TY - JOUR AU - Mascret, Nicolas AU - Delbes, Lisa AU - Goulon, Cédric AU - Montagne, Gilles PY - 2025/5/21 TI - Testing an Innovative Gait Training Program in Immersive Virtual Reality for Healthy Older Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e57866 VL - 14 KW - virtual reality KW - VR KW - exercise KW - locomotion KW - adaptive behavior KW - aging KW - accident prevention KW - falls N2 - Background: Impaired gait adaptability is one of the major causes of falls among older adults owing to inappropriate gait adjustments in cluttered environments. Training programs designed to improve gait adaptability behavior in a systemic approach may prevent falls in older adults. Recently, virtual reality (VR) technology has been prominent as a relevant gait training tool because of its training implementation potential. Objective: This study was designed to compare the effectiveness of a VR-based gait training program (VR group) for improving gait adaptability behavior and, thus, reducing the risk of falls relative to a conventional training program such as Nordic walking (NW; NW group). We hypothesized that the VR-based gait training program will lead to greater gait adaptability improvements. Methods: We will be conducting a randomized controlled trial with pretests, posttests, retention tests, and follow-up. In total, 40 healthy independent-living community dwellers (aged between 65 and 80 years) will be allocated, after a general medical examination, to the VR or the NW group for a training program of 6 weeks. Primary outcomes related to gait adaptability capacities (ie, analysis of adjustments made in different locomotor tasks) and acceptance of the VR device (ie, analysis of acceptance) will be assessed before and after the intervention and 1 month after the completion of the training program (retention). A follow-up will be done during the 12 months after the completion of the gait training program. Results: Data collection will begin in September 2025, and the first results are expected in December 2025. Conclusions: The findings of this study may demonstrate the relative relevance of a gait training program in VR versus a conventional one for improving gait adaptability behavior in healthy older adults and, thus, prevent the chances of a fall. International Registered Report Identifier (IRRID): PRR1-10.2196/57866 UR - https://www.researchprotocols.org/2025/1/e57866 UR - http://dx.doi.org/10.2196/57866 UR - http://www.ncbi.nlm.nih.gov/pubmed/40397488 ID - info:doi/10.2196/57866 ER - TY - JOUR AU - Cross, Joseph AU - Kayalackakom, Tarron AU - Robinson, E. Raymond AU - Vaughans, Andrea AU - Sebastian, Roopa AU - Hood, Ricardo AU - Lewis, Courtney AU - Devaraju, Sumanth AU - Honnavar, Prasanna AU - Naik, Sheetal AU - Joseph, Jillwin AU - Anand, Nikhilesh AU - Mohammed, Abdalla AU - Johnson, Asjah AU - Cohen, Eliran AU - Adeniji, Teniola AU - Nnenna Nnaji, Aisling AU - George, Elizabeth Julia PY - 2025/5/20 TI - Assessing ChatGPT?s Capability as a New Age Standardized Patient: Qualitative Study JO - JMIR Med Educ SP - e63353 VL - 11 KW - medical education KW - standardized patient KW - AI KW - ChatGPT KW - virtual patient KW - assessment KW - standardized patients KW - LLM KW - effectiveness KW - medical school KW - qualitative KW - flexibility KW - diagnostic N2 - Background: Standardized patients (SPs) have been crucial in medical education, offering realistic patient interactions to students. Despite their benefits, SP training is resource-intensive and access can be limited. Advances in artificial intelligence (AI), particularly with large language models such as ChatGPT, present new opportunities for virtual SPs, potentially addressing these limitations. Objectives: This study aims to assess medical students? perceptions and experiences of using ChatGPT as an SP and to evaluate ChatGPT?s effectiveness in performing as a virtual SP in a medical school setting. Methods: This qualitative study, approved by the American University of Antigua Institutional Review Board, involved 9 students (5 females and 4 males, aged 22?48 years) from the American University of Antigua College of Medicine. Students were observed during a live role-play, interacting with ChatGPT as an SP using a predetermined prompt. A structured 15-question survey was administered before and after the interaction. Thematic analysis was conducted on the transcribed and coded responses, with inductive category formation. Results: Thematic analysis identified key themes preinteraction including technology limitations (eg, prompt engineering difficulties), learning efficacy (eg, potential for personalized learning and reduced interview stress), verisimilitude (eg, absence of visual cues), and trust (eg, concerns about AI accuracy). Postinteraction, students noted improvements in prompt engineering, some alignment issues (eg, limited responses on sensitive topics), maintained learning efficacy (eg, convenience and repetition), and continued verisimilitude challenges (eg, lack of empathy and nonverbal cues). No significant trust issues were reported postinteraction. Despite some limitations, students found ChatGPT as a valuable supplement to traditional SPs, enhancing practice flexibility and diagnostic skills. Conclusions: ChatGPT can effectively augment traditional SPs in medical education, offering accessible, flexible practice opportunities. However, it cannot fully replace human SPs due to limitations in verisimilitude and prompt engineering challenges. Integrating prompt engineering into medical curricula and continuous advancements in AI are recommended to enhance the use of virtual SPs. UR - https://mededu.jmir.org/2025/1/e63353 UR - http://dx.doi.org/10.2196/63353 ID - info:doi/10.2196/63353 ER - TY - JOUR AU - Thornhill, W. Kurtis AU - Jewer, Jennifer AU - Jacques, Queen AU - Parsons, H. Michael PY - 2025/5/9 TI - Telesimulation in Medical Education for High-Acuity Low-Occurrence Procedures and Clinical Encounters for Physicians and Medical Trainees in Emergency Medicine: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e53565 VL - 14 KW - assessment KW - task performance KW - medical education KW - emergency medicine KW - telesimulation KW - synchronous KW - asynchronous KW - simulation-based KW - physicians KW - medical trainees KW - systematic review KW - proficiency KW - high-acuity low-occurrence KW - HALO N2 - Background: Proficiency in high-acuity low-occurrence (HALO) procedures and clinical encounters is crucial for physicians and medical trainees in emergency medicine. Simulation-based medical education (SBME) provides valuable learning opportunities for these skills. However, accessing SBME can be challenging. Remotely delivered SBME, known as telesimulation, can enhance access to such training, especially in remote locations. Objective: Based on this review, the research team aims to evaluate the effectiveness of telesimulation in enhancing learning outcomes of HALO procedures and clinical encounters in emergency medicine. Methods: A systematic review will be conducted using the electronic databases PubMed, CINAHL, Embase, and Cochrane, focusing on studies published in English from 2011 to the present. The inclusion criteria are emergency physicians and medical trainees as learners; telesimulation sessions where the adequate performance of the procedure or clinical encounter, retention of information, or user feedback after implementing telesimulation were assessed; and original research in the form of a randomized controlled trial or nonrandomized experiments with an intervention and control group and pre- and posttest design. The exclusion criterion is defined as any study that does not fully meet the inclusion criteria. The primary outcome is the effectiveness of telesimulation in enhancing learning outcomes for HALO procedures and clinical encounters for physicians and medical trainees in emergency medicine. The secondary outcomes are the effectiveness of telesimulation for these procedures and clinical encounters delivered asynchronously and synchronously for physicians and medical trainees in emergency medicine. At least two reviewers will conduct data extraction and quality assessment. The primary and secondary outcomes will be analyzed through a systematic narrative synthesis. The methodological quality of comparative studies will be assessed using the Downs and Black checklist. The interrater reliability among the authors will be analyzed with Cohen ?. Results: This project was funded in the summers of 2022 and 2023 by two Summer Undergraduate Research Awards from the Memorial University of Newfoundland Faculty of Medicine. The literature search and screening will begin in April 2025, and the results of the systematic review will be available in the summer of 2026. Conclusions: The results of the systematic review could inform the development of research on telesimulation for HALO procedures in emergency medicine. By investigating this topic, more effective telesimulation sessions can be designed in the future, potentially enhancing the skills of physicians and medical trainees. International Registered Report Identifier (IRRID): PRR1-10.2196/53565 UR - https://www.researchprotocols.org/2025/1/e53565 UR - http://dx.doi.org/10.2196/53565 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53565 ER - TY - JOUR AU - Ong, Chwen Qi AU - Ang, Chin-Siang AU - Lai, Ming Nai AU - Atun, Rifat AU - Car, Josip PY - 2025/5/9 TI - Differences in Expert Perspectives on AI Training in Medical Education: Secondary Analysis of a Multinational Delphi Study JO - J Med Internet Res SP - e72186 VL - 27 KW - artificial intelligence KW - medical education KW - competencies KW - health professions education KW - Delphi study KW - global health education KW - AI UR - https://jmir.jmir.org/2025/1/e72186 UR - http://dx.doi.org/10.2196/72186 ID - info:doi/10.2196/72186 ER - TY - JOUR AU - Miyagami, Taiju AU - Nishizaki, Yuji AU - Shimizu, Taro AU - Yamamoto, Yu AU - Shikino, Kiyoshi AU - Kataoka, Koshi AU - Nojima, Masanori AU - Deshpande, A. Gautam AU - Naito, Toshio AU - Tokuda, Yasuharu PY - 2025/5/9 TI - Evaluating the Use of a Note-Taking App by Japanese Resident Physicians: Nationwide Cross-Sectional Study JO - JMIR Form Res SP - e55087 VL - 9 KW - note-taking KW - applications KW - digital notes KW - resident physicians KW - medical education N2 - Background: Note-taking is a method that has long been used to optimize studying. Recent innovations have seen the introduction of digital note-taking using software apps. Although the current state of digital note-taking has been verified mainly among students, the use and efficacy of digital note-taking by physicians in actual clinical practice remain unknown. Therefore, we sought to understand the characteristics of note-taking residents using a note-taking app and determine whether there is a difference in basic medical knowledge compared to that of nondigital note-taking residents. Objective: This study investigated the use of a digital note-taking app by Japanese resident physicians. Methods: This analytical cross-sectional study was conducted in resident physicians during the General Medicine In-Training Examination (GM-ITE), a clinical competency examination for resident physicians. The GM-ITE is a multiple-choice test with a maximum score of 80 points. Using a structured questionnaire, we collected data on the sociodemographic characteristics (sex, age, postgraduate year [PGY], or others), clinical training, GM-ITE scores, and the use of an app for note-taking to record case experience. The GM-ITE evaluated the scores by dividing them into 4 groups (groups 1?4), in order from the lowest to the highest. We conducted a multivariate analysis of sociodemographic, clinical training, and GM-ITE score variables to determine the independent predictors of the use of a digital note-taking app. Results: This study included 3833 participants; 1242 (32.4%) were female, 1988 (51.8%) were PGY 1 residents, 2628 (68.6%) were training in a rural area, 3236 (84.4%) were in community-based hospitals, and 1750 (45.3%) were app users. The app users were more likely to be in their PGY 2, to work in a community-based hospital, to have general internal medicine rotation experience, to use online medical resources more frequently, and to have more time for self-study. The results showed that the app users group had a higher GM-ITE score than the nonapp users group (adjusted odds ratio 0.74, 95% CI 0.25 to 1.22; P=.003). Conclusions: To the best of our knowledge, this is the first study to investigate note-taking by physicians in Japan using apps. The app users group had a higher GM-ITE score than the nonapp users, suggesting that they may have higher clinical skills. In the future, we would like to conduct more in-depth research on the facts of note-taking using apps, based on our results. UR - https://formative.jmir.org/2025/1/e55087 UR - http://dx.doi.org/10.2196/55087 ID - info:doi/10.2196/55087 ER - TY - JOUR AU - Wang, Peicheng AU - Wu, Ziye AU - Zhang, Jingfeng AU - He, Yanrong AU - Jiang, Maoqing AU - Zheng, Jianjun AU - Wang, Zhenchang AU - Yang, Zhenghan AU - Chen, Yanhua AU - Zhu, Jiming PY - 2025/5/8 TI - Distance Learning During the COVID-19 Lockdown and Self-Assessed Competency Development Among Radiology Residents in China: Cross-Sectional Survey JO - JMIR Med Educ SP - e54228 VL - 11 KW - radiology residents KW - distance learning KW - mental health status KW - self-assessed competency KW - ACGME competencies KW - Accreditation Council of Graduate Medical Education N2 - Background: During the COVID-19 lockdown, it was difficult for residency training programs to conduct on-site, hands-on training. Distance learning, as an alternative to in-person training, could serve as a viable option during this challenging period, but few studies have assessed its role. Objective: This study aims to investigate the impact of distance learning during the lockdown on residents? self-assessed competency development and to explore the moderating effect of poor mental health on the associations. It is hypothesized that radiology residents who were trained through distance learning during the lockdown were more likely to report higher self-assessed competency compared to those who did not receive organized, formal training. Methods: A cross-sectional survey was conducted in 2021 among all of the radiology residents in 407 radiology residency programs across 31 provinces of China. To estimate the long-term outcomes of radiology residents? training after the initial COVID-19 outbreak, this study measured 6 core competencies developed by the US Accreditation Council for Graduate Medical Education reported by radiology residents. Multiple linear regression and moderating effect analysis were conducted to examine the associations between distance learning, mental health status, and self-assessed competencies. Mental health status moderated the association between distance learning and self-assessed competency of radiology residents. Results: A total of 2381 radiology residents (29.7% of the 8,008 nationwide) met the inclusion criteria and were included in the analysis. Among them, 71.4% (n=1699) received distance learning during the COVID-19 lockdown, and 73.2% (n=1742) reported mental health struggles ranging in severity from slight to extremely severe. Radiology residents who were trained through distance learning (?=0.35, 90% CI 0.24?0.45) were more likely to report higher self-assessed competencies. This was particularly true for the competency of ?interpersonal and communication skills? (?=0.55, 90% CI 0.39?0.70). Whereas, the competency of ?patient care and technical skills? (?=0.14, 90% CI 0.01?0.26) benefited the least from distance learning. Poor mental health significantly moderated the relationship between distance learning and competency (?=?0.15, 90% CI ?0.27 to ?0.02). Conclusions: Distance learning, a means of promoting enabling environments during the COVID-19 lockdown, serves its purpose and helps generally improve residents? self-assessed competencies, though different competency domains benefit unequally. The impact of mental health status calls for special attention so that distance learning can fulfill its potential. UR - https://mededu.jmir.org/2025/1/e54228 UR - http://dx.doi.org/10.2196/54228 ID - info:doi/10.2196/54228 ER - TY - JOUR AU - Elabd, Noor AU - Rahman, Muhammad Zafirah AU - Abu Alinnin, Ibrahim Salma AU - Jahan, Samiyah AU - Campos, Aparecida Luciana AU - Baltatu, Constantin Ovidiu PY - 2025/5/8 TI - Designing Personalized Multimodal Mnemonics With AI: A Medical Student?s Implementation Tutorial JO - JMIR Med Educ SP - e67926 VL - 11 KW - medical education KW - personalized learning KW - prompt engineering KW - multimodal learning KW - memory techniques KW - dual-coding theory KW - student-centered approach KW - student-centered KW - large language model KW - natural language processing KW - NLP KW - machine learning KW - AI KW - ChatGPT KW - medical student KW - digital literacy KW - health care professional N2 - Background: Medical education can be challenging for students as they must manage vast amounts of complex information. Traditional mnemonic resources often follow a standardized approach, which may not accommodate diverse learning styles. Objective: This tutorial presents a student-developed approach to creating personalized multimodal mnemonics (PMMs) using artifical intelligence tools. Methods: This tutorial demonstrates a structured implementation process using ChatGPT (GPT-4 model) for text mnemonic generation and DALL-E 3 for visual mnemonic creation. We detail the prompt engineering framework, including zero-shot, few-shot, and chain-of-thought prompting techniques. The process involves (1) template development, (2) refinement, (3) personalization, (4) mnemonic specification, and (5) quality control. The implementation time typically ranges from 2 to 5 minutes per concept, with 1 to 3 iterations needed for optimal results. Results: Through systematic testing across 6 medical concepts, the implementation process achieved an initial success rate of 85%, improving to 95% after refinement. Key challenges included maintaining medical accuracy (addressed through specific terminology in prompts), ensuring visual clarity (improved through anatomical detail specifications), and achieving integration of text and visuals (resolved through structured review protocols). This tutorial provides practical templates, troubleshooting strategies, and quality control measures to address common implementation challenges. Conclusions: This tutorial offers medical students a practical framework for creating personalized learning tools using artificial intelligence. By following the detailed prompt engineering process and quality control measures, students can efficiently generate customized mnemonics while avoiding common pitfalls. The approach emphasizes human oversight and iterative refinement to ensure medical accuracy