Cultivating creative learners in higher education: Engaging students in anatomy through art

Introduction
Nursing and midwifery students often struggle to engage with bioscience modules because they lack confidence in their ability to study science (Fell et al., 2012). Consequently many have difficulty applying anatomical and physiological information, essential to providing safe and effective patient care (Rogers, 2014; Rogers and Sterling, 2012); therefore a need exists for nurse educators to explore different methods of delivery of these important topics to enhance current curricula (Johnston, 2010). Inspired by the reported success of creative methods to enhance the teaching and learning of anatomy in medical education (Noel, 2013; Finn and McLachlan, 2010), this pilot study engaged nursing students in anatomy through the art of felt. The project was underpinned by the principles of good practice in undergraduate education, staff-student engagement, cooperation among students, active learning, prompt feedback, time on task, high expectations and respect for diverse learning styles (Chickering and Gamson, 1987).

Method
Undergraduate student nurses from Queen’s University, Belfast, enrolled in the year one ‘Health and Wellbeing’ model were invited to participate in the project. Over a six week period the student volunteers worked in partnership with teaching staff to construct individual, unique, three dimensional felt models of the upper body. Students researched the agreed topic for each week in terms of anatomical structure, location, tissue composition and vascular access. Creativity was encouraged in relation to the colour and texture of materials used. The evaluation of the project was based on the four level model detailed by Kirkpatrick and Kirkpatrick (2006) and included both quantitative and qualitative analysis:• pre and post knowledge scores• self-rated confidence• student reflections on the application of learning to practice.

Results
At the end of the project students had created felt pieces reflective of their learning throughout the project and ‘memorable’ three dimensional mental maps of the human anatomy. Evaluation revealed not only acquisition of anatomical knowledge, but the wider benefits of actively engaging in creative learning with other students and faculty teaching staff.

The project has enabled nurse educators to assess the impact of innovative methods for delivery of these important topics.

Divergent Paths of Development: The Modern World-System and Democratization in South Africa and Zambia

This article examines whether a Modern World- Systems (MWS) perspective can provide an improved understanding of the processes of democratization in Africa (and other developing regions of the world) by conducting a comparative case study of South Africa and Zambia in the 1990s, examining the transitions to democracy and divergent processes of democratic consolidation in each country. Semiperipheral South Africa has, due to its more advantageous position in the world-system, been better equipped than peripheral Zambia to safeguard democracy against erosion and reversal. Th e central irony of the MWS is that the weakest states in the MWS can be pushed around by core powers and are more easily forced to democratize while at the same time they are least likely to possess the resources necessary for democratic consolidation. Semiperipheral states can maintain their independence vis-à-vis the core to a higher degree, but if the decision is made to undertake a democratic transition they are more likely to possess the resources necessary for successful consolidation. Th e MWS perspective allows for an improved understanding of the causal pathway of how position in the MWS translates into the ability to consolidate democracy than does approaches that emphasize domestic factors.

The impact of curricular change on medical students' knowledge of anatomy

Background: In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy. Aim: This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy. Setting: Medical student intakes for 1995-98 at the Queen's University of Belfast, UK. Methods: The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, 'old' curriculum, were compared with those from the student intakes of 1996-98, which undertook a new, 'systems-based' curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group. Results: The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum. Conclusion: The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy.

(Dis‑)Harmony in movement: effects of musical dissonance on movement timing and form

While the origins of consonance and dissonance in terms of acoustics, psychoacoustics and physiology have been debated for centuries, their plausible effects on movement synchronization have largely been ignored. The present study aims to address this by investigating whether, and if so how, consonant/dissonant pitch intervals affect the spatiotemporal properties of regular reciprocal aiming movements. We compared movements synchronized either to consonant or to dissonant sounds, and showed that they were differently influenced by the degree of consonance of the sound presented. Interestingly, the difference was present after the sound stimulus was removed. In this case, the performance measured after consonant sound exposure was found to be more stable and accurate, with a higher percentage of information/movement coupling (tau-coupling) and a higher degree of movement circularity when compared to performance measured after the exposure to dissonant sounds. We infer that the neural resonance representing consonant tones leads to finer perception/action coupling which in turn may help explain the prevailing preference for these types of tones.

