined variations in communication confidence, self-efficacy, competence and OSCE efficiency earlier than and after course intervention. Moreover, ANCOVA was used to research the variations between the experimental and management teams for these variables whereas controlling for pre-test scores.