and educational value. The elimination of the need for developing separate databases of mnemonics streamlines the learning process. UR - https://mededu.jmir.org/2025/1/e67926 UR - http://dx.doi.org/10.2196/67926 ID - info:doi/10.2196/67926 ER - TY - JOUR AU - Rubio-López, Alberto AU - García Carmona, Rodrigo AU - Zarandieta Román, Laura AU - Rubio Navas, Alejandro AU - González-Pinto, Angel AU - Cardinal-Fernández, Pablo PY - 2025/5/7 TI - Measuring Stress and Perceptions for a Virtual Reality?Based Pericardiocentesis Procedure Simulation for Medical Training: Usability Study JO - JMIR Serious Games SP - e68515 VL - 13 KW - VR KW - pericardiocentesis simulation KW - usability assessment KW - heart rate variability KW - physiological stress KW - simulator sickness KW - System Usability Scale KW - Presence Questionnaire KW - virtual reality N2 - Background: Virtual reality (VR) is increasingly used in medical education, providing immersive environments for training in high-risk procedures such as pericardiocentesis. This lifesaving procedure requires technical precision and induces cognitive and physiological stress. Evaluating both usability and stress responses in a VR-based pericardiocentesis simulation is essential. Heart rate variability (HRV) serves as an objective stress marker, while prior VR experience may influence usability and stress perception. Objectives: This study aimed to assess the usability of a VR-based pericardiocentesis simulation, examine the relationship between usability perceptions and physiological stress (HRV), and determine the impact of prior VR experience on usability scores and stress responses. Methods: A total of 119 final-year medical students participated in a VR pericardiocentesis simulation. Usability was evaluated using the System Usability Scale (SUS), the Post-Study System Usability Questionnaire, the Presence Questionnaire, and the Simulator Sickness Questionnaire. Physiological stress was assessed through HRV parameters, including the root-mean-square of successive differences (rMSSDs), percentage of differences greater than 50 ms (PNN50), low-frequency to high-frequency ratio, and nonlinear HRV indices (SD1/SD2 ratio, Poincaré area). Statistical analyses included descriptive statistics, Spearman correlations, and Mann-Whitney U tests to explore relationships between usability, stress, and prior VR experience. Results: The VR simulation received a mean SUS score of 75.00 (SD 6.41; 95% CI 73.42?76.58), exceeding the general usability threshold of 68 (P=.002). The mean Post-Study System Usability Questionnaire score of 2.92 (SD 1.83; 95% CI 2.55?3.29) indicated moderate satisfaction, while the mean Presence Questionnaire score of 109.46 (SD 9.12; 95% CI 107.88?111.04) reflected strong immersion. Simulator sickness symptoms were mild (mean Simulator Sickness Questionnaire score 12.43, SD 15.41; 95% CI 9.28?15.58), although novice users reported significantly higher nausea levels (P=.02). Physiological stress analysis revealed a mean rMSSD of 281.27 (SD 98.99; 95% CI 259.45?303.09) ms and PNN50 of 56.85% (SD 19.70%; 95% CI 52.23%?61.47%), indicating moderate autonomic balance. A significant negative correlation was observed between HRV parameters (rMSSD and PNN50) and simulator sickness (P=.04; Spearman ?=?0.23), suggesting that higher physiological stress was associated with increased simulator sickness symptoms. Prior VR experience was linked to higher usability scores (SUS +5.2; 95% CI 3.12-7.28; P=.03) and lower simulator sickness symptoms (P=.02) but did not significantly affect HRV markers. Conclusions: VR-based simulations for high-risk medical procedures are effective training tools with high usability (SUS=75) and strong immersion. Simulator sickness correlated with physiological stress, emphasizing the need for design refinements to improve user comfort. Prior VR experience improved usability and reduced simulator sickness but did not significantly impact HRV markers. Future research should refine VR interfaces to balance immersion with minimized cognitive and physical discomfort. UR - https://games.jmir.org/2025/1/e68515 UR - http://dx.doi.org/10.2196/68515 ID - info:doi/10.2196/68515 ER - TY - JOUR AU - Zhou, Shuo AU - Kagoya, Kawala Enid AU - Coria, Alexandra AU - Beck, Alyssa AU - Evert, Jessica AU - Haque, Marina AU - Lamb, M. Molly AU - Rule, RL Amy AU - Umphrey, Lisa PY - 2025/5/7 TI - Income-Based Disparities in Perceived Benefits and Challenges of Virtual Global Health Activities During the COVID-19 Pandemic: Mixed Methods Analysis JO - J Med Internet Res SP - e63066 VL - 27 KW - global health KW - virtual KW - in-person KW - perceived benefits and challenges KW - COVID-19 pandemic KW - medical education N2 - Background: Global health activities (GHAs) can potentially reduce health disparities by facilitating resource sharing, promoting medical education and professional development worldwide, and enhancing collaboration among high-income countries (HICs) and low- and middle-income countries (LMICs). However, the COVID-19 pandemic disrupted in-person GHAs due to strict infection control and travel restrictions. To ensure the continuity of GHAs and further address health inequity, virtual GHAs (VGHAs) are gaining traction. Objective: Our research aimed to understand how people perceive the benefits and challenges of VGHAs, analyze and compare whether HIC and LMIC respondents have different perceptions of virtual and in-person GHAs, and summarize suggestions for improvement to inform the future development of VGHAs. Methods: We conducted a cross-sectional web-based survey during the COVID-19 pandemic in early 2022. Eligible participants were adult students, trainees, or professionals who participated in, created, taught, or facilitated GHAs. We thematically analyzed participants? free-text responses regarding their perceptions of the benefits and challenges of virtual and in-person GHAs. The patterns differed depending on whether respondents were from HICs or LMICs; thus, we compared frequencies of each theme between the 2 groups. Results: A total of 154 respondents from 34 countries were included in the analysis. Key benefits of VGHAs were improved access to global health resources or content, reduced cost, easier scheduling and planning, expanded remote participation, and wider participation and reach. The themes that emerged as challenges of VGHAs included a lack of infrastructure to engage virtually, being less motivated and engaged, a lack of in-person and hands-on experience, and challenges with virtual communication and collaboration. LMIC respondents, compared to HIC counterparts, were more likely to identify reduced cost (26/67, 39% LMIC compared to 20/87, 23% HIC; ?21=4.5; P=.03) and expanding knowledge, experience, or skills (15/67, 22% LMIC compared to 8/87, 9% HIC; ?21=5.2; P=.02) as benefits of VGHAs, lack of infrastructure to engage virtually as a challenge of VGHAs (38/67, 57% LMIC compared to 31/87, 36% HIC; ?21=6.8; P=.009), and to suggest improving the content to be more interesting and relevant (6/67, 9% LMIC compared to 1/87, 1% HIC; ?21=5.3, P=.02). In contrast, HIC respondents were more likely to identify fostering continuity of relationship or activities (28/87, 32% HIC compared to 6/67, 9% LMIC; ?21=11.9; P<.001) as a benefit of VGHAs and being less engaged and motivated to participate virtually (43/87, 49% HIC compared to 19/67, 28% LMIC; ?21=7.0; P=.008) as a challenge of VGHAs. Conclusions: Our findings add to the existing literature by understanding how GHA participants from HICs and LMICs perceive the benefits and challenges of VGHAs differently. These data help elucidate what makes VGHAs acceptable to global health partners and suggest improvements to ensure partner needs are served equitably within the partnership. UR - https://www.jmir.org/2025/1/e63066 UR - http://dx.doi.org/10.2196/63066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63066 ER - TY - JOUR AU - Fernández-Alcántara, Manuel AU - Escribano, Silvia AU - Juliá-Sanchis, Rocío AU - Castillo-López, Ana AU - Pérez-Manzano, Antonio AU - Macur, M. AU - Kalender-Smajlovi?, Sedina AU - García-Sanjuán, Sofía AU - Cabañero-Martínez, José María PY - 2025/5/6 TI - Virtual Simulation Tools for Communication Skills Training in Health Care Professionals: Literature Review JO - JMIR Med Educ SP - e63082 VL - 11 KW - communication skills KW - virtual patient KW - virtual simulation KW - health care professionals KW - virtual simulation tool KW - skill training KW - communication KW - heterogeneous KW - heterogeneous characteristics KW - virtual tool KW - patient-centered KW - patient-centered communication KW - implementation N2 - Background: Quality clinical care is supported by effective patient-centered communication. Health care professionals can improve their communication skills through simulation-based training, but our knowledge about virtual simulation and its effectiveness and use in training health professionals and students is still growing rapidly. Objective: The objective of this study was to review the current academic literature to identify and evaluate the virtual simulation tools used to train communication skills in health care students and professionals. Methods: This review was carried out in June 2023 by collecting data from the MEDLINE/PubMed and Web of Science electronic databases. Once applicable studies were identified, we recorded data related to type of technology used, learning objectives, degree of learning autonomy, outcomes, and other details. Results: We found 35 articles that had developed and/or applied a virtual environment for training communication skills aimed at patients, in which 24 different learning tools were identified. Most had been developed to independently train communication skills in English, either generally or in the specific context of medical history (anamnesis) interviews. Many of these tools used a virtual patient that looked like a person and had the ability to vocally respond. Almost half of the tools analyzed allowed the person being trained to respond orally using natural language. Of note, not all these studies described the technology they had used in detail. Conclusions: Many different learning tools with very heterogeneous characteristics are being used for the purposes of communication skills training. Continued research will still be required to develop virtual tools that include the most advanced features to achieve high-fidelity simulation training. UR - https://mededu.jmir.org/2025/1/e63082 UR - http://dx.doi.org/10.2196/63082 ID - info:doi/10.2196/63082 ER - TY - JOUR AU - Mazur, Lukasz AU - Butler, Logan AU - Mitchell, Cody AU - Lashani, Shaian AU - Buchanan, Shawna AU - Fenison, Christi AU - Adapa, Karthik AU - Tan, Xianming AU - An, Selina AU - Ra, Jin PY - 2025/5/1 TI - Effect of Immersive Virtual Reality Teamwork Training on Safety Behaviors During Surgical Cases: Nonrandomized Intervention Versus Controlled Pilot Study JO - JMIR Med Educ SP - e66186 VL - 11 KW - Teamwork Evaluation of Non-Technical Skills KW - TENTS KW - Team Strategies and Tools to Enhance Performance and Patient Safety KW - TeamSTEPPS KW - immersive virtual reality KW - virtual reality KW - VR KW - safety behavior KW - surgical error KW - operating room KW - OR KW - training intervention KW - training KW - pilot study KW - nontechnical skills KW - surgery KW - surgical KW - patient safety KW - medical training KW - medical education N2 - Background: Approximately 4000 preventable surgical errors occur per year in the US operating rooms, many due to suboptimal teamwork and safety behaviors. Such errors can result in temporary or permanent harm to patients, including physical injury, emotional distress, or even death, and can also adversely affect care providers, often referred to as the ?second victim.? Objective: Given the persistence of adverse events in the operating rooms, the objective of this study was to quantify the effect of an innovative and immersive virtual reality (VR)?based educational intervention on (1) safety behaviors of surgeons in the operating rooms and (2) sense-making regarding the overall training experience. Methods: This mixed methods pre- versus postintervention pilot study was conducted in a large academic medical center with 55 operating rooms. Safety behaviors were observed and quantified using validated Teamwork Evaluation of Non-Technical Skills instrument during surgical cases at baseline (101 observations; 83 surgeons) and postimmersive VR based intervention (postintervention: 24 observations within each group; intervention group [with VR training; 10 surgeons] and control [no VR training; 10 surgeons]). VR intervention included a 45-minute immersive VR-based training incorporating a pre- and postdebriefing based on Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) principles to improve safety behaviors. A 2-tailed, 2-sample t-test with adjustments for multiplicity of the tests was used to test for significance in observable safety behaviors between the groupings. The debriefing data underwent analysis through the phenomenological analysis method to gain insights into how participants interpreted the training. Results: Preintervention, all safety behaviors averaged slightly above ?acceptable? scores, with an overall average of 2.2 (range 2?2.3; 0?3 scale). The 10 surgeons that underwent our intervention showed statistically significant (P<.05) improvements in 90% (18/20) of safety behaviors when compared to the 10 surgeons that did not receive the intervention (overall average 2.5, range 2.3?2.7 vs overall average 2.1, range 1.9?2.2). Our qualitative analysis based on 492 quotes from participants suggests that the observed behavioral changes are a result of an immersive experience and sense-making of key TeamSTEPPS training concepts. Conclusions: VR-based immersive training intervention focused on TeamSTEPPS principles seems effective in improving safety behaviors in the operating rooms as quantified via observations using the Teamwork Evaluation of Non-Technical Skills instrument. Further research with larger, more diverse sample sizes is needed to confirm the generalizability of these findings. International Registered Report Identifier (IRRID): RR2-10.2196/40445. UR - https://mededu.jmir.org/2025/1/e66186 UR - http://dx.doi.org/10.2196/66186 ID - info:doi/10.2196/66186 ER - TY - JOUR AU - Schnetzler, Nicolas AU - Taramarcaz, Victor AU - Herren, Tara AU - Golay, Eric AU - Regard, Simon AU - Mach, François AU - Nasution, Amanta AU - Larribau, Robert AU - Suppan, Melanie AU - Schiffer, Eduardo AU - Suppan, Laurent PY - 2025/4/24 TI - Recruiting Medical, Dental, and Biomedical Students as First Responders in the Immediate Aftermath of the COVID-19 Pandemic: Prospective Follow-Up Study JO - JMIR Med Educ SP - e63018 VL - 11 KW - basic life support KW - out-of-hospital cardiac arrest KW - cardiopulmonary resuscitation KW - e-learning KW - blended learning KW - first responder KW - undergraduate medical education KW - student motivation KW - motivational strategies KW - medical student KW - COVID-19 KW - pandemic KW - life support KW - survival prognosis KW - biomedical students KW - dental students KW - motivational interventions N2 - Background: Basic life support improves survival prognosis after out-of-hospital cardiac arrest, but is too rarely provided before the arrival of professional rescue services. First responder networks have been developed in many regions of the world to decrease the delay between collapse and initiation of resuscitation maneuvers. Their efficiency depends on the number of first responders available and many networks lack potential rescuers. Medical, dental, and biomedical students represent an almost untapped source of potential first responders, and a first study, carried out during the COVID-19 pandemic, led to the recruitment of many of these future professionals even though many restrictions were still in effect. Objective: The objective of this study was to determine the impact of an enhanced strategy on the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. Methods: This was a prospective follow-up study, conducted between November 2021 and March 2022 at the University of Geneva Faculty of Medicine, Geneva, Switzerland. A web-based study platform was used to manage consent, registrations, and certificates. A first motivational intervention was held early in the academic year and targeted all first-year medical, dental, and biomedical students. Participants first answered a questionnaire designed to assess their initial basic life support knowledge before following an e-learning module. Those who completed the module were able to register for a face-to-face training session held by senior medical students. A course certificate was awarded to those who completed these sessions, enabling them to register as first responders on the Save a Life first responder network. Since the number of students who had enlisted as first responders 2 months after the motivational intervention was markedly lower than expected, a second, unplanned motivational intervention was held in an attempt to recruit more students. Results: Out of a total of 674 first-year students, 19 (2.5%) students had registered as first responders after the first motivational intervention. This was significantly less than the proportion achieved through the initial study (48/529, 9.1%; P<.001). The second motivational intervention led to the enrollment of 7 more students (26/674, 3.9%), a figure still significantly lower than that of the original study (P<.001). At the end of the study, 76 (11.3%) students had been awarded a certificate of competence. Conclusions: Contrary to expectations, an earlier presentation during the academic year outside the COVID restriction period did not increase the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. The reasons underlying this drop in motivation should be explored to enable the design of focused motivational interventions. UR - https://mededu.jmir.org/2025/1/e63018 UR - http://dx.doi.org/10.2196/63018 ID - info:doi/10.2196/63018 ER - TY - JOUR AU - Baldridge, S. Abigail AU - Odukwe, Adaora AU - Dabiri, Olabisi AU - Mobisson, Nneka L. AU - Munnee, Moosa Maria AU - Ogboye, Ayoposi AU - Aryee, Korkoi Dorothy Naa AU - Mwale, Rodrick AU - Akpakli, Jonas AU - Orji, A. Ikechukwu AU - Okoli, B. Rosemary C. AU - Ripiye, R. Nanna AU - Ojji, B. Dike AU - Huffman, D. Mark AU - Kandula, R. Namratha AU - Hirschhorn, R. Lisa PY - 2025/4/24 TI - Implementation of the Extension for Community Healthcare Outcomes Model for Hypertension Education of Frontline Health Care Workers in the Federal Capital Territory, Nigeria: Explanatory Sequential Mixed Methods Evaluation JO - J Med Internet Res SP - e66351 VL - 27 KW - hypertension KW - implementation KW - primary care KW - education KW - Kirkpatrick model N2 - Background: The Extension for Community Healthcare Outcomes (ECHO) model was adapted for hypertension