Factors affecting adherence to use of hip protectors amongst residents of nursing homes - A correlation study

Background: Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. Promising results from randomised controlled trials in nursing homes have resulted in hip protectors being widely recommended in the health care literature and in national guidelines. Objectives: The objectives of the study were to identify characteristics of individual residents, and the organisational features of the homes in which they live, which may affect adherence to wearing hip protectors. Design: An observational, correlation study designed to identify factors related to adherence. Setting: Forty nursing and residential homes in the UK. Participants: 1346 residents of the homes who were not confined to bed and with no pressure sore on the hip. Methods: The introduction of an evidence-based policy to offer Safehips hip protectors to residents free of charge and with support from a nurse facilitator. Adherence to wearing the hip protectors was observed over 72 weeks. Results: Initial acceptance of the hip protectors was 37.2%. Continued adherence was 23.9% at 24 weeks; 23.2% at 48 weeks; and 19.9% at 72 weeks. Greater adherence was associated with the following individual resident characteristics: a greater degree of dependency (95% CI 1.39 - m3.78) and cognitive impairment (95% CI 1.01 - 2.98); being male rather than female (95% CI 1.06 - 2.48). Greater adherence was also associated with the following organisational characteristics of homes: fewer changes of senior manager during the study period (95% CI 1.01 - 8.51), and being resident in a home with a resident profile showing a greater proportion of residents with a higher degree of dependency (95% CI 1.04 - 1.27). There was wide a variation in the degree of success in implementation between homes (adherence of 0 - 100% at 24 weeks). Conclusions: Those implementing a policy of introducing hip protectors into nursing and residential homes should consider targeting residents with cognitive impairment. Such residents are at greater risk of hip fracture and appear to be more likely to continue wearing hip protectors. Those charged with implementing changes inpractice or policy should consider how the context for implementation can be optimised to increase the likelihood of success.

The control of porosity at nano scale in resorcinol formaldehyde carbon aerogels

Organic aerogels were synthesized by sol–gel polymerization of resorcinol (R) with formaldehyde (F) catalyzed by sodium carbonate (C) followed by vacuum drying. The influence of the resorcinol/sodium carbonate ratio (R/C) on the porous structure of the resultant aerogels was investigated. The nitrogen adsorption–desorption measurements show that the aerogels possess a well developed porous structure and mesoporosity was found to increase with increasing the R/C ratio. Carbon aerogels were obtained by carbonization of RF aerogels. The carbonization temperature impacts the microstructure of the aerogels by pore transformations during carbonization probably due to the formation of micropores and shrinkage of the gel structure. The results showed that a temperature of 1073 Kis more effective in the development of the pore structure of the gel. Activated carbon aerogels were obtained from the CO2 activation of carbon aerogels. Activation results in an increase in the number of both micropores and mesopores, indicative of pore creation in the structure of the carbon. Activation at higher temperatures results in a higher degree of burn off and increases the pore volume and the surface area remarkably without change of the basic porous structure, pore size, and pore size distribution.

Protic ionic liquids based on the dimeric and oligomeric anions: [(AcO)(x)Hx-1](-)

We describe a fluidity and conductivity study as a function of composition in N-methylpyrrolidine-acetic acid mixtures. The simple 1 : 1 acid-base mixture appears to form an ionic liquid, but its degree of ionicity is quite low and such liquids are better thought of as poorly dissociated mixtures of acid and base. The composition consisting of 3 moles acetic acid and 1 mole N-methylpyrrolidine is shown to form the highest ionicity mixture in this binary due to the presence of oligomeric anionic species [(AcO)(x)Hx-1](-) stabilised by hydrogen bonds. These oligomeric species, being weaker bases than the acetate anion, shift the proton transfer equilibrium towards formation of ionic species, thus generating a higher degree of ionicity than is present at the 1 : 1 composition. A Walden plot analysis, thermogravimetric behaviour and proton NMR data, as well as ab initio calculations of the oligomeric species, all support this conclusion.

