Background Late-life depression (LLD) has a poorer prognosis and higher relapse rate than younger adults, with up to one third of patients with LLD showing suboptimal response to antidepressant therapy. LLD has been associated with significant impairment in cognition and daily functioning. Few studies have evaluated the therapeutic effects of high-definition transcranial direct current stimulation (HD-tDCS) on depressive and cognitive symptoms of LLD. The current randomized controlled trial assesses the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects with LLD. Methods Fifty-eight patients with LLD will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response and the remission rate as measured with the Hamilton Depression Rating scale (HAMD-17) before and after the intervention, and at the 4th and 12th week after the completed intervention. Secondary outcome measures include cognitive symptoms, anxiety symptoms, daily functioning and adverse effects. Discussion Older adults with depression are associated with poorer outcomes or unsatisfactory responses to antidepressant therapy, and significant cognitive decline. Therefore, a new effective treatment option is needed. This randomized control trial aims at assessing the efficacy of HD-tDCS on ameliorating the depressive, cognitive and anxiety symptoms, and improving the daily functioning of subjects with LLD. Trial registration ClinicalTrials.gov NCT05322863. Registered on 11 April 2022.

This study describes the development and validation of a psychometrically-sound instrument, the Active Learning Strategies Inventory (ALSI), designed to measure learners’ perceptions of their active learning strategies within an active learning context. Active learning encompasses a broad range of pedagogical practices and instructional methods that connect with an individual learner's active learning strategies. In order to fulfill the study's goals, a conceptual framework on learners’ active learning strategies was developed and proposed, drawing upon the research literature on active learning. The development and construct validation of the Active Learning Strategies Inventory (ALSI), based on the conceptual and methodological underpinnings, involved identifying five scales of learners’ active learning strategies: engagement, cognitive processing, orientation to learning, readiness to learn and motivational orientation. An item pool of 20 items was generated following an extensive review of the literature, standardized card sorting procedures including confirmatory factor analysis and scale validation of a pilot (n = 407) survey. The ALSI scale demonstrated strong internal consistency and reliability with a Cronbach's alpha ranging from 0.81 to 0.87. High item loading scores from the factor analysis provided initial support for the instrument's construct validity of the five-factor model. The ALSI scale provides a reliable and valid method for researchers and academicians who wish to measure learners' perceptions of their active learning strategies within an active learning context. Finally, we discuss the implications and address the limitations and directions for future research.

Backgroud:Under the circumstance of school closures caused by the coronavirus outbreak, medical schools in China began implementing online teaching, including histology and embryology (HE) beginning in the middle of February 2020. The changes in HE education in responding to the pandemic in China needs to be determined, for further adaption of online teaching delivery or blended learning. Methods:A nationwide survey of the major medical colleges was conducted via WeChat. Results:In total, 83 medical schools (one respondent per school) were invited to survey, 78 medical schools responded which represented most medical schools across all the provinces in mainland China, as well as Hong Kong and Macao. The results revealed that 77% (n = 60) and 58% (n = 45) of the responding schools had conducted HE theoretical and practical online teaching, respectively, prior to the pandemic; however, 27% (n = 21) of the medical schools had temporally suspended practical sessions at the time the survey was completed. During the pandemic, 73% (n = 57) and 29% (n = 23) of the medical schools delivered HE theoretical and practical sessions by synchronous live broadcasting, respectively; 65% (n = 51) of the medical schools increased virtual microscopy using during practical sessions. During the pandemic, 54% (n = 42) of the medical schools implemented teaching activities promoting active learning; meanwhile, online assessment was implemented in 84% (n = 66) of the responding medical schools. With regard to the satisfaction with the effectiveness of online teaching during the pandemic, 64% (n = 50) of the medical schools gave positive answers and considered that it was a good opportunity to develop novel and diversified teaching methods. Despite various difficulties such as work overload and unstable online teaching environments, most medical schools are willing to continue or increase theoretical online teaching after the pandemic. Conclusions:Medical institutes in China were the earliest of closing campuses and having complete online teaching experience during the pandemic. This paper presents overall HE teaching situation extracted from the survey, to assist other medical schools optimizing the transitions to quality online teaching within a short time, and to serve as reference for schools that demand essential knowledge in online teaching methods, infrastructure construction, and platform integrations.

Interprofessional education has been widely integrated into health education curricula to enable students to work comfortably as members of a healthcare team. However, not much is known about the psychosocial mechanism that defines students' readiness for interprofessional learning. Drawing from social cognitive theory, we examined the pathway where collective efficacy was construed to influence subsequent students' satisfaction with team experiences, readiness for interprofessional learning, and attainment of interprofessional learning outcomes. Through path analysis, we examined data from 1,005 health and social care students who participated in a large-scale interprofessional education in Hong Kong. Results indicated that collective efficacy directly and indirectly predicted students' readiness for interprofessional learning and perception of attainment of IPE learning outcomes. Theoretical and practical implications of findings in the management of interprofessional education are discussed.