education of community health extension workers in the Federal Capital Territory, Nigeria, and delivered as a 7-part series. Objective: This study aims to evaluate implementation outcomes of the hypertension ECHO series mapped to the first 3 levels of the Kirkpatrick model. Outcomes included reach, appropriateness (level 1), effectiveness (level 2), and penetration (level 3). Methods: From August 2022 to April 2023, 7 hypertension ECHO sessions were delivered via Zoom (Zoom Video Communications, Inc) to a health care worker audience including targeted community health extension workers at 12 primary health centers (PHCs) in the Hypertension Treatment in Nigeria Program. Health care workers provided demographic information, engaged in pre- and postsession knowledge quizzes, and shared feedback during live sessions. Surveys were sent to health care workers at 12 PHCs approximately 1 month after each session to ask about the use of the presented material and focus group discussions were performed with these health care workers after the ECHO program concluded. Qualitative and quantitative results were evaluated using an explanatory sequential mixed methods design wherein qualitative data were used to help explain outcomes and variability among participants. Results: Across 7 ECHO sessions, a total of 1407 live participants were documented. Participants largely found the program was acceptable, with more than 97% of respondents reporting that the session was useful. Postsession knowledge scores increased (range: 2.3%-10.5%) relative to presession scores demonstrating moderate effectiveness. Among 12 PHCs, most (more than 70%) health care workers applied information learned in each session to provide patient care. In 6 focus group discussions, with 31 health care workers (n=15; 48% community health extension workers), participants reported that network connectivity and clinical demands were barriers to live participation and expressed preferences for blended training and asynchronous resources. Conclusions: Results show that a hypertension ECHO program adapted for community health extension workers effectively increased knowledge among participants and was useful to a majority. Insights gained may inform the scaling of remote hypertension education programs for community health extension workers in similar settings. Trial Registration: ClinicalTrials.gov NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154 UR - https://www.jmir.org/2025/1/e66351 UR - http://dx.doi.org/10.2196/66351 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66351 ER - TY - JOUR AU - Herman, Patricia AU - M Kibusi, Stephen AU - C Millanzi, Walter PY - 2025/4/23 TI - Effectiveness of an Interactive Web-Based Clinical Practice Monitoring System on Enhancing Motivation in Clinical Learning Among Undergraduate Nursing Students: Longitudinal Quasi-Experimental Study in Tanzania JO - JMIR Med Educ SP - e45912 VL - 11 KW - clinical monitoring system KW - clinical practice KW - motivation in clinical learning KW - nursing students KW - smartphone KW - mobile phone KW - Ruaha Catholic University KW - web-based teaching N2 - Background: Nursing students? motivation in clinical learning is very important not only for their academic and professional achievement but also for making timely, informed, and appropriate decisions in providing quality and cost-effective care to people. However, the increased number of students and the scarcity of medical supplies, equipment, and patients, just to mention a few, have posed a challenge to educators in identifying and navigating the best approaches to motivate nursing students to learn during their clinical placements. Objective: This study primarily used descriptive and analytical methods to examine undergraduate nursing students? desire for clinical learning both before and after participating in the program. Methods: An uncontrolled longitudinal quasi-experimental study in a quantitative research approach was conducted from February to March 2021 among 589 undergraduate nursing students in Tanzania. Following a baseline evaluation, nursing students were enrolled in an interactive web-based clinical practice monitoring system by their program, institution, names, registration numbers, and emails via unique codes created by the lead investigator and trainers. The system recorded and generated feedback on attendance, clinical placement unit, selected or performed clinical nursing procedures, and in-between and end-of-shift feedback. The linear regression was used to assess the effect of the intervention (interactive web-based clinical practice monitoring system) controlled for other correlated factors on motivation in clinical learning (outcome) among nursing students. Nursing students? sociodemographic characteristics and levels of motivation in clinical learning were analyzed descriptively while a 2-tailed paired sample t test established a comparative mean difference in motivation in clinical learning between the pretest and the posttest. The association between variables was determined using regression analysis set at a 95% CI and 5% statistical significance. Results: The mean age of study participants (N=589) was 23 (SD 2.69) years of which 383 (65.0%) were male. The estimated effect (?) of a 3-week intervention to improve nursing students? motivation in clinical learning was 3.041 (P=.03, 95% CI 1.022-7.732) when controlled for other co-related factors. The mean score for motivation in clinical learning increased significantly from the baseline (mean 9.31, SD 2.315) to the postintervention (mean 20.87, SD 5.504), and this improvement presented a large effect size of 2.743 (P<.001, 95% CI 1.011-4.107). Conclusions: Findings suggest that an interactive web-based clinical practice monitoring system is viable and has the potential to improve undergraduate nursing students? motivation for clinical learning. One alternative clinical pedagogy that educators in nursing education can use to facilitate clinical learning activities and develop motivated undergraduate nursing students is the integration of such technology throughout nursing curricula. UR - https://mededu.jmir.org/2025/1/e45912 UR - http://dx.doi.org/10.2196/45912 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45912 ER - TY - JOUR AU - Wang, Zi-Ru AU - Wang, Yunqi AU - Duan, Shuning AU - Chen, Xier AU - Ni, Guoxin PY - 2025/4/18 TI - Effects of an e-Learning Program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]) on Chinese Physical Therapists? Confidence and Knowledge: Randomized Controlled Trial JO - J Med Internet Res SP - e71057 VL - 27 KW - osteoarthritis KW - telehealth KW - exercise therapy KW - e-learning KW - physiotherapist KW - Knee Osteoarthritis Knowledge Scale N2 - Background: Knee osteoarthritis (OA) presents a significant burden in China due to its high prevalence, aging population, and rising obesity rates. Despite clinical guidelines recommending evidence-based care, limited practitioner training and inadequate telehealth integration hinder effective OA management. Objective: The aim of this study was to evaluate the effectiveness of an e-learning program in improving the confidence and knowledge of Chinese physical therapists in managing knee OA and to explore their perceptions of the program. Methods: This was a randomized controlled trial with 2 parallel arms involving 81 rehabilitation practitioners from 18 Chinese provinces. The intervention group completed a 4-week web-based training program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]-Chinese), while the control group received no training. The primary outcome was self-reported confidence in OA management (11-point scale). Secondary outcomes included knowledge (Chinese Knee Osteoarthritis Knowledge Scale [KOAKS]) and likelihood of clinical application of core OA treatments. Process measures and semistructured interviews captured participants? training perceptions. Quantitative data were analyzed using regression models, 2-sided t tests, and descriptive statistics, while thematic analysis was performed on the interview data of 10 participants. Results: A total of 80 participants completed the outcome measures at 4 weeks. The intervention group demonstrated significant improvements in confidence compared to the control group, including managing OA with exercise-based programs (adjusted mean difference=3.27, 95% CI 2.72-3.81), prescribing exercise (adjusted mean difference=3.13, 95% CI 2.55-3.72), and delivering telehealth (adjusted mean difference=4.41, 95% CI 3.77-5.05). KOAKS scores also improved significantly (mean change=9.46); however, certain belief bias related to OA concepts and the use of scans remained unchanged (25/41, 61% and 27/41, 66%, respectively). Approximately 73% (30/41) of the intervention participants rated the course as extremely useful. Interviews emphasized the need for cultural adaptation and practical telehealth training with real-life scenarios to enhance program applicability. Conclusions: The PEAK program improved Chinese practitioners? confidence and knowledge in managing knee OA, underscoring e-learning?s potential to support evidence-based OA care in China. To optimize future implementations, further research strategies could include enhancing cultural relevance, addressing misconceptions, and incorporating practical, real-world training. Trial Registration: Chinese Clinical Trial Register ChiCTR2400091007; https://www.chictr.org.cn/showproj.html?proj=239680 UR - https://www.jmir.org/2025/1/e71057 UR - http://dx.doi.org/10.2196/71057 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71057 ER - TY - JOUR AU - Gashi, Andi AU - Brodmann Maeder, Monika AU - Hennel, K. Eva PY - 2025/4/16 TI - Making Medical Education Courses Visible: Theory-Based Development of a National Database JO - JMIR Med Educ SP - e62838 VL - 11 KW - curriculum mapping KW - faculty development KW - competencies KW - database KW - medical education N2 - Background: Medical education has undergone professionalization during the last decades, and internationally, educators are trained in specific medical education courses also known as ?train the trainer? courses. As these courses have developed organically based on local needs, the lack of a general structure and terminology can confuse and hinder educators? information and development. The first aim of this study was to conduct a national search, analyze the findings, and provide a presentation of medical education courses based on international theoretical frameworks to support Swiss course providers and educators searching for courses. The second aim was to provide a blueprint for such a procedure to be used by the international audience. Objective: In this study, we devised a scholarly approach to sorting and presenting medical education courses to make their content accessible to medical educators. This approach is presented in detailed steps and our openly available exemplary database to make it serve as a blueprint for other settings. Methods: Following our constructivist paradigm, we examined content from medical education courses using a theory-informed inductive data approach. Switzerland served as an example, covering 4 languages and different approaches to medical education. Data were gathered through an online search and a nationwide survey with course providers. The acquired data and a concurrently developed keyword system to standardize course terminology are presented using Obsidian, a software that shows data networks. Results: Our iterative search included several strategies (web search, survey, provider enquiry, and snowballing) and yielded 69 courses in 4 languages, with varying terminology, target audiences, and providers. The database of courses is interactive and openly accessible. An open-access template database structure is also available. Conclusions: This study proposes a novel method for sorting and visualizing medical education courses and the competencies they cover to provide an easy-to-use database, helping medical educators? practical and scholarly development. Notably, our analysis identified a specific emphasis on undergraduate teaching settings, potentially indicating a gap in postgraduate educational offerings. This aspect could be pivotal for future curriculum development and resource allocation. Our method might guide other countries and health care professions, offering a straightforward means of cataloging and making information about medical education courses widely available and promotable. UR - https://mededu.jmir.org/2025/1/e62838 UR - http://dx.doi.org/10.2196/62838 ID - info:doi/10.2196/62838 ER - TY - JOUR AU - Mohd Kassim, Amiruddin Mohd AU - Azli Shah, Yusoff Sidi Muhammad AU - Lim, Yn Jane Tze AU - Mohd Daud, Iryani Tuti PY - 2025/4/15 TI - Online-Based and Technology-Assisted Psychiatric Education for Trainees: Scoping Review JO - JMIR Med Educ SP - e64773 VL - 11 KW - online learning KW - telepsychiatry KW - remote learning KW - virtual KW - training KW - education KW - psychiatry KW - trainees KW - residents N2 - Background: The concept of online learning in medical education has been gaining traction, but whether it can accommodate the complexity of higher-level psychiatric training remains uncertain. Objective: This review aims to identify the various online-based and technology-assisted educational methods used in psychiatric training and to examine the outcomes in terms of trainees? knowledge, skills, and levels of confidence or preference in using such technologies. Methods: A comprehensive search was conducted in PubMed, Cochrane, PsycINFO, Scopus, and ERIC to identify relevant literature from 1991 until 2024. Studies in English and those that had English translations were identified. Studies that incorporated or explored the use of online-based or technology-assisted learning as part of psychiatric training in trainees and had outcomes of interest related to changes in the level of knowledge or skills, changes in the level of preference or confidence in using online-based or technology-assisted learning, and feedback of participants were included. Studies were excluded if they were conducted on populations excluding psychiatric trainees or residents, were mainly descriptive of the concept of the intervention without any relevant study outcome, were not in English or did not have English translations, or were review articles. Results: A total of 82 articles were included in the review. The articles were divided into 3 phases: prior to 2015, 2015 to 2019 (prepandemic), and 2020 onward (postpandemic). Articles mainly originated from Western countries, and there was a significant increase in relevant studies after the pandemic. There were 5 methods identified, namely videoconference, online modules/e-learning, virtual patients, software/applications, and social media. These were applied in various aspects of psychiatric education, such as theory knowledge, skills training, psychotherapy supervision, and information retrieval. Conclusions: Videoconference-based learning was the most widely implemented approach, followed by online modules and virtual patients. Despite the outcome heterogeneity and small sample sizes in the included studies, the application of such approaches may have utility in terms of knowledge and skills attainment and could be beneficial for the training of future psychiatrists, especially those in underserved low- and middle-income countries. UR - https://mededu.jmir.org/2025/1/e64773 UR - http://dx.doi.org/10.2196/64773 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64773 ER - TY - JOUR AU - Gavarkovs, Adam AU - Miller, Erin AU - Coleman, Jaimie AU - Gunasegaran, Tharsiga AU - Kusurkar, A. Rashmi AU - Kulasegaram, Kulamakan AU - Anderson, Melanie AU - Brydges, Ryan PY - 2025/4/11 TI - Motivation Theories and Constructs in Experimental Studies of Online Instruction: Systematic Review and Directed Content Analysis JO - JMIR Med Educ SP - e64179 VL - 11 KW - motivation KW - internet KW - systematic review KW - experimental studies KW - online instruction KW - educator KW - learner KW - researcher KW - health professional KW - education KW - tool-kit KW - autonomy N2 - Background: The motivational design of online instruction is critical in influencing learners? motivation. Given the multifaceted and situated nature of motivation, educators need access to a range of evidence-based motivational design strategies that target different motivational constructs (eg, interest or confidence). Objective: This systematic review and directed content analysis aimed to catalog the motivational constructs targeted in experimental studies of online motivational design strategies in health professions education. Identifying which motivational constructs have been most frequently targeted by design strategies?and which remain under-studied?can offer valuable insights into potential areas for future research. Methods: Medline, Embase, Emcare, PsycINFO, ERIC, and Web of Science were searched from 1990 to August 2022. Studies were included if they compared online instructional design strategies intending to support a motivational construct (eg, interest) or motivation in general among learners in licensed health professions. Two team members independently screened and coded the studies, focusing on the motivational theories that researchers used and the motivational constructs targeted by their design strategies. Motivational constructs were coded into the following categories: intrinsic value beliefs, extrinsic value beliefs, competence and control beliefs, social connectedness, autonomy, and goals. Results: From 10,584 records, 46 studies were included. Half of the studies (n=23) tested strategies aimed at making instruction more interesting, enjoyable, and fun (n=23), while fewer studies tested strategies aimed at influencing extrinsic value beliefs (n=9), competence and control beliefs (n=6), social connectedness (n=4), or autonomy (n=2). A focus on intrinsic value beliefs was particularly evident in studies not informed by a theory of motivation. Conclusions: Most research in health professions education has focused on motivating learners by making online instruction more interesting, enjoyable, and fun. We recommend that future research expand this focus to include other motivational constructs, such as relevance, confidence, and autonomy. Investigating design strategies that influence these constructs would help generate a broader toolkit of strategies for educators to support learners? motivation in online settings. Trial Registration: PROSPERO CRD42022359521; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022359521 UR - https://mededu.jmir.org/2025/1/e64179 UR - http://dx.doi.org/10.2196/64179 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64179 ER - TY - JOUR AU - Bolgova, Olena AU - Shypilova, Inna AU - Mavrych, Volodymyr PY - 2025/4/10 TI - Large Language Models in Biochemistry Education: Comparative Evaluation of Performance JO - JMIR Med Educ SP - e67244 VL - 11 KW - ChatGPT KW - Claude KW - Gemini KW - Copilot KW - biochemistry KW - LLM KW - medical education KW - artificial intelligence KW - NLP KW - natural language processing KW - machine learning KW - large language model KW - AI KW - ML KW - comprehensive analysis KW - medical students KW - GPT-4 KW - questionnaire KW - medical course KW - bioenergetics N2 - Background: Recent advancements in artificial intelligence (AI), particularly in large language models (LLMs), have started a new era of innovation across various fields, with medicine at the forefront of this technological revolution. Many studies indicated that at the current level of development, LLMs can pass different board exams. However, the ability to answer specific subject-related questions requires validation. Objective: The objective of this study was to conduct a comprehensive analysis comparing the performance of advanced LLM chatbots?Claude (Anthropic), GPT-4 (OpenAI), Gemini (Google), and Copilot (Microsoft)?against the academic results of medical students in the medical biochemistry course. Methods: We used 200 USMLE (United States Medical Licensing Examination)?style multiple-choice questions (MCQs) selected from the course exam database. They encompassed various complexity levels and were distributed across 23 distinctive topics. The questions with tables and images were not included in the study. The results of 5 successive attempts by Claude 3.5 Sonnet, GPT-4?1106, Gemini 1.5 Flash, and Copilot to answer this questionnaire set were evaluated based on accuracy in August 2024. Statistica 13.5.0.17 (TIBCO Software Inc) was used to analyze the data?s basic statistics. Considering the binary nature of the data, the chi-square test was used to compare results among the different chatbots, with a statistical significance level of P<.05. Results: On average, the selected chatbots correctly answered 81.1% (SD 12.8%) of the questions, surpassing the students? performance by 8.3% (P=.02). In this study, Claude showed the best performance in biochemistry MCQs, correctly answering 92.5% (185/200) of questions, followed by GPT-4 (170/200, 85%), Gemini (157/200, 78.5%), and Copilot (128/200, 64%). The chatbots demonstrated the best results in the following 4 topics: eicosanoids (mean 100%, SD 0%), bioenergetics and electron transport chain (mean 96.4%, SD 7.2%), hexose monophosphate pathway (mean 91.7%, SD 16.7%), and ketone bodies (mean 93.8%, SD 12.5%). The Pearson chi-square test indicated a statistically significant association between the answers of all 4 chatbots (P<.001 to P<.04). Conclusions: Our study suggests that different AI models may have unique strengths in specific medical fields, which could be leveraged for targeted support in biochemistry courses. This performance highlights the potential of AI in medical education and assessment. UR - https://mededu.jmir.org/2025/1/e67244 UR - http://dx.doi.org/10.2196/67244 ID - info:doi/10.2196/67244 ER - TY - JOUR AU - Jourdi, Georges AU - Selmi, Mayssa AU - Gaussem, Pascale AU - Truchot, Jennifer AU - Margaill, Isabelle AU - Siguret, Virginie PY - 2025/4/10 TI - Evaluation of the Inverted Classroom Approach in a Case-Study Course on Antithrombotic Drug Use in a PharmD Curriculum: French Monocentric Randomized Study JO - JMIR Med Educ SP - e67419 VL - 11 KW - antithrombotic drugs KW - case-study course KW - inverted classroom KW - pharmacy students KW - traditional educational approach KW - medical education N2 - Background: Appropriate antithrombotic drug use is crucial knowledge for pharmacy students. Objective: We sought to compare the inverted classroom (IC) approach to a traditional question-and-answer educational approach with the aim of enhancing pharmacy students? engagement with a case-study course on antithrombotic drug use. Methods: Third-year PharmD (Doctor of Pharmacy) students from Paris Cité University were randomly assigned to control (n=171) and IC (n=175) groups. The latter were instructed to read and prepare the preprovided course material 1 week before the in-class session to assume the instructor role on the target day, whereas students of the control group attended a traditional case-study course carried out by the same instructor. All students completed pre- and posttest multiple-choice questions surveys assessing their knowledge levels as well as stress, empathy, and satisfaction questionnaires. Results: A significantly higher participation rate was observed in the control group (93/171, 54%) compared to the IC group (65/175, 37%; P=.002). Women (110/213, 52%) participated more than men (48/133, 36%; P=.002) whatever the group was. Students? knowledge scores from both groups had similar results with no difference neither in the prescore (1.17, SD 0.66 and 1.24, SD 0.72 of 5, respectively) nor in the short-term knowledge retention (2.45, SD 0.61 and 2.35, SD 0.73, respectively). The IC approach did not increase student stress or enhance their empathy for the instructor. It increased the preclass workload (P=.02) and was not well received among students. Conclusions: This study showed that the traditional educational approach remains an efficient method for case-study courses in the early stages (ie, third-year) of the 6-year PharmD curriculum, yet dynamic methods improving the active role of students in the learning process are still needed. UR - https://mededu.jmir.org/2025/1/e67419 UR - http://dx.doi.org/10.2196/67419 ID - info:doi/10.2196/67419 ER - TY - JOUR AU - Wei, Bin AU - Yao, Lili AU - Hu, Xin AU - Hu, Yuxiang AU - Rao, Jie AU - Ji, Yu AU - Dong, Zhuoer AU - Duan, Yichong AU - Wu, Xiaorong PY - 2025/4/10 TI - Evaluating the Effectiveness of Large Language Models in Providing Patient Education for Chinese Patients With Ocular Myasthenia Gravis: Mixed Methods Study JO - J Med Internet Res SP - e67883 VL - 27 KW - LLM KW - large language models KW - ocular myasthenia gravis KW - patient education KW - China KW - effectiveness KW - deep learning KW - artificial intelligence KW - health care KW - accuracy KW - applicability KW - neuromuscular disorder KW - extraocular muscles KW - ptosis KW - diplopia KW - ophthalmology KW - ChatGPT KW - clinical practice KW - digital health N2 - Background: Ocular myasthenia gravis (OMG) is a neuromuscular disorder primarily affecting the extraocular muscles, leading to ptosis and diplopia. Effective patient education is crucial for disease management; however, in China, limited health care resources often restrict patients? access to personalized medical guidance. Large language models (LLMs) have emerged as potential tools to bridge this gap by providing instant, AI-driven health information. However, their accuracy and readability in educating patients with OMG remain uncertain. Objective: The purpose of this study was to systematically evaluate the effectiveness of multiple LLMs in the education of Chinese patients with OMG. Specifically, the validity of these models in answering patients with OMG-related questions was assessed through accuracy, completeness, readability, usefulness, and safety, and patients? ratings of their usability and readability were analyzed. Methods: The study was conducted in two phases: 130 choice ophthalmology examination questions were input into 5 different LLMs. Their performance was compared with that of undergraduates, master?s students, and ophthalmology residents. In addition, 23 common patients with OMG-related patient questions were posed to 4 LLMs, and their responses were evaluated by ophthalmologists across 5 domains. In the second phase, 20 patients with OMG interacted with the 2 LLMs from the first phase, each asking 3 questions. Patients assessed the responses for satisfaction and readability, while ophthalmologists evaluated the responses again using the 5 domains. Results: ChatGPT o1-preview achieved the highest accuracy rate of 73% on 130 ophthalmology examination questions, outperforming other LLMs and professional groups like undergraduates and master?s students. For 23 common patients with OMG-related questions, ChatGPT o1-preview scored highest in correctness (4.44), completeness (4.44), helpfulness (4.47), and safety (4.6). GEMINI (Google DeepMind) provided the easiest-to-understand responses in readability assessments, while GPT-4o had the most complex responses, suitable for readers with higher education levels. In the second phase with 20 patients with OMG, ChatGPT o1-preview received higher satisfaction scores than Ernie 3.5 (Baidu; 4.40 vs 3.89, P=.002), although Ernie 3.5?s responses were slightly more readable (4.31 vs 4.03, P=.01). Conclusions: LLMs such as ChatGPT o1-preview may have the potential to enhance patient education. Addressing challenges such as misinformation risk, readability issues, and ethical considerations is crucial for their effective and safe integration into clinical practice. UR - https://www.jmir.org/2025/1/e67883 UR - http://dx.doi.org/10.2196/67883 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67883 ER - TY - JOUR AU - El Arab, Adel Rabie AU - Al Moosa, Abdulaziz Omayma AU - Abuadas, H. Fuad AU - Somerville, Joel PY - 2025/4/4 TI - The Role of AI in Nursing Education and Practice: Umbrella Review JO - J Med Internet Res SP - e69881 VL - 27 KW - artificial intelligence KW - nursing practice KW - nursing education KW - ethical implications KW - social implications KW - AI integration KW - AI literacy KW - ethical frameworks N2 - Background: Artificial intelligence (AI) is rapidly transforming health care, offering substantial advancements in patient care, clinical workflows, and nursing education. Objective: This umbrella review aims to evaluate the integration of AI into nursing practice and education, with a focus on ethical and social implications, and to propose evidence-based recommendations to support the responsible and effective adoption of AI technologies in nursing. Methods: We included systematic reviews, scoping reviews, rapid reviews, narrative reviews, literature reviews, and meta-analyses focusing on AI integration in nursing, published up to October 2024. A new search was conducted in January 2025 to identify any potentially eligible reviews published thereafter. However, no new reviews were found. Eligibility was guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework; databases (PubMed or MEDLINE, CINAHL, Web of Science, Embase, and IEEE Xplore) were searched using comprehensive keywords. Two reviewers independently screened records and extracted data. Risk of bias was assessed with Risk of Bias in Systematic Reviews (ROBIS) and A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2), which we adapted for systematic and nonsystematic review types. A thematic synthesis approach, conducted independently by 2 reviewers, identified recurring patterns across the included reviews. Results: The search strategy yielded 18 eligible studies after screening 274 records. These studies encompassed diverse methodologies and focused on nursing professionals, students, educators, and researchers. First, ethical and social implications were consistently highlighted, with studies emphasizing concerns about data privacy, algorithmic bias, transparency, accountability, and the necessity for equitable access to AI technologies. Second, the transformation of nursing education emerged as a critical area, with an urgent need to update curricula by integrating AI-driven educational tools and fostering both technical competencies and ethical decision-making skills among nursing students and professionals. Third, strategies for integration were identified as essential for effective implementation, calling for scalable models, robust ethical frameworks, and interdisciplinary collaboration, while also addressing key barriers such as resistance to AI adoption, lack of standardized AI education, and disparities in technology access. Conclusions: AI holds substantial promises for revolutionizing nursing practice and education. However, realizing this potential necessitates a strategic approach that addresses ethical concerns, integrates AI literacy into nursing curricula, and ensures equitable access to AI technologies. Limitations of this review include the heterogeneity of included studies and potential publication bias. Our findings underscore the need for comprehensive ethical frameworks and regulatory guidelines tailored to nursing applications, updated nursing curricula to include AI literacy and ethical training, and investments in infrastructure to promote equitable AI access. Future research should focus on developing standardized implementation strategies and evaluating the long-term impacts of AI integration on nursing practice and patient outcomes. UR - https://www.jmir.org/2025/1/e69881 UR - http://dx.doi.org/10.2196/69881 UR - http://www.ncbi.nlm.nih.gov/pubmed/40072926 ID - info:doi/10.2196/69881 ER - TY - JOUR AU - Zhang, Manlin AU - Zhao, Tianyu PY - 2025/4/2 TI - Citation Accuracy Challenges Posed by Large Language Models JO - JMIR Med Educ SP - e72998 VL - 11 KW - chatGPT KW - medical education KW - Saudi Arabia KW - perceptions KW - knowledge KW - medical students KW - faculty KW - chatbot KW - qualitative study KW - artificial intelligence KW - AI KW - AI-based tools KW - universities KW - thematic analysis KW - learning KW - satisfaction KW - LLM KW - large language model UR - https://mededu.jmir.org/2025/1/e72998 UR - http://dx.doi.org/10.2196/72998 ID - info:doi/10.2196/72998 ER - TY - JOUR AU - Temsah, Mohamad-Hani AU - Al-Eyadhy, Ayman AU - Jamal, Amr AU - Alhasan, Khalid AU - Malki, H. Khalid PY - 2025/4/2 TI - Authors? Reply: Citation Accuracy Challenges Posed by Large Language Models JO - JMIR Med Educ SP - e73698 VL - 11 KW - ChatGPT KW - Gemini KW - DeepSeek KW - medical education KW - AI KW - artificial intelligence KW - Saudi Arabia KW - perceptions KW - medical students KW - faculty KW - LLM KW - chatbot KW - qualitative study KW - thematic analysis KW - satisfaction KW - RAG retrieval-augmented generation UR - https://mededu.jmir.org/2025/1/e73698 UR - http://dx.doi.org/10.2196/73698 ID - info:doi/10.2196/73698 ER - TY - JOUR AU - Yan, Zelin AU - Liu, Jingwen AU - Fan, Yihong AU - Lu, Shiyuan AU - Xu, Dingting AU - Yang, Yun AU - Wang, Honggang AU - Mao, Jie AU - Tseng, Hou-Chiang AU - Chang, Tao-Hsing AU - Chen, Yan PY - 2025/3/31 TI - Ability of ChatGPT to Replace Doctors in Patient Education: Cross-Sectional Comparative Analysis of Inflammatory Bowel Disease JO - J Med Internet Res SP - e62857 VL - 27 KW - AI-assisted KW - patient education KW - inflammatory bowel disease KW - artificial intelligence KW - ChatGPT KW - patient communities KW - social media KW - disease management KW - readability KW - online health information KW - conversational agents N2 - Background: Although large language models (LLMs) such as ChatGPT show promise for providing specialized information, their quality requires further evaluation. This is especially true considering that these models are trained on internet text and the quality of health-related information available online varies widely. Objective: The aim of this study was to evaluate the performance of ChatGPT in the context of patient education for individuals with chronic diseases, comparing it with that of industry experts to elucidate its strengths and limitations. Methods: This evaluation was conducted in September 2023 by analyzing the responses of ChatGPT and specialist doctors to questions posed by patients with inflammatory bowel disease (IBD). We compared their performance in terms of subjective accuracy, empathy, completeness, and overall quality, as well as readability to support objective analysis. Results: In a series of 1578 binary choice assessments, ChatGPT was preferred in 48.4% (95% CI 45.9%-50.9%) of instances. There were 12 instances where ChatGPT?s responses were unanimously preferred by all evaluators, compared with 17 instances for specialist doctors. In terms of overall quality, there was no significant difference between the responses of ChatGPT (3.98, 95% CI 3.93-4.02) and those of specialist doctors (3.95, 95% CI 3.90-4.00; t524=0.95, P=.34), both being considered ?good.? Although differences in accuracy (t521=0.48, P=.63) and empathy (t511=2.19, P=.03) lacked statistical significance, the completeness of textual output (t509=9.27, P<.001) was a distinct advantage of the LLM (ChatGPT). In the sections of the questionnaire where patients and doctors responded together (Q223-Q242), ChatGPT demonstrated inferior performance (t36=2.91, P=.006). Regarding readability, no statistical difference was found between the responses of specialist doctors (median: 7th grade; Q1: 4th grade; Q3: 8th grade) and those of ChatGPT (median: 7th grade; Q1: 7th grade; Q3: 8th grade) according to the Mann-Whitney U test (P=.09). The overall quality of ChatGPT?s output exhibited strong correlations with other subdimensions (with empathy: r=0.842; with accuracy: r=0.839; with completeness: r=0.795), and there was also a high correlation between the subdimensions of accuracy and completeness (r=0.762). Conclusions: ChatGPT demonstrated more stable performance across various dimensions. Its output of health information content is more structurally sound, addressing the issue of variability in the information from individual specialist doctors. ChatGPT?s performance highlights its potential as an auxiliary tool for health information, despite limitations such as artificial intelligence hallucinations. It is recommended that patients be involved in the creation and evaluation of health information to enhance the quality and relevance of the information. UR - https://www.jmir.org/2025/1/e62857 UR - http://dx.doi.org/10.2196/62857 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62857 ER - TY - JOUR AU - Hylander, Johan AU - Gyllencreutz, Lina AU - Haney, Michael AU - Westman, Anton PY - 2025/3/28 TI - Ambulance Commanders? Reluctance to Enter Road Tunnels in Simulated Incidents and the Effects of a Tunnel-Specific e-Learning Course on Decision-Making: Web-Based Randomized Controlled Trial JO - JMIR Form Res SP - e58542 VL - 9 KW - e-learning KW - major incident KW - incident management KW - disaster medicine KW - road tunnels N2 - Background: The optimal response to a major incident in a road tunnel involves efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness. Objective: We aimed to assess decision-making among ambulance commanders in simulated road tunnel incidents after they had participated in a tunnel-specific e-learning course designed to support timely and correct decisions in this context. Methods: We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden who were randomly allocated to a test or control group. The control group (n=10, 50%) received a lecture on general incident management, while the intervention group (n=10, 50%) completed an e-learning course consisting of 5 modules focused on tunnel structure, safety, and collaboration in response. The participants took part in 2 simulation-based assessments for ambulance commander decision-making in major road tunnel incidents 1 month and 6 months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the question regarding how to appropriately enter the road tunnel. