Evaluation of a Visual Metaphor of Suicide Risk Factors: Results from a Pilot Randomized Controlled Trial in Psychology Students

M Alyami^1, , H Alyami², F Sundram³ and B A Haarhoff⁴

¹School of Psychology, Massey University, Auckland, New Zealand

²Consult Liaison Psychiatry, Starship Hospital, Auckland District Health Board, New Zealand and South Auckland Clinical Campus, The University of Auckland, New Zealand

³Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

⁴Senior lecturer and Registered Clinical Psychologist, Massey University, Auckland, New Zealand

Cite this paper:
M Alyami, H Alyami, F Sundram and B A Haarhoff. Evaluation of a Visual Metaphor of Suicide Risk Factors: Results from a Pilot Randomized Controlled Trial in Psychology Students. American Journal of Educational Research. 2017; 5(6):606-611. doi: 10.12691/education-5-6-2

Abstract

Background: Although comprehensive knowledge of suicide risk assessment is fundamental, training programs for such an essential skill often include passive and didactic methods that may not facilitate recall. Objectives: To examine the efficacy of a recently published novel visual metaphor (VM) for teaching suicide risk factors as an adjunct to traditional teaching methods in a group of novice learners. Methods: A pilot non-blinded randomized controlled trial (RCT) was conducted. 22 first-year undergraduate psychology students were randomly assigned to either a control group, where they received traditional teaching (TT) or an intervention group, where they received traditional teaching and the visual metaphor (TT+VM). Participants then completed post-learning assessment including immediate free recall of suicide risk factors and knowledge application based on a clinical vignette. Cognitive load and participants’ satisfaction were also assessed. Descriptive statistics and the Mann-Whitney U test were used to analyse the data. Results: The TT+VM group demonstrated significantly better immediate free recall of suicide risk factors (mean= 14.56, SD= 3.2, p=.026), and superior application in the clinical vignette (mean= 14.33, SD= 1.00, p= .036). Furthermore, the TT+VM group also reported significantly less cognitive loading while learning suicide risk factors (mean= 3.44, SD= .88, p=.001) and significantly higher satisfaction levels (mean= 26.44, SD= 3.6, p=.001). The differences between the two groups on these domains ranged between medium and large effect sizes. Conclusions: Preliminary findings show that the use of TT+VM enhanced the learning of suicide risk factors. The VM could be a useful learning tool for novice learners but future large-scale studies are warranted to replicate this positive preliminary effect.