Problem-based learning (PBL) designs are addressing the demands and potentials of an information-saturated era where accessing inquiry resources and new information is reconfiguring tutor-facilitated dialogues. Unclear is how incorporation of CSCL tools and the rich digital multimodal resources they collaboratively access and generate are re-shaping the traditional problem-based cycle of inquiry and intersubjective sense-making. This study in higher education adopts Interactional Ethnography (IE) as a logic-of-inquiry to examine how a group of medical undergraduate students and their facilitator (n = 12) collaborated to access, review, appropriate and devise multimodal digital and visual texts within and across one problem cycle (three face-to-face tutorials and self-directed learning). Drawing on concepts of ‘multimodality’ and ‘intervisuality’ from literacy theory, we extend theoretical understandings of how multimodal texts become actors within a developing PBL event, not just objects of study or cultural tools. Through this multi-focal approach, we make visible how what occurs at one point in time with these texts in the developing dialogic space is consequential for what students can and do undertake in subsequent engagements with such texts in and across one bounded cycle of learning activities. Arising from this analysis, we propose the concept of dialogic intervisualizing to characterize the dynamic interplay between and among information problem-solving processes, textual negotiations and purposeful, facilitated dialogue for deep knowledge co-construction within and across collaborative, computer supported learning activity in an inquiry cycle.

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation‐wide survey of the five‐year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990–1999, 2000–2009, and 2010–2018). The directors or senior teachers from 90 out of the 130 five‐year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty‐five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem‐based learning has been adopted in thirty‐five (54%) of the surveyed schools, and team‐based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000–2009 to 36.10 ± 47.26 in 2010–2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990–1999 to 14.22 ± 5.0 in 2010–2018). A decreasing trend regarding the teacher‐student ratio (1:25.5 in 2000–2009 to 1:33.2 in 2010–2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

The Covid-19 pandemic launched the use of online courses in Chinese medical schools during February 2020. To evaluate the state of gross anatomy education in China during the pandemic, a nationwide survey was conducted through convenience sampling by email or respondent invitations on social media. A total of 359 questionnaires were received from the respondents. The first response from a given school was included in the study to represent that school, thus, 77 questionnaires were used for analyses. Schools represented were from all provinces in mainland China as well as Hong Kong and Macao. The survey found that before the pandemic, 74.0% and 33.8% of the 77 schools conducted online theoretical and practical sessions, respectively, on gross anatomy, and 36 (46.8% of 77) had temporarily suspended practical sessions at the time the survey was conducted. Body donation programs were also affected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased number of donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of active learning, and online assessment was continued in 49.4% of the 77 medical schools. Another 26 (33.8%) schools initiated online assessment during the pandemic. A total of 359 answers were included for the analysis of the "teachers' perception of the online teaching experience." Over half (51.0%) of the 359 responded teachers were very statisfied or satisfied with the effectiveness of online teaching during the pandemic. A total of 36.2% of these respondents preferred to implement online teaching of theoretical sessions after the pandemic, and 89 (24.8%) teachers were keen to return to traditional face-to-face anatomy education.

BACKGROUND:Teamwork and collaboration are central to interprofessional education but fostering these attributes in large undergraduate cohorts is challenging.OBJECTIVES:This study aimed to examine the complexities of IPE group learning processes by examining how the material and intersubjective intertwine when newly formed interprofessional groups (Chinese medicine, medicine, nursing, pharmacy, and social work) synchronously engaged with face-to-face and online learning in a blended, team-based learning environment.METHODS:It was a micro-ethnography study using a sociomaterial theoretical lens. We selected two undergraduate interprofessional healthcare student groups within a large scale programme for contrastive video analysis of synchronous spatial and physical configurations, associated talk, and online activity.RESULTS:Video analysis of evolving physical configurations indicated that Group B was spatially more evenly grouped, and physically orientated to an identifiable leader, despite their blinded peer evaluations indicating distributed leadership. Group A faced a critical event at a public forum leading to spatial disruption breaking into subgroups and isolates; however, this group identified one member as a defined leader in the peer evaluations.CONCLUSIONS:Based on online scores, we found that peer identification of leaders may influence learning processes but not learning outcomes in the first IPE team meeting. The design of the physical and virtual learning environments contributed to the developing, sociomaterial processes of group cohesion in interprofessional team-based learning.