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5, 25%), and collected data were analyzed using qualitative content analysis. Results: All 20 participants completed the first simulation, and 16 (80%) completed the second. The main finding was that none (0/20, 0%) of the participants correctly answered the question on entering the tunnel system in the 1-month assessment. There were no significant differences between the groups (P=.59; 2-sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups: ?0.58 points, 95% CI ?1.88 to 0.73; P=.36). The e-learning course was also not associated with a shorter time to completion compared to the nonintervention group in either assessment. Interviews identified 3 categories linked to the main outcome: information (lack of), risk (limited knowledge and equipment), and mitigation (access to maps and aide-mémoire). Conclusions: Participation in a tunnel-specific e-learning course did not result in a measurable change in ambulance commanders? decision-making behavior during simulated road tunnel incidents. The observed hesitation to enter the road tunnel system may have several plausible causes, such as the lack of actionable intelligence and tunnel-specific plans. This novel approach to assessing commander decision-making may be transferable to other educational settings. UR - https://formative.jmir.org/2025/1/e58542 UR - http://dx.doi.org/10.2196/58542 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58542 ER - TY - JOUR AU - Wang, Yongyi AU - Xi, An AU - Wong, K. Stella S. AU - Yam, Kong AU - Leung, Yee Janet Tsin AU - Zhu, Shimin PY - 2025/3/27 TI - Efficacy of a Web-Based Integrated Growth Mindset Intervention on Reducing Anxiety Among Social Work and Counseling Practicum Trainees: Protocol for a 2-Arm Randomized Controlled Trial JO - JMIR Res Protoc SP - e67234 VL - 14 KW - implicit theory KW - growth mindset KW - social work students KW - counselling students KW - practicum KW - anxiety N2 - Background: Practicum is indispensable for the development of professional practitioners; yet, trainees may encounter psychological distress, especially anxiety, brought on by new challenges. Research stated that a positive mindset promotes better learning and mental status. Well-designed interventions have been shown to relieve anxiety and help trainees thrive in their practicums and professions. The proposed study adapted an integrated intervention, We-SMILE (Web-Based Single-Session Intervention of Mindset on Intelligence, Failure, and Emotion), for improving prepracticum anxiety and coping. We-SMILE has the potential to be a low-intensity self-help prepracticum intervention to support students in adjusting their mindsets and overcoming the challenges in practicum. Objective: Using a 2-arm randomized controlled trial, this study aims to examine the efficacy of We-SMILE on reducing anxiety (primary outcome) and enhancing psychological status, psychological well-being, learning orientation, academic self-efficacy, and confidence (secondary outcomes). Methods: A total of 117 students will be recruited from the social work and counseling programs and randomly assigned to existing prepracticum training (training as usual [TAU]) or that plus the We-SMILE. Participants will be assessed repeatedly at 3 time points: baseline, 2 weeks post intervention, and 8 weeks post intervention. The outcomes will be measured by validated items and scales on anxiety, mindsets, psychological well-being, and the Failure Mindset Scale. Recruitment for the pilot study was initiated in May 2024 during social work and counseling prepracticum briefing sessions. Participants were randomly assigned to the intervention or TAU group. The intention-to-treat (ITT) analysis principle and linear regression?based maximum likelihood multilevel models will be used for data analysis. Results: This study has received research ethics approval in May 2024. Participant recruitment started at the end of May 2024, and enrollment was ongoing as of when this protocol was submitted. Data collection and analyses are expected to be complete in 2025. Conclusions: The randomized controlled trial will compare the efficacy of the We-SMILE intervention group and the TAU group. The results of this study will benefit practicum students, fieldwork supervisors, and social work and counseling programs. Trial Registration: ClinicalTrials.gov NCT06509802; https://tinyurl.com/36vkwd63 International Registered Report Identifier (IRRID): DERR1-10.2196/67234 UR - https://www.researchprotocols.org/2025/1/e67234 UR - http://dx.doi.org/10.2196/67234 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67234 ER - TY - JOUR AU - Muthukumar, Radhakrishnan AU - Thepwongsa, Isaraporn AU - Sripa, Poompong AU - Jindawong, Bangonsri AU - Jenwitheesuk, Kamonwan AU - Virasiri, Surapol PY - 2025/3/27 TI - Preclinical Medical Students' Perspectives and Experiences With Structured Web-Based English for Medical Purposes Courses: Cross-Sectional Study JO - JMIR Med Educ SP - e65779 VL - 11 KW - English for medical purposes KW - online course KW - online learning KW - online education KW - medical students KW - medical school KW - online KW - online learners KW - perspectives KW - English KW - English language KW - medical research KW - educational method KW - lesson KW - course KW - instructional designs KW - English for medical professional KW - EMP KW - barriers KW - web-based N2 - Background: English for medical purposes (EMP) is essential for medical students as it serves as a foundational language for medical communication and education. However, students often undervalue its importance within the medical curriculum. Given their demanding schedules and workload, educational methods for EMP must align with their needs. Structured web-based learning offers flexibility and convenience, yet limited research has explored its exclusive application for EMP in undergraduate medical education. Objective: This study aimed to evaluate medical students? perspectives on structured web-based EMP courses and assess their impact on medical English proficiency using objective and subjective measures. Methods: Structured web-based EMP courses were developed based on evidence-based guidelines, addressing barriers to web-based learning during development and implementation. A cross-sectional study was conducted with 535 medical students who completed these courses. Data were collected via questionnaires, the learning management system, and the Khon Kaen University Medical English Test (KKUMET), which assessed proficiency in listening, reading, writing, and speaking. Data were analyzed using descriptive statistics. Results: Of the 535 students, 452 (84.5%) completed the survey. Participants reported confidence in reading (mean 4.11, SD 0.87), vocabulary (mean 4.04, SD 0.84), and listening skills (mean 4, SD 0.89), but lower confidence in writing skills (mean 3.46, SD 1.07). The KKUMET results showed statistically significant improvements in all 4 language skills after course completion (P<.001). The top-rated benefits of the courses were convenience (mean 4.77, SD 0.59), sufficient instruction (mean 4.5, SD 0.85), and clear content (mean 4.41, SD 0.80). Conclusions: Structured web-based EMP courses are relevant and well received by medical students. These courses significantly improve students? medical English proficiency, as evidenced by both subjective feedback and objective measures. Medical educators should consider integrating structured web-based EMP programs to better support students? language proficiency in medical contexts. UR - https://mededu.jmir.org/2025/1/e65779 UR - http://dx.doi.org/10.2196/65779 ID - info:doi/10.2196/65779 ER - TY - JOUR AU - Ba, Hongjun AU - Zhang, Lili AU - He, Xiufang AU - Li, Shujuan PY - 2025/3/26 TI - Knowledge Mapping and Global Trends in Simulation in Medical Education: Bibliometric and Visual Analysis JO - JMIR Med Educ SP - e71844 VL - 11 KW - medical education KW - simulation-based teaching KW - bibliometrics KW - visualization analysis KW - knowledge mapping N2 - Background: With the increasing recognition of the importance of simulation-based teaching in medical education, research in this field has developed rapidly. To comprehensively understand the research dynamics and trends in this area, we conducted an analysis of knowledge mapping and global trends. Objective: This study aims to reveal the research hotspots and development trends in the field of simulation-based teaching in medical education from 2004 to 2024 through bibliometric and visualization analyses. Methods: Using CiteSpace and VOSviewer, we conducted bibliometric and visualization analyses of 6743 articles related to simulation-based teaching in medical education, published in core journals from 2004 to 2024. The analysis included publication trends, contributions by countries and institutions, author contributions, keyword co-occurrence and clustering, and keyword bursts. Results: From 2004 to 2008, the number of articles published annually did not exceed 100. However, starting from 2009, the number increased year by year, reaching a peak of 850 articles in 2024, indicating rapid development in this research field. The United States, Canada, the United Kingdom, Australia, and China published the most articles. Harvard University emerged as a research hub with 1799 collaborative links, although the overall collaboration density was low. Among the 6743 core journal articles, a total of 858 authors were involved, with Lars Konge and Adam Dubrowski being the most prolific. However, collaboration density was low, and the collaboration network was relatively dispersed. A total of 812 common keywords were identified, forming 4189 links. The keywords ?medical education,? ?education,? and ?simulation? had the highest frequency of occurrence. Cluster analysis indicated that ?cardiopulmonary resuscitation? and ?surgical education? were major research hotspots. From 2004 to 2024, a total of 20 burst keywords were identified, among which ?patient simulation,? ?randomized controlled trial,? ?clinical competence,? and ?deliberate practice? had high burst strength. In recent years, ?application of simulation in medical education,? ?3D printing,? ?augmented reality,? and ?simulation training? have become research frontiers. Conclusions: Research on the application of simulation-based teaching in medical education has become a hotspot, with expanding research areas and hotspots. Future research should strengthen interinstitutional collaboration and focus on the application of emerging technologies in simulation-based teaching. UR - https://mededu.jmir.org/2025/1/e71844 UR - http://dx.doi.org/10.2196/71844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71844 ER - TY - JOUR AU - Seel, Mariella AU - Mihalic, Alexander Julian AU - Froschauer, Mathias Stefan AU - Holzner, Bernhard AU - Meier, Jens AU - Gotterbarm, Tobias AU - Holzbauer, Matthias PY - 2025/3/25 TI - Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study JO - JMIR Form Res SP - e65114 VL - 9 KW - carpal tunnel release surgery KW - patient education KW - structured web-based education KW - online information KW - health education literacy KW - web-based KW - health education KW - information seeking KW - carpal tunnel release KW - carpal tunnel surgery KW - non-randomized KW - controlled study KW - self-management KW - perioperative KW - online health information KW - health literacy KW - day surgery KW - online search KW - carpal tunnel KW - carpal N2 - Background: With advancements in anesthesiologic and surgical techniques, many surgeries are now performed as day-surgery procedures, requiring greater responsibilities for self-management from patients during the perioperative process. Online health information often lacks reliability and comprehensibility, posing risks for patients with low health literacy. Carpal tunnel release (CTR) surgery, a common day-surgery procedure, necessitates effective patient education for optimal recovery and self-management. Objective: This study introduces the CTS Academy, a web-based education program designed for patients undergoing CTR day surgery. The study aimed to evaluate the CTS Academy?s impact on patients? health education literacy (HEL) compared with self-directed online information seeking. Methods: A scoping review on education programs focusing on the perioperative process of CTR was conducted before this study. In a nonrandomized controlled study, 60 patients scheduled for CTR were assigned to 2 groups based on the patients? preferences; the test group used the CTS Academy, while the control group performed self-directed online searches. HEL was assessed using the Health Education Literacy of Patients with chronic musculoskeletal diseases (HELP) questionnaire, focusing on patients?s comprehension of medical information (COMPR), patients?s ability to apply health-related information in an everyday life (APPLY), and patient?s ability to communicate with health care professional (COMM). Secondary outcomes included content comprehensibility, patient preferences, platform usability, and clinical carpal tunnel syndrome (CTS)?related parameters. Results: In the scoping review, 17 studies could be identified and included for full-text analysis. Eighteen patients each were included in the test group (13 women and 5 men) and in the control group (11 women and 7 men). The average time spent in the study was 167 and 176 days for the test and control groups, respectively. The test group showed significant improvements in APPLY (mean 28, SD 7.99 vs mean 24, SD 5.14; P<.05) and COMM (mean 30, SD 10.52 vs mean 25, SD 6.01; P=.02) after using the CTS Academy in a longitudinal analysis. No significant changes were observed in the control group. In a comparison between groups, the test group had significantly higher APPLY scores at follow-up (mean 24, SD 5.14 vs mean 33, SD 14.78; P=.044) and fewer comprehension issues at baseline (mean 38, SD 16.60 vs mean 50, SD 19.00; P=.03). The CTS-related knowledge assessment yielded 92% (66/72) versus 90% (65/72) correct answers in the test and control groups, respectively. The test group rated the CTS Academy highly in usability (6.22 of 7.00 points) and utility (6.13 of 7.00 points). Preferences leaned toward using CTS Academy alongside doctor consultations (16/18, 89%) and over self-directed searches (15/18, 84%). No significant differences were found in CTS-related symptoms between groups. Conclusions: The CTS Academy effectively enhanced patients? HEL, especially in applying and communicating medical information. The platform?s usability and utility were rated favorably, and patients preferred it over independent online information seeking. This suggests that structured, web-based education enhances patient self-management during the day surgery process. UR - https://formative.jmir.org/2025/1/e65114 UR - http://dx.doi.org/10.2196/65114 ID - info:doi/10.2196/65114 ER - TY - JOUR AU - Domann, Maximilian AU - Richters, Constanze AU - Stadler, Matthias PY - 2025/3/25 TI - Student Acceptance of Digital Entrustable Professional Activities: Protocol for a Cohort Study JO - JMIR Res Protoc SP - e59326 VL - 14 KW - medical education KW - entrustable professional activities KW - EPAs KW - digital EPAs KW - technology acceptance model N2 - Background: Integrating digital entrustable professional activities (EPAs) and simulations in medical education represents a substantial shift toward competency-based learning. This approach focuses on developing specific skills through manageable units and enhancing proficiency in high-stakes environments. The technology acceptance model provides a framework to evaluate the adoption of these educational technologies, emphasizing the roles of perceived usefulness and ease of use. Objective: This cohort study aims to investigate the acceptance of digital EPAs among medical students within simulated training environments. It seeks to understand how perceived usefulness and ease of use influence this acceptance, guided by the principles of the technology acceptance model. Methods: The cohort study will involve medical students in the clinical phase of their education at Ludwig Maximilians University Munich. The survey, distributed through the Module-6 distributor, will capture their perceptions of digital EPAs. The data will be analyzed using regression analysis. Results: Data collection is anticipated to be complete by April 2025, with analysis concluded by May 2025. The results will provide insights into students? attitudes toward digital EPAs and their willingness to integrate these tools into their learning. Conclusions: This study will contribute to the understanding of digital EPAs? role in medical education, potentially guiding future design and implementation of these tools. While highlighting the importance of perceived usefulness and ease of use, the study also acknowledges limitations in sample size and recruitment methodology, indicating the need for further research with more diverse and larger groups. This research is poised to shape future medical training programs, aligning with the evolving landscape of medical education. International Registered Report Identifier (IRRID): PRR1-10.2196/59326 UR - https://www.researchprotocols.org/2025/1/e59326 UR - http://dx.doi.org/10.2196/59326 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59326 ER - TY - JOUR AU - Govender, Samantha AU - Cochrane, Elizabeth Maria AU - Mogale, Mabina AU - Gordon, Reno AU - Tshephe, Tjodwapi PY - 2025/3/25 TI - Establishing a Digital Health Care Ecosystem in a Health Sciences University in South Africa: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e57821 VL - 14 KW - health sciences KW - digital ecosystem KW - curriculum KW - community engagement KW - tertiary education institutions N2 - Background: Comprehensive and formalized digital health care ecosystems in health sciences tertiary education in South Africa do not currently exist, but they have the potential to influence teaching and learning, research, and community engagement. Objective: A total of 3 key objectives underpin the study, that is, determining the health care curriculum needs and required content for the development of a formalized digital health ecosystem, determining the level of readiness of staff and students to participate in a digital health care ecosystem, and determining whether community engagement and strategic partnerships can contribute to the sustainability of a digital health care ecosystem. Methods: A multipronged approach will be used to address the objectives, with a mixed methods design being undertaken. The qualitative phases will be phenomenological in nature, and triangulation of information along with thematic analysis will be conducted