Large-Range Movements of Neotropical Orchid Bees Observed via Radio Telemetry

Neotropical orchid bees (Euglossini) are often cited as classic examples of trapline-foragers with potentially extensive foraging ranges. If long-distance movements are habitual, rare plants in widely scattered locations may benefit from euglossine pollination services. Here we report the first successful use of micro radio telemetry to track the movement of an insect pollinator in a complex and forested environment. Our results indicate that individual male orchid bees (Exaerete frontalis) habitually use large rainforest areas (at least 42-115 ha) on a daily basis. Aerial telemetry located individuals up to 5 km away from their core areas, and bees were often stationary, for variable periods, between flights to successive localities. These data suggest a higher degree of site fidelity than what may be expected in a free living male bee, and has implications for our understanding of biological activity patterns and the evolution of forest pollinators.

Thermomechanical Response of Variable Stiffness Composite Panels

Analysis of non-traditional Variable Stiffness (VS) laminates, obtained by steering the fiber orientation as a spatial function of location, have shown to improve buckling load carrying capacity of flat rectangular panels under axial compressive loads. In some cases the buckling load of simply supported panels doubled compared to the best conventional laminate with straight fibers. Two distinct cases of stiffness variation, one due to fiber orientation variation in the direction of the loading, and the other one perpendicular to the loading direction, were identified as possible contributors to the buckling load improvements. In the first case, the increase was attributed to the favorable distribution of the transverse in-plane stresses over the panel platform. In the second case, a higher degree of improvement was obtained due to the re-distribution of the applied in-plane loads. Experimental results, however, showed substantially higher levels of buckling load improvements compared with theoretical predictions. The additional improvement was determined to be due to residual stresses introduced during curing of the laminates. The present paper provides a simplified thermomechanical analysis of residual stress state of variable stiffness laminates. Systematic parametric analyses of both cases of fiber orientation variations show that, indeed much higher buckling loads could result from the residual stresses present in such laminates.

Emotions and identity in the figured world of becoming a doctor

CONTEXT: There is little room in clerkship curricula for students to express emotions, particularly those associated with the development of a caring identity. Yet it is recognised that competence, alone, does not make a good doctor. We therefore set out to explore the relationship between emotions and identity in clerkship education. Our exploration was conceptually oriented towards Figured Worlds theory, which is linked to Bakhtin's theory of dialogism.

METHODS: Nine female and one male member of a mixed student cohort kept audio-diaries and participated in both semi-structured and cognitive individual interviews. The researchers identified 43 emotionally salient utterances in the dataset and subjected them to critical discourse analysis. They applied Figured Worlds constructs to within-case and cross-case analyses, supporting one another's reflexivity and openness to different interpretations, and constantly comparing their evolving interpretation against the complete set of transcripts.

RESULTS: Students' emotions were closely related to their identity development in the world of medicine. Patients were disempowered by their illnesses. Doctors were powerful because they could treat those illnesses. Students expressed positive emotions when they were granted positions in the world of medicine and were able to identify with the figures of doctors or other health professionals. They identified with doctors who behaved in caring and professionally appropriate ways towards patients and supportively towards students. Students expressed negative emotions when they were unable to develop their identities.

CONCLUSIONS: Critical discourse analysis has uncovered a link between students' emotions and their identity development in the powerful world of becoming and being a doctor. At present, identity development, emotions and power are mostly tacit in undergraduate clinical curricula. We speculate that helping students to express emotions and exercise power in the most effective ways might help them to develop caring identities.

A proposed simple method for measurement in the anterior chamber angle: biometric gonioscopy

OBJECTIVE:

To design a system of gonioscopy that will allow greater interobserver reliability and more clearly defined screening cutoffs for angle closure than current systems while being simple to teach and technologically appropriate for use in rural Asia, where the prevalence of angle-closure glaucoma is highest.

DESIGN:

Clinic-based validation and interobserver reliability trial.

