Design
A situated cognition study was designed to built a training environment and The Task Cognitive Load Scale (NASA-TLX Scale) and self-developed questionnaires were conduct, aiming to assess how their workload in this training task, how well they were prepared for the sudden epidemic and how will their performance for the future public health prevention , to implicate how well our public public health prevention training for our GP medical students and GP residents.
Setting (A situated cognition study)
Situated cognition is classified into studies of situational context design, legitimate peripheral participation, and the construction of a community of practice. [1]
2.1 Situational Context Design
Following the outbreak of the COVID-19 epidemic, China initiated a first-level response to the public health emergency.[13] The main purpose of standardized training is to train qualified grassroots general practices, and an important part of the training content concerns responding to public health emergencies. Community health service centers played an extremely important role as the first line of defense in the prevention and control of the COVID-19 epidemic. They also provided real training scenarios for scientists’ basic epidemic prevention practices. Each grassroots practice base must be reinforced according to the epidemic prevention and control situation.The teaching, training, and practice of infectious disease prevention and control knowledge and skills will use the completed training practice as an important basis for assessment of the process.
a. Pre-vocational training (they short training the participants get before they tackle the real task ) and assessment
1. National Basic Public Health Service Standards - Service Standards for Reporting and Handling of Infectious Diseases and Public Health Emergencies
2. Knowledge of epidemic prevention and control, hospital infection prevention and control, personal protection skills, etc.
3. Introduction to each point of the institution’s epidemic prevention and control work (layout, process, work content, specifications, etc.)
4. Written examination to assess knowledge of epidemic prevention and control
5. Standard patient (SP) assessment, prevention and control deployment process
b. Materials guarantee
Provide personal protective materials (such as masks, gloves, protective clothing, isolation clothing, etc.) required for training participants at different points in the work
2.2 Legitimate Peripheral Participation
“legal peripheral participation” means learners should enter the scene, start at the edges, and continue to advance gradually and more deeply to master the core essentials and exert their subjective initiative in practice.[14, 15] The acquisition of practical skills by students is a gradual process that does not occur overnight and requires the joint effort and participation of teachers and students. Online virtual simulation experiments can provide modular learning, and learners can complete different learning tasks according to their own learning needs.[16-18] Through activities ranging from easy to difficult, teachers can inspire or induce students to actively explore in real or virtual experimental environments to give full play to the students’ subjective initiative and in-depth studies. When students has cultivated themselves with competence , support and help from teachers can be appropriately reduced. According to the prevention and control work needs, the West China Hospital of Sichuan University arranges training for trainees to rotate in various epidemic prevention and control positions in the community health center and participate in prevention and control work. In addition, it arranges special personnel to be responsible for teaching. Under the guidance of the senior physician, the resident gradually becomes familiar with the work process.
The real epidemic situated training (REST) program during COVID-19 was conducted as following.
1. Pre-inspection and triage: participate in pre-inspection and triage, become familiar with the work process and specifications, master the main points of pre-inspection (temperature measurement, epidemiological history collection, simple inquiry of clinical symptoms, full use of general practice thinking) and become familiar with the triage process (outpatient clinic, general outpatient clinic, fever clinic, and referral).
2. Medical observation of quarantined persons:
1) Home quarantine personnel: participate in the medical observation work of home quarantine personnel temperature measurement and health and travelling history inquiries.
2) Observation and isolation personnel: participants in medical observation on the personnel under centralized observation.
3) Concentrated residents: trainees of the plan can participate in the duty and medical observation of the hotels where people from Hubei (or other areas with a high rate of infection)
3, Participation in epidemic prevention and control and the daily work of the family medicine team:
1) Education on epidemic prevention and control knowledge of contracted residents conducted through online methods such as online telephone and online software.
2) Chronic disease follow-up and health management during the epidemic period
3) Practice of group epidemic prevention and elimination in enterprises, institutions, and schools
4) Prevention and control of hospital infection and practice of occupational protection
5) Other public health work in the community
4. According to the specific situation, arrange for training students to participate in fever clinics, general clinics, children’s health care, Chinese medicine, and rehabilitation and record the workload.
2.3 Construction of a Community of Practice
Contextual cognitive learning theory emphasizes the construction of a community of practice. Teachers are not only lecturers of knowledge, but also the promoters of knowledge, the learning partners of students, and the promoters of communication among members of the community.[19, 20] While teaching knowledge and cultivating abilities, experimental teaching also emphasizes the establishment of good thinking habits for students. Based on the real clinical cases, students can restore the complex context of knowledge generation and development under the guidance of teachers and obtain more flexible knowledge which adapt to the real situation . Through different case situations, students will have more opportunities to solve problems and apply the theoretical knowledge they have learned to their practice. In the community, there is interaction among individuals and between individuals and the environment. This learning process is a process of interaction, communication, and dialogue. Participants share resources, respect, and trust one another. In the practice community, the identity of the learner is continuously reproduced, and the learner moves from being a bystander to a participant and, finally, to a demonstrator of mature practice. In other words, they change from being a legitimate marginal participant as a novice to being a core member of the community as an expert step by step.[21, 22]
As it is described above , the real situational design of REST program is drawn in Table 1
Participant
Resident doctors in a GP training program from West China Hospital of Sichuan University, and 183 questionnaires were collected. The participants were described in Table 2.
Cognitive Load Scale (NASA-TLX Scale) and Questionnaires
The NASA Task Load Index (TLX) is a popular technique for measuring subjective mental workload.[23-25] It relies on a multidimensional construct to derive an overall workload score based on a weighted average of ratings on six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration level.[24, 26] The Object Cognitive Load Scale (NASA-TLX Scale) and self-developed questionnaires were adopted to conduct a questionnaire survey of resident doctors who were in a GP training program in West China Hospital of Sichuan University, and 183 questionnaires were finally collected. The NASA-TLX Scale and self-developed questionnaires were finally merged into one questionnaire. The questionnaire prompts were as follows:
1. Have you participated in community epidemic prevention work?
2. When you participated in the epidemic prevention work, your identity was [single-choice question]
3. You participated in the prevention and control of the epidemic several months after the outbreak. [single-choice question]
4. In which community health service centers did you participate in epidemic prevention and control? [multiple-choice question]
5. The main contents of your participation were [multiple-choice question]
6. The training you received before taking up your post included [multiple-choice question]
7. The teacher who provided you with pre-vocational training came from [multiple-choice question]
8. Degree of mental and cognitive stress when you participated in prevention and control work [single-choice question]
9. When you participated in the prevention and control work, did you have a heavy mental and physical burden? [multiple-choice question]
10. When you participated in the prevention and control work, did you have a strong sense of time urgency? [multiple-choice question]
11. When you participated in the prevention and control work, how hard did you need to work compared with other work? [single-choice question]
12. Did you feel pressure or worry during your participation in the prevention and control work? [multiple-choice question]
13. What is your satisfaction score with the REST program?
14. Are you willing to participate in epidemic prevention and control and continue to receive relevant training? [multiple-choice question]
15. Before the outbreak, the public health training you received included [multiple-choice question]
16. Before the outbreak, the public health knowledge and training you received came from [multiple-choice question]
17. If you are responsible for the prevention and control of an epidemic situation in a community in the future, the level you can achieve is [single-choice question]
Date analysis
SPSS 23.0 statistical software was used for the statistical analysis of data.(Chi-square estimates, confidence interval 95%)