on the collected data. Quantitative data will be collected prospectively and cross-sectionally and analyzed using descriptive analysis. Sampling will include subject experts for the Delphi technique, staff and students at the University, clinical training and education partners, and community leaders. This study has received ethical approval from the Sefako Makgatho Health Sciences University Research and Ethics Committee (SMUREC/H/260/2023:PG). Results: Data collection for the first phase will begin in January 2024 and conclude in December 2024. Phase 2 and 3 of the study will be conducted concurrently, with data collection starting in January 2025 and concluding in December 2026. Conclusions: The establishment of a digital health care ecosystem has the potential to benefit staff, students, and communities through stakeholder collaboration, educational opportunities, research projects, and improved service delivery. International Registered Report Identifier (IRRID): DERR1-10.2196/57821 UR - https://www.researchprotocols.org/2025/1/e57821 UR - http://dx.doi.org/10.2196/57821 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57821 ER - TY - JOUR AU - Andalib, Saman AU - Spina, Aidin AU - Picton, Bryce AU - Solomon, S. Sean AU - Scolaro, A. John AU - Nelson, M. Ariana PY - 2025/3/21 TI - Using AI to Translate and Simplify Spanish Orthopedic Medical Text: Instrument Validation Study JO - JMIR AI SP - e70222 VL - 4 KW - large language models KW - LLM KW - patient education KW - translation KW - bilingual evaluation understudy KW - GPT-4 KW - Google Translate N2 - Background: Language barriers contribute significantly to health care disparities in the United States, where a sizable proportion of patients are exclusively Spanish speakers. In orthopedic surgery, such barriers impact both patients? comprehension of and patients? engagement with available resources. Studies have explored the utility of large language models (LLMs) for medical translation but have yet to robustly evaluate artificial intelligence (AI)?driven translation and simplification of orthopedic materials for Spanish speakers. Objective: This study used the bilingual evaluation understudy (BLEU) method to assess translation quality and investigated the ability of AI to simplify patient education materials (PEMs) in Spanish. Methods: PEMs (n=78) from the American Academy of Orthopaedic Surgery were translated from English to Spanish, using 2 LLMs (GPT-4 and Google Translate). The BLEU methodology was applied to compare AI translations with professionally human-translated PEMs. The Friedman test and Dunn multiple comparisons test were used to statistically quantify differences in translation quality. A readability analysis and feature analysis were subsequently performed to evaluate text simplification success and the impact of English text features on BLEU scores. The capability of an LLM to simplify medical language written in Spanish was also assessed. Results: As measured by BLEU scores, GPT-4 showed moderate success in translating PEMs into Spanish but was less successful than Google Translate. Simplified PEMs demonstrated improved readability when compared to original versions (P<.001) but were unable to reach the targeted grade level for simplification. The feature analysis revealed that the total number of syllables and average number of syllables per sentence had the highest impact on BLEU scores. GPT-4 was able to significantly reduce the complexity of medical text written in Spanish (P<.001). Conclusions: Although Google Translate outperformed GPT-4 in translation accuracy, LLMs, such as GPT-4, may provide significant utility in translating medical texts into Spanish and simplifying such texts. We recommend considering a dual approach?using Google Translate for translation and GPT-4 for simplification?to improve medical information accessibility and orthopedic surgery education among Spanish-speaking patients. UR - https://ai.jmir.org/2025/1/e70222 UR - http://dx.doi.org/10.2196/70222 ID - info:doi/10.2196/70222 ER - TY - JOUR AU - Sun, Chao AU - Dai, Huohuo AU - M.J.J. van der Kleij, Rianne AU - Li, Rong AU - Wu, Hengchang AU - Hallensleben, Cynthia AU - Willems, H. Sofie AU - Chavannes, H. Niels PY - 2025/3/18 TI - Digital Health Education for Chronic Lung Disease: Scoping Review JO - J Med Internet Res SP - e53142 VL - 27 KW - digital health education KW - digital health interventions KW - chronic lung disease KW - eHealth KW - scoping review N2 - Background: Chronic lung disease (CLD) is one of the most prevalent noncommunicable diseases globally, significantly burdening patients and increasing health care expenditures. Digital health education (DHE) is increasingly important in chronic disease prevention and management. However, DHE characteristics and impacts in CLD are rarely reported. Objective: This study aimed to provide an overview of the existing literature on DHE for CLD, with a focus on exploring the DHE mediums, content, mechanisms, and reported outcomes in patients with CLD. Methods: We searched PubMed, Web of Science, Embase, PsycINFO, and The Cochrane Library with the assistance of a librarian specialist. Articles were screened by the reviewer team with ASReview (Utrecht University) and EndNote X9 (Clarivate Analytics) based on predefined inclusion and exclusion criteria and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Quality assessment was conducted with the Critical Appraisal Skills Program tool. A descriptive analysis was used to summarize the study characteristics, DHE characteristics, and outcomes. Results: A total of 22 studies were included in this review with medium or high quality. They were published between 2000 and 2022, showing an increasing publication trend with the year, mostly in developed countries (16/22, 73%). Websites and mobile apps (10/22, 45%) were the most widely used DHE medium. Education on self-management skills of CLD was the primary topic (21/22, 95%), 4/22 (18%) of which mentioned DHE mechanisms. The majority of studies reported positive changes in CLD awareness (14/16, 88%), clinical outcomes (3/6, 50%), DHE feasibility, acceptability, and satisfaction (6/8, 75%), lifestyle outcomes (3/3, 100%), and psychosocial outcomes (7/8, 88%). Only 2 studies reported cost-effectiveness (2/22, 9%). Conclusions: Despite the heterogeneity of the study situation, some aspects can be concluded. DHE can improve disease awareness and clinical outcomes in patients with chronic lung disease, with good feasibility, acceptability, and satisfaction through different mediums and learning content. There is still relatively little research among people in low- and middle-income countries. Future research should consider the impact on cost-effectiveness, duration, frequency, and theoretical mechanisms of the DHE to maximize the potential impact. It should also be conducted in the context of health services research to better reflect the real world. UR - https://www.jmir.org/2025/1/e53142 UR - http://dx.doi.org/10.2196/53142 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53142 ER - TY - JOUR AU - Jacobs, Chris PY - 2025/3/18 TI - Examining Multimodal AI Resources in Medical Education: The Role of Immersion, Motivation, and Fidelity in AI Narrative Learning JO - JMIR Med Educ SP - e72190 VL - 11 KW - artificial intelligence KW - cinematic clinical narrative KW - cinemeducation KW - medical education KW - narrative learning KW - AI KW - medical students KW - preclinical education KW - long-term retention KW - pharmacology KW - AI tools KW - GPT-4 KW - image KW - applicability KW - CCN UR - https://mededu.jmir.org/2025/1/e72190 UR - http://dx.doi.org/10.2196/72190 ID - info:doi/10.2196/72190 ER - TY - JOUR AU - Bland, Tyler PY - 2025/3/18 TI - Author?s Reply: Examining Multimodal AI Resources in Medical Education: The Role of Immersion, Motivation, and Fidelity in AI Narrative Learning JO - JMIR Med Educ SP - e72336 VL - 11 KW - artificial intelligence KW - cinematic clinical narrative KW - cinemeducation KW - medical education KW - narrative learning KW - pharmacology KW - AI KW - medical students KW - preclinical education KW - long-term retention KW - AI tools KW - GPT-4 KW - image KW - applicability KW - CCN UR - https://mededu.jmir.org/2025/1/e72336 UR - http://dx.doi.org/10.2196/72336 ID - info:doi/10.2196/72336 ER - TY - JOUR AU - Fleet, Andrew AU - Kaustov, Lilia AU - Belfiore, BR Elio AU - Kapralos, Bill AU - Matava, Clyde AU - Wiegelmann, Julian AU - Giacobbe, Peter AU - Alam, Fahad PY - 2025/3/11 TI - Current Clinical and Educational Uses of Immersive Reality in Anesthesia: Narrative Review JO - J Med Internet Res SP - e62785 VL - 27 KW - virtual reality KW - augmented reality KW - mixed reality KW - anesthesia KW - immersive reality KW - medical education KW - artificial intelligence N2 - Background: The concept of immersive reality (IR), an umbrella term that encompasses virtual reality, augmented reality, and mixed reality, has been established within the health care realm as a potentially valuable tool with numerous applications in both medical education and patient care. Objective: This review aimed to introduce anesthesiologists to the emerging and rapidly evolving literature on IR, its use in anesthesia education, and its transferability into the clinical context. Methods: A review of the relevant literature was conducted using the PubMed database from inception to July 5, 2023. Additional references were identified from the reference lists of selected papers. Results: A total of 51 papers related to the use of IR in anesthesia medical education (including both technical and nontechnical skills) and 63 papers related to applications in clinical practice (eg, preprocedure planning, patient education, and pain management) were included. We present evidence supporting the use of IR in the training and clinical practice of modern anesthesiologists. Conclusions: IR is useful for a variety of applications in anesthesia medical education and has potential advantages over existing simulation approaches. Similarly, IR has demonstrated potential improvements in patient care across several clinical contexts relevant to practicing anesthesiologists. However, many applications remain in the early stages of development, and robust trials are urgently needed to confirm clinical or educational effectiveness and to assess mechanisms, educational validity, and cost-effectiveness. UR - https://www.jmir.org/2025/1/e62785 UR - http://dx.doi.org/10.2196/62785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62785 ER - TY - JOUR AU - Zainal, Humairah AU - Xiao Hui, Xin AU - Thumboo, Julian AU - Kok Yong, Fong PY - 2025/3/7 TI - Organizational Leaders? Views on Digital Health Competencies in Medical Education: Qualitative Semistructured Interview Study JO - JMIR Med Educ SP - e64768 VL - 11 KW - technology KW - medical education KW - curriculum KW - clinical competence KW - digital competence KW - Singapore KW - digital health KW - qualitative study KW - medical school KW - risk KW - comprehensive framework KW - doctor KW - thematic analysis KW - information technology KW - evidence-based KW - undergraduate KW - healthcare systems KW - mobile phone N2 - Background: Digital technologies (DTs) have profoundly impacted health care delivery globally and are increasingly used in clinical practice. Despite this, there is a scarcity of guidelines for implementing training in digital health competencies (DHC) in medical schools, especially for clinical practice. A lack of sustained integration of DHC risks creating knowledge gaps due to a limited understanding of how DT should be used in health care. Furthermore, few studies have explored reasons for this lag, both within and beyond the medical school curriculum. Current frameworks to address these barriers are often specific to individual countries or schools and focus primarily on curriculum design and delivery. A comprehensive framework is therefore required to ensure consistent implementation of DHC across various contexts and times. Objective: This study aims to use Singapore as a case study and examine the perspectives of doctors in organizational leadership positions to identify and analyze the barriers to DHC implementation in the undergraduate curriculum of Singapore?s medical schools. It also seeks to apply the Normalization Process Theory (NPT) to address these barriers and bridge the gap between health care systems and digital health education (DHE) training. Methods: Individual semistructured interviews were conducted with doctors in executive and organizational leadership roles. Participants were recruited through purposive sampling, and the data were interpreted using qualitative thematic analysis. Results: A total of 33 doctors participated, 26 of whom are currently in organizational leadership roles and 7 of whom have previously held such positions. A total of 6 barriers were identified: bureaucratic inertia, lack of opportunities to pursue nontraditional career pathways, limited protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, insufficient integration between medical school education and clinical experience, and poor IT integration within the health care industry. Conclusions: These barriers are also present in other high-income countries experiencing health care digitalization, highlighting the need for a theoretical framework that broadens the generalizability of existing recommendations. Applying the NPT underscores the importance of addressing these barriers to effectively integrate DHC into the curriculum. The active involvement of multiple stakeholders and the incorporation of continuous feedback mechanisms are essential. Our proposed framework provides concrete, evidence-based, and step-by-step recommendations for implementation practice, supporting the introduction of DHC in undergraduate medical education. UR - https://mededu.jmir.org/2025/1/e64768 UR - http://dx.doi.org/10.2196/64768 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053774 ID - info:doi/10.2196/64768 ER - TY - JOUR AU - Koka, Avinash AU - Stuby, Loric AU - Carrera, Emmanuel AU - Gabr, Ahmed AU - O'Connor, Margaret AU - Missilier Peruzzo, Nathalie AU - Waeterloot, Olivier AU - Medlin, Friedrich AU - Rigolet, Fabien AU - Schmutz, Thomas AU - Michel, Patrik AU - Desmettre, Thibaut AU - Suppan, Mélanie AU - Suppan, Laurent PY - 2025/3/4 TI - Asynchronous Distance Learning Performance and Knowledge Retention of the National Institutes of Health Stroke Scale Among Health Care Professionals Using Video or e-Learning: Web-based Randomized Controlled Trial JO - J Med Internet Res SP - e63136 VL - 27 KW - stroke KW - e-learning KW - video KW - medical education KW - randomized controlled trial KW - knowledge retention KW - knowledge acquisition KW - NIHSS KW - National Institutes of Health Stroke Scale KW - learner satisfaction N2 - Background: Stroke treatment has significantly improved over the last decades, but the complexity of stroke cases requires specialized care through dedicated teams with specific knowledge and training. The National Institutes of Health Stroke Scale (NIHSS), widely used to assess neurological deficits and make treatment decisions, is reliable but requires specific training and certification. The traditional didactic training method, based on a video, may not adequately address certain NIHSS intricacies nor engage health care professionals (HCPs) in continuous learning, leading to suboptimal proficiency. In the context of time-constrained clinical settings, highly interactive e-learning could be a promising alternative for NIHSS knowledge acquisition and retention. Objective: This study aimed to assess the efficacy of a highly interactive e-learning module compared with a traditional didactic video in improving NIHSS knowledge among previously trained HCPs. Furthermore, its impact on knowledge retention was also assessed. Methods: A prospective, multicentric, triple-blind, and web-based randomized controlled trial was conducted in 3 Swiss university hospitals, involving HCPs previously trained in NIHSS. Invitations were sent through email, and participants were randomized to either the e-learning or traditional didactic video group through a fully automated process upon self-registration on the website. A 50-question quiz was administered before and after exposure to the training method, and scores were compared to assess knowledge acquisition. The quiz was repeated after 1 month to evaluate retention. Subjective assessments of learning methods that is, user satisfaction, probability of recommendation, perceived difficulty, and perception of duration, were also collected through a Likert-scale questionnaire. A sample size of 72 participants were deemed necessary to have an 80% chance of detecting a difference of 2 points in the postcourse quiz between groups at the 5% significance level. Results: Invitations to participate were sent through email to an estimated 325 HCPs. 174 HCPs enrolled in the study, of which 97 completed the study course. Both learning methods significantly improved NIHSS knowledge, with an improvement of 3.2 (range 2.0-4.3) points in the e-learning group and of 2.1 (1.2-3.1) points in the video group. However, the e-learning group performed better, with higher scores in knowledge acquisition (median score 39.0, IQR 36.0-41.0 vs 37, IQR 34.0-39.0; P=.03) and in knowledge retention (mean score 38.2, 95% CI 36.7-39.7 vs 35.8, 95% CI 34.8-36.8; P=.007). Participants in the e-learning group were more likely to recommend the learning method (77% vs 49%, P=.02), while no significant difference was found for satisfaction (P=.17), perceived duration (P=.17), and difficulty (P=.32). Conclusions: A highly interactive e-learning module was found to be an effective asynchronous method for NIHSS knowledge acquisition and retention in previously NIHSS-trained HCPs, and may now be considered for inclusion in NIHSS training programs for HCPs. International Registered Report Identifier (IRRID): RR2-10.3390/healthcare9111460 UR - https://www.jmir.org/2025/1/e63136 UR - http://dx.doi.org/10.2196/63136 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053772 ID - info:doi/10.2196/63136 ER - TY - JOUR AU - Borg, Alexander AU - Georg, Carina AU - Jobs, Benjamin AU - Huss, Viking AU - Waldenlind, Kristin AU - Ruiz, Mini AU - Edelbring, Samuel AU - Skantze, Gabriel AU - Parodis, Ioannis PY - 2025/3/3 TI - Virtual Patient Simulations Using Social Robotics Combined With Large Language Models for Clinical Reasoning Training in Medical Education: Mixed Methods Study JO - J Med Internet Res SP - e63312 VL - 27 KW - virtual patients KW - clinical reasoning KW - large language models KW - social robotics KW - medical education KW - sustainable learning KW - medical students N2 - Background: Virtual patients (VPs) are computer-based simulations of clinical scenarios used in health professions education to address various learning outcomes, including clinical reasoning (CR). CR is a