Keywords:
visual metaphor suicide risk factors learning cognitive load theory

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Cramer RJ, Johnson SM, McLaughlin J, Rausch EM, Conroy MA. Suicide risk assessment training for psychology doctoral programs: Core competencies and a framework for training. Training and Education in Professional Psychology. 2013 Feb; 7(1): 1-11.
[2]	Sudak D, Roy A, Sudak H, Lipschitz A, Maltsberger J, Hendin H. Deficiencies in suicide training in primary care specialties: A survey of training directors. Academic Psychiatry. 2007; 31(5): 345-349.
[3]	Schmitz WM, Allen MH, Feldman BN, Gutin NJ, Jahn DR, Kleespies PM, et al. Preventing suicide through improved training in suicide risk assessment and care: An American Association of Suicidology Task Force report addressing serious gaps in US mental health training. Suicide and Life-Threatening Behavior. 2012; 42(3): 292-304.
[4]	Alyami M, Alyami H, Sundram F, Cheung G, Haarhoff BA, Lyndon MP, et al. Enhancing suicide risk assessment: A novel visual metaphor learning tool. Australasian Psychiatry. 2016; 1039856216657695.
[5]	Dexter-Mazza ET, Freeman KA. Graduate training and the treatment of suicidal clients: The students’ perspective. Suicide and Life-Threatening Behavior. 2003; 33(2): 211-8.
[6]	Kleespies PM, Penk WE, Forsyth JP. The stress of patient suicidal behavior during clinical training: Incidence, impact, and recovery. Professional Psychology: Research and Practice. 1993; 24(3): 293-303.
[7]	Davies S, Amos T, Appleby L. How much risk training takes place in mental health services? A national survey of training and policies. Psychiatric Bulletin. 2001; 25(6): 217-9.
[8]	Palmieri G, Forghieri M, Ferrari S, Pingani L, Coppola P, Colombini N, et al. Suicide intervention skills in health professionals: A multidisciplinary comparison. Archives of Suicide Research. 2008 Jun 11; 12(3): 232-7.
[9]	Valente SM. Oncology nurses’ knowledge of suicide evaluation and prevention. Cancer Nursing. 2010 Jul; 33(4): 290-5.
[10]	Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health: A review of systematic reviews. International Journal of Technology Assessment in Health Care. 2005; 21(3): 380-385.
[11]	Eppler MJ. A comparison between concept maps, mind maps, conceptual diagrams, and visual metaphors as complementary tools for knowledge construction and sharing. Information Visualization. 2006 Sep 21; 5(3): 202-10.
[12]	Lakoff G, Johnson M. Metaphors we live by. 2nd ed. Chicago: University of Chicago Press; 2003.
[13]	Klemm WR. What good is learning if you don’t remember it? Journal of Effective Teaching. 2007; 7(1): 61-73.
[14]	Suebsom K, Dahalin ZM. Measuring knowledge transfer as learning outcomes using electronic media. Asia-Pacific collaborative Education Journal. 2010; 6(1): 77-97.
[15]	Lee CY, Wu FC. Factors affecting knowledge transfer and absorptive capacity in multinational corporations. The Journal of International Management Studies. 2010; 5(2): 119-126.
[16]	Paas FG. Training strategies for attaining transfer of problem-solving skill in statistics: A cognitive-load approach. Journal of Educational Psychology. 1992; 84(4): 429-34.
[17]	Szulewski A, Gegenfurtner A, Howes DW, Sivilotti MLA, Merriënboer JJG van. Measuring physician cognitive load: Validity evidence for a physiologic and a psychometric tool. Adv in Health Sci Educ. 2016 Oct 27; 1-18.
[18]	IBM Support. Downloading IBM SPSS Statistics 23 [Internet]. 2016 [cited 2017 Apr 14]. Available from: http://www.ibm.com/support, //www.ibm.com/support/docview.wss?uid=swg24038592
[19]	Cowan N. The magical mystery four: How is working memory capacity limited, and why? Current Directions in Psychological Science. 2010 Feb 1; 19(1): 51-7.
[20]	Sweller J, Ayres PL, Kalyuga S. Cognitive load theory. New York: Springer; 2011. 274 p.
[21]	Schweppe J, Rummer R. Attention, working memory, and long-term memory in multimedia learning: An integrated perspective based on process models of working memory. Educ Psychol Rev. 2014 Jun 1; 26(2): 285-306.
[22]	Kirschner PA. Cognitive load theory: Implications of cognitive load theory on the design of learning. Learning and Instruction. 2002; 12(1): 1-10.
[23]	Clark RC, Nguyen F, Sweller J. Efficiency in learning: Evidence-based guidelines to manage cognitive load. San Francisco, CA: Wiley; 2011.
[24]	Qiao YQ, Shen J, Liang X, Ding S, Chen FY, Shao L, et al. Using cognitive theory to facilitate medical education. BMC Medical Education. 2014; 14(1): 79-86.
[25]	Kalyuga S, Chandler P, Tuovinen J, Sweller J. When problem solving is superior to studying worked examples. Journal of Educational Psychology. 2001; 93(3): 579-88.
[26]	Leahy W, Sweller J. Cognitive load and the imagination effect. Appl Cognit Psychol. 2004 Nov 1; 18(7): 857-75.
[27]	Chi M, Glaser R, Rees E. Expertise in problem solving. In: Sternberg R, editor. Advances in the psychology of human intelligence. Hillsdale, NJ: Erlbaum; 1982. p. 7-75.
[28]	Borgo R, Abdul-Rahman A, Mohamed F, Grant PW, Reppa I, Floridi L, et al. An empirical study on using visual embellishments in visualization. IEEE Transactions on Visualization and Computer Graphics. 2012; 18(12): 2759-2768.
[29]	Paivio A, Csapo K. Picture superiority in free recall: Imagery or dual coding? Cognitive Psychology. 1973 Sep; 5(2): 176-206.
[30]	Paivio A. Mental representations: A dual coding approach. New York: Oxford University Press; 1986.