PARTICIPANTS:

Study 1: 21 patients 18 years of age and older recruited from a university-based specialty glaucoma clinic; study 2: 32 patients 18 years of age and older recruited from the same clinic.

INTERVENTION:

In study 1, all participants underwent conventional gonioscopy by an experienced observer (GLS) using the Spaeth system and in the same eye also underwent Scheimpflug photography, ultrasonographic measurement of anterior chamber depth and axial length, automatic refraction, and biometric gonioscopy with measurement of the distance from iris insertion to Schwalbe's line using a reticule based in the slit-lamp ocular. In study 2, all participants underwent both conventional gonioscopy and biometric gonioscopy by an experienced gonioscopist (NGC) and a medical student with no previous training in gonioscopy (JK).

MAIN OUTCOME MEASURES:

Study 1: The association between biometric gonioscopy and conventional gonioscopy, Scheimpflug photography, and other factors known to correlate with the configuration of the angle. Study 2: Interobserver agreement using biometric gonioscopy compared to that obtained with conventional gonioscopy.

RESULTS:

In study 1, there was an independent, monotonic, statistically significant relationship between biometric gonioscopy and both Spaeth angle (P = 0.001, t test) and Spaeth insertion (P = 0.008, t test) grades. Biometric gonioscopy correctly identified six of six patients with occludable angles according to Spaeth criteria. Biometric gonioscopic grade was also significantly associated with the anterior chamber angle as measured by Scheimpflug photography (P = 0.005, t test). In study 2, the intraclass correlation coefficient between graders for biometric gonioscopy (0.97) was higher than for Spaeth angle grade (0.72) or Spaeth insertion grade (0.84).

CONCLUSION:

Biometric gonioscopy correlates well with other measures of the anterior chamber angle, shows a higher degree of interobserver reliability than conventional gonioscopy, and can readily be learned by an inexperienced observer.

Undergraduate interprofessional education using high-fidelity paediatric simulation

BACKGROUND: High-fidelity simulation is becoming increasingly important in the delivery of teaching and learning to health care professionals within a safe environment. Its use in an interprofessional context and at undergraduate level has the potential to facilitate the learning of good communication and teamworking, in addition to clinical knowledge and skills.

METHODS: Interprofessional teaching and learning workshops using high-fidelity paediatric simulation were developed and delivered to undergraduate medical and nursing students at Queen's University Belfast. Learning outcomes common to both professions, and essential in the clinical management of sick children, included basic competencies, communication and teamworking skills. Quantitative and qualitative evaluation was undertaken using published questionnaires.

RESULTS: Quantitative results - the 32-item questionnaire was analysed for reliability using spss. Responses were positive for both groups of students across four domains - acquisition of knowledge and skills, communication and teamworking, professional identity and role awareness, and attitudes to shared learning. Qualitative results - thematic content analysis was used to analyse open-ended responses. Students from both groups commented that an interprofessional education (IPE) approach to paediatric simulation improved clinical and practice-based skills, and provided a safe learning environment. Students commented that there should be more interprofessional and simulation learning opportunities.

DISCUSSION: High-fidelity paediatric simulation, used in an interprofessional context, has the potential to meet the requirements of undergraduate medical and nursing curricula. Further research is needed into the long-term benefits for patient care, and its generalisability to other areas within health care teaching and learning.

The validity of critical thinking tests for predicting degree performance: A longitudinal study

This study explored the validity of using critical thinking tests to predict final psychology degree marks over and above that already predicted by traditional admission exams (A-levels). Participants were a longitudinal sample of 109 psychology students from a university in the United Kingdom. The outcome measures were: total degree marks; and end of year marks. The predictor measures were: university admission exam results (A-levels); critical thinking test scores (skills & dispositions); and non-verbal intelligence scores. Hierarchical regressions showed A-levels significantly predicted 10% of the final degree score and the 11-item measure of ‘Inference skills’ from the California Critical Thinking Skills Test significantly predicted an additional 6% of degree outcome variance. The findings from this study should inform decisions about the precise measurement constructs included in aptitude tests used in the higher education admission process.