crucial skill for health care practitioners, and its inadequacy can compromise patient safety. Recent advancements in large language models (LLMs) and social robots have introduced new possibilities for enhancing VP interactivity and realism. However, their application in VP simulations has been limited, and no studies have investigated the effectiveness of combining LLMs with social robots for CR training. Objective: The aim of the study is to explore the potential added value of a social robotic VP platform combined with an LLM compared to a conventional computer-based VP modality for CR training of medical students. Methods: A Swedish explorative proof-of-concept study was conducted between May and July 2023, combining quantitative and qualitative methodology. In total, 15 medical students from Karolinska Institutet and an international exchange program completed a VP case in a social robotic platform and a computer-based semilinear platform. Students? self-perceived VP experience focusing on CR training was assessed using a previously developed index, and paired 2-tailed t test was used to compare mean scores (scales from 1 to 5) between the platforms. Moreover, in-depth interviews were conducted with 8 medical students. Results: The social robotic platform was perceived as more authentic (mean 4.5, SD 0.7 vs mean 3.9, SD 0.5; odds ratio [OR] 2.9, 95% CI 0.0-1.0; P=.04) and provided a beneficial overall learning effect (mean 4.4, SD 0.6 versus mean 4.1, SD 0.6; OR 3.7, 95% CI 0.1-0.5; P=.01) compared with the computer-based platform. Qualitative analysis revealed 4 themes, wherein students experienced the social robot as superior to the computer-based platform in training CR, communication, and emotional skills. Limitations related to technical and user-related aspects were identified, and suggestions for improvements included enhanced facial expressions and VP cases simulating multiple personalities. Conclusions: A social robotic platform enhanced by an LLM may provide an authentic and engaging learning experience for medical students in the context of VP simulations for training CR. Beyond its limitations, several aspects of potential improvement were identified for the social robotic platform, lending promise for this technology as a means toward the attainment of learning outcomes within medical education curricula. UR - https://www.jmir.org/2025/1/e63312 UR - http://dx.doi.org/10.2196/63312 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053778 ID - info:doi/10.2196/63312 ER - TY - JOUR AU - Ecclestone, Amy AU - Linden, Brooke AU - Rose, Jessica AU - Kullar, Kiran PY - 2025/2/27 TI - Mobilizing Health Promotion Through Canada?s Student Mental Health Network: Concurrent, Mixed Methods Process Evaluation JO - JMIR Form Res SP - e58992 VL - 9 KW - mental health KW - health promotion KW - program evaluation KW - postsecondary KW - knowledge translation N2 - Background: Mental health issues among Canadian postsecondary students are prevalent. In tandem, an increased acknowledgment of the need for upstream mental health support has been highlighted. While the majority of institutions offer some form of mental health promotion, research suggests students are failing to access support due to barriers including lack of awareness, geographical and financial barriers, and lack of relevance in offerings. Canada?s Student Mental Health Network is a web-based knowledge mobilization initiative designed to fill these gaps. With content created and curated ?for-students, by-students? and reviewed by subject matter experts, the Network serves as a one-stop shop for evidence-based, mental health support for postsecondary students. Objective: The goal of this research was to conduct the first component of a comprehensive program evaluation of the Network. This paper details a formative, process evaluation after approximately 1 year of operations, with the goal of assessing acceptability and feasibility. Methods: Using a concurrent mixed methods study design, quantitative and qualitative data were simultaneously collected from students in order to evaluate the acceptability and feasibility of the Network as a mental health promotion resource. Quantitative data were automatically collected through Google Analytics via the website over the course of the first year of operations. Data collected included the number of users accessing the website, user engagement, and user ?stickiness.? Quantitative data were used to evaluate both accessibility and feasibility. Qualitative data were collected via individual, digital interviews conducted with a modest sample of students (n=8) across areas and levels of study. Qualitative data derived more detailed insights into user experience and website attributes, as well as feedback on content delivery, providing evidence used to evaluate feasibility. Results: A total of 1200 users globally accessed the Network within the first year of operations, with Canadian users accounting for nearly 90% of total website traffic. An overall 66% engagement rate was observed, with the average user visiting 7 pages per session. Further support for the acceptability of the Network is demonstrated in the Canada-wide reach of the content development and review team. Evidence for the feasibility of the Network was observed through website use statistics indicating the most frequently viewed pages aligned with our goals: providing mental health education and increasing awareness of available resources. Qualitative feedback provided additional context surrounding the feasibility of the space, including positive feedback on the esthetics, relevance, usability, inclusion, and accessibility. Areas for content expansion and improvements to accessibility were also identified. Conclusions: The results of this study provide evidence in support of the feasibility and acceptability of the Network as a web-based knowledge mobilization initiative in support of postsecondary students? mental health and well-being. Future research will pursue a summative, impact assessment to evaluate utility. UR - https://formative.jmir.org/2025/1/e58992 UR - http://dx.doi.org/10.2196/58992 ID - info:doi/10.2196/58992 ER - TY - JOUR AU - Fathalla, M. Ahmed AU - Chiang, Cherie AU - Audehm, Ralph AU - Gorelik, Alexandra AU - Chang, Shanton AU - Yates, J. Christopher AU - Snow, Steve AU - Barmanray, Rahul AU - Price, Sarah AU - Collins, Lucy AU - Wark, D. John PY - 2025/2/25 TI - Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study JO - JMIR Res Protoc SP - e57511 VL - 14 KW - community-based fracture capture bone hub KW - osteoporosis KW - virtual communities of practice KW - continuing professional development KW - primary care physicians KW - web-based learning platform KW - case-based education N2 - Background: The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program?s design and content, showing promising potential. Objective: We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants? interactions, satisfaction levels, and overall experience. Methods: Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs? knowledge and confidence after engagement with the CFC Learning Hub. Results: Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. Conclusions: The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs? needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. International Registered Report Identifier (IRRID): DERR1-10.2196/57511 UR - https://www.researchprotocols.org/2025/1/e57511 UR - http://dx.doi.org/10.2196/57511 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57511 ER - TY - JOUR AU - Ranzato, Erica AU - Holloway, Catherine AU - Bandukda, Maryam PY - 2025/2/25 TI - Use of Educational Technology in Inclusive Primary Education: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e65045 VL - 14 KW - special education needs KW - disabilities KW - primary education KW - inclusive education KW - education technology KW - assistive technology KW - high-income countries KW - systematic review N2 - Background: Educational technology (EdTech) has been instrumental in the last few decades in promoting inclusive education by overcoming various learning barriers and offering tools and opportunities to all students, including those with special educational needs and disabilities (SEND). However, there is limited understanding of current classroom practices and policies and of the effects of the COVID-19 pandemic on EdTech use in the inclusive classroom. Objective: This systematic review aims to outline the current knowledge on the use of EdTech to support the learning of students with SEND in inclusive primary schools in high-income countries. Methods: We followed the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) and the Generalized Systematic Review Registration Form in reporting the details of this protocol. The inclusion criteria for the systematic review require that studies focus on students with SEND who are attending the primary stage of school in high-income countries. The studies can be qualitative or quantitative and should explore the design and use of EdTech with these students. Eligible studies must be published between 2016 and 2024, be peer-reviewed, and be available in English. We systematically searched the ACM, Directory of Open Access Journals, British Educational Index, ERIC, Google Scholar (first 100 records), IEEE, PsycINFO, Scopus, and Web of Science databases. The titles and abstracts of all records will be screened for relevance according to the inclusion criteria. Following this, the full text of the articles will be screened. To ensure the reliability of the screening process, an independent reviewer will screen a percentage of the records for the first screening round. The data extraction process for this systematic review will start with a pilot stage to validate and eventually update the list of entities to be extracted. Following the pilot stage, the final data extraction will be undertaken. An independent reviewer will extract data from a subsample of the records to ensure the reliability of the data extraction process. Results: The database search was conducted in July 2024. The database search identified a total of 547 records. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of January 2025. Conclusions: This study will provide up-to-date evidence of the use of EdTech in inclusive primary school settings in high-income countries and will describe the impact of the COVID-19 pandemic on the use of EdTech with students with SEND. International Registered Report Identifier (IRRID): DERR1-10.2196/65045 UR - https://www.researchprotocols.org/2025/1/e65045 UR - http://dx.doi.org/10.2196/65045 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65045 ER - TY - JOUR AU - Kim, Soeun AU - Kim, Hyejun AU - Kim, Seokjun AU - Lee, Hojae AU - Hammoodi, Ahmed AU - Choi, Yujin AU - Kim, Jin Hyeon AU - Smith, Lee AU - Kim, Seo Min AU - Fond, Guillaume AU - Boyer, Laurent AU - Baik, Wook Sung AU - Lee, Hayeon AU - Park, Jaeyu AU - Kwon, Rosie AU - Woo, Selin AU - Yon, Keon Dong PY - 2025/2/24 TI - Machine Learning?Based Prediction of Substance Use in Adolescents in Three Independent Worldwide Cohorts: Algorithm Development and Validation Study JO - J Med Internet Res SP - e62805 VL - 27 KW - adolescents KW - machine learning KW - substance KW - prediction KW - XGBoost KW - random forest KW - ML KW - substance use KW - adolescent KW - South Korea KW - United States KW - Norway KW - web-based survey KW - survey KW - risk behavior KW - smoking KW - alcohol KW - intervention KW - interventions N2 - Background: To address gaps in global understanding of cultural and social variations, this study used a high-performance machine learning (ML) model to predict adolescent substance use across three national datasets. Objective: This study aims to develop a generalizable predictive model for adolescent substance use using multinational datasets and ML. Methods: The study used the Korea Youth Risk Behavior Web-Based Survey (KYRBS) from South Korea (n=1,098,641) to train ML models. For external validation, we used the Youth Risk Behavior Survey (YRBS) from the United States (n=2,511,916) and Norwegian nationwide Ungdata surveys (Ungdata) from Norway (n=700,660). After developing various ML models, we evaluated the final model?s performance using multiple metrics. We also assessed feature importance using traditional methods and further analyzed variable contributions through SHapley Additive exPlanation values. Results: The study used nationwide adolescent datasets for ML model development and validation, analyzing data from 1,098,641 KYRBS adolescents, 2,511,916 YRBS participants, and 700,660 from Ungdata. The XGBoost model was the top performer on the KYRBS, achieving an area under receiver operating characteristic curve (AUROC) score of 80.61% (95% CI 79.63-81.59) and precision of 30.42 (95% CI 28.65-32.16) with detailed analysis on sensitivity of 31.30 (95% CI 29.47-33.20), specificity of 99.16 (95% CI 99.12-99.20), accuracy of 98.36 (95% CI 98.31-98.42), balanced accuracy of 65.23 (95% CI 64.31-66.17), F1-score of 30.85 (95% CI 29.25-32.51), and area under precision-recall curve of 32.14 (95% CI 30.34-33.95). The model achieved an AUROC score of 79.30% and a precision of 68.37% on the YRBS dataset, while in external validation using the Ungdata dataset, it recorded an AUROC score of 76.39% and a precision of 12.74%. Feature importance and SHapley Additive exPlanation value analyses identified smoking status, BMI, suicidal ideation, alcohol consumption, and feelings of sadness and despair as key contributors to the risk of substance use, with smoking status emerging as the most influential factor. Conclusions: Based on multinational datasets from South Korea, the United States, and Norway, this study shows the potential of ML models, particularly the XGBoost model, in predicting adolescent substance use. These findings provide a solid basis for future research exploring additional influencing factors or developing targeted intervention strategies. UR - https://www.jmir.org/2025/1/e62805 UR - http://dx.doi.org/10.2196/62805 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62805 ER - TY - JOUR AU - Briggs, Blake AU - Mulekar, Madhuri AU - Morales, Hannah AU - Husain, Iltifat PY - 2025/2/21 TI - Comparison of an Emergency Medicine Asynchronous Learning Platform Usage Before and During the COVID-19 Pandemic: Retrospective Analysis Study JO - JMIR Med Educ SP - e58100 VL - 11 KW - asynchronous learning KW - medical education KW - podcast KW - COVID-19 KW - emergency medicine KW - online learning KW - engagement KW - web-based KW - online study KW - online class KW - videoconferencing KW - assessment KW - effectiveness KW - challenges KW - knowledge retention KW - performance KW - virtual learning KW - pre-pandemic KW - post-pandemic N2 - Background: The COVID-19 pandemic challenged medical educators due to social distancing. Podcasts and asynchronous learning platforms help distill medical education in a socially distanced environment. Medical educators interested in providing asynchronous teaching should know how these methods performed during the pandemic. Objective: The purpose of this study was to assess the level of engagement for an emergency medicine (EM) board review podcast and website platform, before and during the COVID-19 pandemic. We measured engagement via website traffic, including such metrics as visits, bounce rate, unique visitors, and page views. We also evaluated podcast analytics, which included total listeners, engaged listeners, and number of plays. Methods: Content was designed after the American Board of EM Model, covering only 1 review question per episode. Website traffic and podcast analytics were studied monthly from 2 time periods of 20 months each, before the pandemic (July 11, 2018, to February 31, 2020) and during the pandemic (May 1, 2020, to December 31, 2021). March and April 2020 data were omitted from the analysis due to variations in closure at various domestic and international locations. Results underwent statistical analysis in March 2022. Results: A total of 132 podcast episodes and 93 handouts were released from July 11, 2018, to December 31, 2021. The mean number of listeners per podcast increased significantly from 2.11 (SD 1.19) to 3.77 (SD 0.76; t test, P<.001), the mean number engaged per podcast increased from 1.72 (SD 1.00) to 3.09 (SD 0.62; t test, P<.001), and the mean number of plays per podcast increased from 42.54 (SD 40.66) to 69.23 (SD 17.54; t test, P=.012). Similarly, the mean number of visits per posting increased from 5.85 (SD 3.28) to 15.39 (SD 3.06; t test, P<.001), the mean number of unique visitors per posting increased from 3.74 (SD 1.83) to 10.41 (SD 2.33; t test, P<.001), and the mean number of page views per posting increased from 17.13 (SD 10.63) to 33.32 (SD 7.01; t test, P<.001). Note that, all measures showed a decrease from November 2021 to December 2021. Conclusions: During the COVID-19 pandemic, there was an increased engagement for our EM board review podcast and website platform over a long-term period, specifically through website visitors and the number of podcast plays. Medical educators should be aware of the increasing usage of web-based education tools, and that asynchronous learning is favorably viewed by learners. Limitations include the inability to view Spotify (Spotify Technology S.A.) analytics during the study period, and confounding factors like increased popularity of social media inadvertently promoting the podcast. UR - https://mededu.jmir.org/2025/1/e58100 UR - http://dx.doi.org/10.2196/58100 ID - info:doi/10.2196/58100 ER - TY - JOUR AU - Abouammoh, Noura AU - Alhasan, Khalid AU - Aljamaan, Fadi AU - Raina, Rupesh AU - Malki, H. Khalid AU - Altamimi, Ibraheem AU - Muaygil, Ruaim AU - Wahabi, Hayfaa AU - Jamal, Amr AU - Alhaboob, Ali AU - Assiri, Assad Rasha AU - Al-Tawfiq, A. Jaffar AU - Al-Eyadhy, Ayman AU - Soliman, Mona AU - Temsah, Mohamad-Hani PY - 2025/2/20 TI - Perceptions and Earliest Experiences of Medical Students and Faculty With ChatGPT in Medical Education: Qualitative Study JO - JMIR Med Educ SP - e63400 VL - 11 KW - ChatGPT KW - medical education KW - Saudi Arabia KW - perceptions KW - knowledge KW - medical students KW - faculty KW - chatbot KW - qualitative study KW - artificial intelligence KW - AI KW - AI-based tools KW - universities KW - thematic analysis KW - learning KW - satisfaction N2 - Background: With the rapid development of artificial intelligence technologies, there is a growing interest in the potential use of artificial intelligence?based tools like ChatGPT in medical education. However, there is limited research on the initial perceptions and experiences of faculty and students with ChatGPT, particularly in Saudi Arabia. Objective: This study aimed to explore the earliest knowledge, perceived benefits, concerns, and limitations of using ChatGPT in medical education among faculty and students at a leading Saudi