Physician training is built on a model that frames development as moving from novice to expert through a series of milestones, measurable competencies, and outcomes (Epstein and Hundert, 2002; Leach, 2002; Carraccio et al., 2008; ten Cate et al., 2010; Holmboe et al., 2016; ACGME, 2018). One well-known articulation of this framework, the Dreyfus Model, stages the individual from novice to advanced beginner to competent, proficient, and then expert (Dreyfus and Dreyfus, 1980). Within medicine, continuing professional development (CPD) and the expectation that medical professionals will be held accountable for knowledge and skills improvement is a mainstay of their expertise (Leach, 2002; Ericsson and Pool, 2016). To this end, a focus on practice with measurable outcomes and feedback is considered cornerstone for determined competency. On the contrary, while it may be natural to assume experience (number of years in practice) to be a proxy for expertise, studies have shown these to have a consistent negative relationship (Ericsson, 2004; Durning et al., 2010). In light of such findings, medical educators stress the role of deliberate practice in validating the development of expertise (Ericsson, 2004; Causer et al., 2014; Ericsson and Pool, 2016). As long as the practice of medicine continues to maintain a sorority with basic sciences (Sbayeh et al., 2016) authentic expertise as it relates to scientific, clinical, and technological advancement as well as the evolving social needs of the patient, the responsibility for up-to-date-expertise becomes an imperative for all professionals (Turney, 2007; Burgess and Ramsey-Stewart, 2015). Within such an environment, basic science education has to meet current practice demands by evolving into “authentic learning” practices that emphasize teamwork, leadership, interprofessional learning, and reflection (Pawlina and Drake, 2016). In the current teaching and learning environment expert productivity, deliverables and formal evaluation have become imperatives governing much of what we do and how we perform as teachers, facilitators and anatomists. For many anatomy educators, student evaluations of teaching have stood as the “grim reaper” for quality improvement. Despite the growing evidence questioning the reliability of student feedback (Uttl et al., 2017; Mullikin et al., 2019), its impact as a measure of faculty teaching performance remains the default standard for most; mainly because it is the only metric available or used by many departments and institutions. Often instructors who are more likable, charismatic, animated, or entertaining receive disproportionally better evaluations (Delucchi, 2000; Titus, 2008). In the absence of other objective metrics and under unremitting pressure from university administration, instructors may be unduly inclined to accentuate the entertainment value in course delivery at the expense of knowledge, expertise, and pedagogy; or to inflate grades, since students with higher grades are more likely to provide more positive feedback on teaching (Adams and Umbach, 2012; Rowan et al., 2017). While student perceptions of teacher effectiveness must not be discounted as a driver for self-improvement, it is essential to reflect on what it may take to establish, maintain, and uphold professional identity within an expertise in the complex embodiment of what it means to become an “expert.” In the context of the professions of anatomical sciences, the debate continues to gain momentum with arguments for and against such CPD expectations (Rizzolo and Drake, 2008). Within the diverse field of anatomical sciences, no one benchmark can, or should, be applied. Furthermore, standardization of knowledge competency with congruent pedagogic skills (Berman, 2015) will be met with challenge and not surprisingly, resistance. In the realm of anatomy education, it is easy to lose sight of the fact that familiarity of subject content, if left unchallenged, can impose a deceptive sense of assurance in delivery of expertise. As a subject, anatomy has the propensity for perpetuating a mentality that once learned the knowledge is good forever. In the current climate, students, scientists, public domains no longer depend on professors for information strengthening the notion that “everyone is an expert.” This sense of confidence while empowering for many outside the profession of anatomy, may at the same time be foreboding to its scientific and academic rigor. Within the profession, it is no longer sufficient to be satisfied with status quo, nor is it progressive to foster an erroneous sense of identity that if left unchallenged, can promote a reign of self-imposed mediocrity or a sense of all knowing and self-importance. The current professional environment however continues to prove time and time again that anatomy no longer exists as a predetermined science (Eizenberg, 2015). In the study and application of anatomy, audience, emphasis, curricular placement, and expertise required to interpret its content continues to transform, keeping the bar for required expertise in constant flux. In reality, the very progressive spirit of 21st century thinking appears to have circumvented the invaluable role that deliberate practice, critical analysis and reflection have to play in establishing expertise. Simultaneously, the “commodification” of science and the ability to harness large research grants sometimes undermines pedagogic rigor through a different metric but by its very nature, the field of anatomical sciences is built through mentorship and hands on experience underpinned by a commitment to continued learning and improvement of knowledge and skills. This is further fostered by interactional expertise (Collins and Evans, 2002), which can be acquired by “deeper immersion in the linguistic discourse” of the applicable scientific field (e.g., medicine, forensic science, surgery, biomedical sciences). In the academic environment difficulty in securing experts who not only are able to competently deliver a demanding subject, but also provide context to the clinical and scientific application of the subject material is a tangible impediment (McCuskey et al., 2005; Doss and Brooks, 2016). While not academically desirable, it is no longer uncommon for new anatomy graduates to be prematurely catapulted to levels of expert roles that may require greater skill sets and knowledge at which the level of proficiency may not provide. At the same time, the consistently evolving teaching and learning environment and generational shift in student cohort and associated expectations challenges existing anatomy professoriate to rethink, adapt, and innovate (Schaefer et al., 2019). Nonetheless, while most have done well through self-driven efforts, in the absence of any recertification/CPD requirements or opportunity to gain accreditation and advance anatomical knowledge, the impetus, and momentum for enhancement of expertise diminishes. The profession of anatomy is starting to see trends toward establishing a set of standards that would govern how individuals reach, establish, and maintain expertise in anatomical content, pedagogy, and education research. More emphasis is directed toward training of future anatomists in education-focused programs where students conduct rigorous evidence-based education research (Brokaw and O’Loughlin, 2015) and by engaging present anatomists in the scholarship of teaching and learning (O’Loughlin et al., 2019). In fact, there is mounting interest and evidence of professional societies commitment in supporting this effort e.g., American Association of Anatomists (AAA), American Association of Clinical Anatomists (AACA), Anatomical Society (AS) in UK, International Federative Association of Anatomists (IFAA) to enable both early and established career members to participate in formal learning sessions and to further develop expertise through collaborative training programs, postgraduate courses, and funded visiting professorships (Fraher and Evans, 2009; O’Loughlin et al., 2019). As a journal, Anatomical Sciences Education unifies these efforts by striving to maintain custodianship of its content through vigorous peer review and editorial oversight. In an effort to provide a platform for self-directed academic enhancement, the journal is purposeful in its selection of manuscripts so as to align global practices and provide opportunity for remote peer teaching, learning, and education research within the professional framework (Pawlina and Drake, 2010). While akin to medical practice in which expertise is built on deliberate practice, expertise in the anatomical sciences may be more appropriately constructed on deliberate performance – an activity defined by the “effort to increase domain expertise while engaging in routine work activity” (Fadde and Klein, 2010; Norman et al., 2018; Stigler and Miller, 2018). Applying features of deliberate practice (i.e., dissection performance, targeted study of core anatomical knowledge and its relevance to practice), deliberate performance (i.e., active teaching, student interaction, content delivery, hands on laboratory instruction) can be enhanced through several targeted approaches including mentorship, scientific avenues, and professional platforms (Streeter, 2014). Generating and enhancing relationships with peers and colleagues will create a diverse network of sponsors eager to help you succeed (Sulaiman et al., 2016). Even for anatomists whose practice may remain behind closed doors where teaching and learning co-partnerships are not accessible, the era of incentivized, media-driven, web- and electronic-based informational platforms, makes access to information empowering. As anatomists, our responsibility lies in service; through the promotion and innovation of teaching and learning, through the advancement of clinical practice, and through the curatorship of its science. To be satisfied with individual status quo is simply not good enough. In the absence of formal expectation, the drive for self-improvement in whatever form it may take is crucial to the maintenance of the collective profession and its science.

Background: Nurses are significant healthcare team members. It is vital to examine their gains in an interprofessional education (IPE). Purpose: We aimed to examine the perceived benefits of interprofessional team-based learning (IPTBL) on the entry level nursing students. Methods: Content analysis was adopted to identify categories in the reflections of the entry-level undergraduate nursing student IPTBL experiences. Results: There were 205 (male = 34) undergraduate nursing students (response rate 82.2%) participating in the present study. In line with the Interprofessional Education Collaborative Report (IPEC) core competencies, four categories were identified: 1) Values/Ethics for Interprofessional Practice, 2) Roles/Responsibilities, 3) Interprofessional Communication, and 4) Teams and Teamwork. A new category emerged—individual learning outcomes. Conclusion: Through IP interactions and the expectation of the IP team, the nursing students had built confidence and defined the nurses’ roles.

: Examining the nature of digital texts in the developing contexts of problem-based learning (PBL) constitutes an expansion in research on dialogic approaches to learning in technology-rich, inquiry-based designs. This study adopts Interactional Ethnography as an orienting theory to frame the purposeful tracing of the unfolding knowledge co-construction processes across a medical PBL cycle. We investigate how these processes are interactionally accomplished in and across intertextually tied events where devised, generated, accessed, curated and appropriated digital texts are connected in webs of meaning. The concepts of multimodality and intertextuality from literacy studies provide explanatory theories to investigate how digital texts in the developing dialogic space are consequential the learning process across the phases of a PBL cycle. We propose the concept of dialogic intervisualizing to theorize these new text-discourse relations in inquiry-based learning.