Arabian university. Methods: A qualitative exploratory study was conducted in April 2023, involving focused meetings with medical faculty and students with varying levels of ChatGPT experience. A thematic analysis was used to identify key themes and subthemes emerging from the discussions. Results: Participants demonstrated good knowledge of ChatGPT and its functions. The main themes were perceptions of ChatGPT use, potential benefits, and concerns about ChatGPT in research and medical education. The perceived benefits included collecting and summarizing information and saving time and effort. However, concerns and limitations centered around the potential lack of critical thinking in the information provided, the ambiguity of references, limitations of access, trust in the output of ChatGPT, and ethical concerns. Conclusions: This study provides valuable insights into the perceptions and experiences of medical faculty and students regarding the use of newly introduced large language models like ChatGPT in medical education. While the benefits of ChatGPT were recognized, participants also expressed concerns and limitations requiring further studies for effective integration into medical education, exploring the impact of ChatGPT on learning outcomes, student and faculty satisfaction, and the development of critical thinking skills. UR - https://mededu.jmir.org/2025/1/e63400 UR - http://dx.doi.org/10.2196/63400 UR - http://www.ncbi.nlm.nih.gov/pubmed/39977012 ID - info:doi/10.2196/63400 ER - TY - JOUR AU - Gerdes, John AU - Schooley, Benjamin AU - Sharp, Dakota AU - Miller, Juliana PY - 2025/2/20 TI - The Design and Evaluation of a Simulation Tool for Audiology Screening Education: Design Science Approach JO - JMIR Form Res SP - e47150 VL - 9 KW - design science KW - audiology KW - simulation KW - hearing screening KW - framework KW - speech pathology KW - training N2 - Background: The early identification of hearing loss and ear disorders is important. Regular screening is recommended for all age groups to determine whether a full hearing assessment is necessary and allow for timely treatment of hearing problems. Procedural training is needed for new speech-language pathology students as well as continuing education for those trained to perform this screening procedure. Limited availability and access to physical training locations can make it difficult to receive the needed training. Objective: The aims of this study were to (1) develop a new hearing screening simulation software platform and (2) assess its effectiveness in training a group of graduate-level speech-language pathology students in hearing screening procedures. Methods: An audiology simulator modeled after the commercial Grason-Stadler GSI39 combination audiometer and tympanometer device was developed to serve as a precursor to traditional face-to-face clinical instruction. A description of the simulator development process, guided by a design science approach, is presented. The initiation phase established the initial criteria for the simulator design. This was followed by an iterative process involving prototype development, review, and critique by the clinical faculty. This feedback served as input for the subsequent iteration. The evaluation of the final prototype involved 33 speech-language pathology graduate students as part of an introductory audiology class. These students were randomly assigned to control (receiving in-person instruction) and test (in-person instruction and simulation tool use) groups. Students in both groups were subsequently evaluated as they performed audiology screenings on human participants and completed a 25-item pretest and posttest survey. Nonparametric Mann-Whitney U tests were conducted on the mean differences between pretest and posttest ordinal survey response data to compare the control and intervention groups. Results: The results indicated that the students who used the simulation tool demonstrated greater confidence in their ability to (1) explain hearing screening procedures to a child (P=.02), (2) determine whether otoscopy results are normal (P=.02), and (3) determine whether otoscopy results are abnormal (P=.03). Open-ended responses indicated that the students found that the hands-on experience provided by the simulator resulted in an easy-to-use and useful learning experience with the audiometer, which increased their confidence in their ability to perform hearing screenings. Conclusions: Software-based education simulation tools for audiology screening may provide a beneficial approach to educating students and professionals in hearing screening training. The tool tested in this study supports individualized, self-paced learning with context-sensitive feedback and performance assessment, incorporating an extensible approach to supporting simulated subjects. UR - https://formative.jmir.org/2025/1/e47150 UR - http://dx.doi.org/10.2196/47150 UR - http://www.ncbi.nlm.nih.gov/pubmed/39977027 ID - info:doi/10.2196/47150 ER - TY - JOUR AU - Escamilla-Sanchez, Alejandro AU - López-Villodres, Antonio Juan AU - Alba-Tercedor, Carmen AU - Ortega-Jiménez, Victoria María AU - Rius-Díaz, Francisca AU - Sanchez-Varo, Raquel AU - Bermúdez, Diego PY - 2025/2/19 TI - Instagram as a Tool to Improve Human Histology Learning in Medical Education: Descriptive Study JO - JMIR Med Educ SP - e55861 VL - 11 KW - medical education KW - medical students KW - histology KW - pathology KW - e-learning KW - computer-based KW - social media KW - Instagram KW - Meta KW - community-oriented KW - usability KW - utility KW - accessibility N2 - Background: Student development is currently taking place in an environment governed by new technologies and social media. Some platforms, such as Instagram or X (previously known as ?Twitter?), have been incorporated as additional tools for teaching and learning processes in higher education, especially in the framework of image-based applied disciplines, including radiology and pathology. Nevertheless, the role of social media in the teaching of core subjects such as histology has hardly been studied, and there are very few reports on this issue. Objective: The aim of this work was to investigate the impact of implementing social media on the ability to learn human histology. For this purpose, a set of voluntary e-learning activities was shared on Instagram as a complement to traditional face-to-face teaching. Methods: The proposal included questionnaires based on multiple-choice questions, descriptions of histological images, and schematic diagrams about the subject content. These activities were posted on an Instagram account only accessible by second-year medical students from the University of Malaga. In addition, students could share their own images taken during the laboratory practice and interact with their peers. Results: Of the students enrolled in Human Histology 2, 85.6% (143/167) agreed to participate in the platform. Most of the students valued the initiative positively and considered it an adequate instrument to improve their final marks. Specifically, 68.5% (98/143) of the student body regarded the multiple-choice questions and image-based questions as the most useful activities. Interestingly, there were statistically significant differences between the marks on the final exam (without considering other evaluation activities) for students who participated in the activity compared with those who did not or barely participated in the activity (P<.001). There were no significant differences by degree of participation between the more active groups. Conclusions: These results provide evidence that incorporating social media may be considered a useful, easy, and accessible tool to improve the learning of human histology in the context of medical degrees. UR - https://mededu.jmir.org/2025/1/e55861 UR - http://dx.doi.org/10.2196/55861 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55861 ER - TY - JOUR AU - Potter, Alison AU - Munsch, Chris AU - Watson, Elaine AU - Hopkins, Emily AU - Kitromili, Sofia AU - O'Neill, Cameron Iain AU - Larbie, Judy AU - Niittymaki, Essi AU - Ramsay, Catriona AU - Burke, Joshua AU - Ralph, Neil PY - 2025/2/19 TI - Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study JO - J Med Internet Res SP - e66157 VL - 27 KW - digital education KW - health professions education KW - research priorities KW - umbrella review KW - Delphi KW - artificial intelligence KW - AI N2 - Background: In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness. Objective: This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education. Methods: We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method. Results: A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals? education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions? digital education be defined and standardized? Conclusions: This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education. UR - https://www.jmir.org/2025/1/e66157 UR - http://dx.doi.org/10.2196/66157 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969988 ID - info:doi/10.2196/66157 ER - TY - JOUR AU - Stenseth, Vistven Hege AU - Steindal, A. Simen AU - Solberg, Trygg Marianne AU - Ølnes, Alexandra Mia AU - Sørensen, Lene Anne AU - Strandell-Laine, Camilla AU - Olaussen, Camilla AU - Farsjø Aure, Caroline AU - Pedersen, Ingunn AU - Zlamal, Jaroslav AU - Gue Martini, Jussara AU - Bresolin, Paula AU - Linnerud, Wang Silje Christin AU - Nes, Gonçalves Andréa Aparecida PY - 2025/2/18 TI - Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Scoping Review JO - J Med Internet Res SP - e58744 VL - 27 KW - critical thinking KW - simulation-based learning KW - technologically supported simulation-based learning KW - nursing education KW - nursing students KW - review N2 - Background: Critical thinking is a crucial skill in the nursing profession and must be fostered through nursing education. Simulation-based learning (SBL) with technological modalities is a pedagogical approach to enhance critical thinking skills for nursing students. The use of technology in SBL to achieve critical thinking skills is diverse. No previous scoping review has systematically mapped studies on SBL supported by technology to enhance critical thinking in nursing students. Objective: This scoping review aimed to systematically map research on the use of SBL supported by technology to enhance critical thinking in nursing students. Methods: This scoping review was conducted according to the framework by Arksey and O?Malley and was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, Embase, PsycINFO, and Web of Science databases in 2021 and repeated in 2023 and 2024. Pairs of authors independently assessed titles, abstracts, and full-text papers and extracted data from the included studies. The data underwent summative and thematic analysis and were categorized according to the findings. Results: In total, 4 main categories of technology applied in SBL were identified: computer-based simulations, human-patient simulators, virtual reality or immersive virtual reality, and others. The findings revealed a shift across time in the technology used for SBL to enhance critical thinking, from human patient simulators to computer-based simulations. A dominant part of the included studies published after 2018 (21/44, 48%) incorporated a combination of asynchronous and synchronous learning activities. The theoretical foundation of the studies revealed a range of scientific theories and conceptual frameworks and models. Enablers of or barriers to the enhancement of critical thinking skills in nursing students were identified within the following themes: affinity for and availability of technology, realism, accessibility, engagement and motivation, validation, return on investment, and enhanced critical thinking through SBL using technology. Conclusions: There has been a noticeable shift in the technology and use of technology in SBL. Descriptions of the applied technology and pedagogical considerations are pivotal for comparing or synthesizing research results. There has been a trend toward a blended educational approach combining synchronous and asynchronous learning activities. User technological proficiency and the perceived quality of the technology are imperative in the development of critical thinking. Realism, engagement, and motivation play pivotal roles in the enhancement of critical thinking in technologically supported SBL. The establishment of robust theoretical foundations of research and standardized research practices will strengthen the evidence obtained from the research conducted. UR - https://www.jmir.org/2025/1/e58744 UR - http://dx.doi.org/10.2196/58744 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58744 ER - TY - JOUR AU - Rivera García, Esmeralda Guadalupe AU - Cervantes López, Janet Miriam AU - Ramírez Vázquez, Carlos Juan AU - Llanes Castillo, Arturo AU - Cruz Casados, Jaime PY - 2025/2/14 TI - Reviewing Mobile Apps for Teaching Human Anatomy: Search and Quality Evaluation Study JO - JMIR Med Educ SP - e64550 VL - 11 KW - anatomy KW - Google Play KW - mobile health KW - mHealth KW - Mobile App Rating Scale KW - MARS N2 - Background: Mobile apps designed for teaching human anatomy offer a flexible, interactive, and personalized learning platform, enriching the educational experience for both students and health care professionals. Objective: This study aimed to conduct a systematic review of the human anatomy mobile apps available on Google Play, evaluate their quality, highlight the highest scoring apps, and determine the relationship between objective quality ratings and subjective star ratings. Methods: The Mobile App Rating Scale (MARS) was used to evaluate the apps. The intraclass correlation coefficient was calculated using a consistency-type 2-factor random model to measure the reliability of the evaluations made by the experts. In addition, Pearson correlations were used to analyze the relationship between MARS quality scores and subjective evaluations of MARS quality item 23. Results: The mobile apps with the highest overall quality scores according to the MARS (ie, sections A, B, C, and D) were Organos internos 3D (anatomía) (version 4.34), Sistema óseo en 3D (Anatomía) (version 4.32), and VOKA Anatomy Pro (version 4.29). To measure the reliability of the MARS quality evaluations (sections A, B, C, and D), the intraclass correlation coefficient was used, and the result was ?excellent.? Finally, Pearson correlation results revealed a significant relationship (r=0.989; P<.001) between the quality assessments conducted by health care professionals and the subjective evaluations of item 23. Conclusions: The average evaluation results of the selected apps indicated a ?good? level of quality, and those with the highest ratings could be recommended. However, the lack of scientific backing for these technological tools is evident. It is crucial that research centers and higher education institutions commit to the active development of new mobile health apps, ensuring their accessibility and validation for the general public. UR - https://mededu.jmir.org/2025/1/e64550 UR - http://dx.doi.org/10.2196/64550 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64550 ER - TY - JOUR AU - Kitapcioglu, Dilek AU - Aksoy, Emin Mehmet AU - Ozkan, Ekin Arun AU - Usseli, Tuba AU - Cabuk Colak, Dilan AU - Torun, Tugrul PY - 2025/2/14 TI - Enhancing Immersion in Virtual Reality?Based Advanced Life Support Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e68272 VL - 13 KW - artificial intelligence KW - voice recognition KW - serious gaming KW - immersion KW - virtual reality N2 - Background: Serious game?based training modules are pivotal for simulation-based health care training. With advancements in artificial intelligence (AI) and natural language processing, voice command interfaces offer an intuitive alternative to traditional virtual reality (VR) controllers in VR applications. Objective: This study aims to compare AI-supported voice command interfaces and traditional VR controllers in terms of user performance, exam scores, presence, and confidence in advanced cardiac life support (ACLS) training. Methods: A total of 62 volunteer students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology, aged 20-22 years, participated in the study. All the participants completed a pretest consisting of 10 multiple-choice questions about ACLS. Following the pretest, participants were randomly divided into 2 groups: the voice command group (n=31) and the VR controller group (n=31). The voice command group members completed the VR-based ACLS serious game in training mode twice, using an AI-supported voice command as the game interface. The VR controller group members also completed the VR-based ACLS serious game in training mode twice, but they used VR controllers as the game interface. The participants completed a survey to assess their level of presence and confidence during gameplay. Following the survey, participants completed the exam module of the VR-based serious gaming module. At the final stage of the study, participants completed a posttest, which had the same content as the pretest. VR-based exam scores of the voice command and VR controller groups were compared using a 2-tailed, independent-samples t test, and linear regression analysis was conducted to examine the effect of presence and confidence rating. Results: Both groups showed an improvement in performance from pretest to posttest, with no significant difference in the magnitude of improvement between the 2 groups (P=.83). When comparing presence ratings, there was no significant difference between the voice command group (mean 5.18, SD 0.83) and VR controller group (mean 5.42, SD 0.75; P=.25). However, when comparing VR-based exam scores, the VR controller group (mean 80.47, SD 13.12) significantly outperformed the voice command group (mean 66.70, SD 21.65; P=.005), despite both groups having similar time allocations for the exam (voice command group: mean 18.59, SD 5.28 minutes and VR controller group: mean 17.3, SD 4.83 minutes). Confidence levels were similar between the groups (voice command group: mean 3.79, SD 0.77 and VR controller group: mean 3.60, SD 0.72), but the voice command group displayed a significant overconfidence bias (voice command group: mean 0.09, SD 0.24 and VR controller group: mean ?0.09, SD 0.18; P=.002). Conclusions: VR-based ACLS training demonstrated effectiveness; however, the use of voice commands did not result in improved performance. Further research should explore ways to optimize AI?s role in education through VR. Trial Registration: ClinicalTrials.gov NCT06458452; https://clinicaltrials.gov/ct2/show/NCT06458452 UR - https://games.jmir.org/2025/1/e68272 UR - http://dx.doi.org/10.2196/68272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68272 ER - TY - JOUR AU - Almashmoum, Maryam AU - Payton, Antony AU - Johnstone, Emily AU - Cunningham, James AU - Ainsworth, John PY - 2025/2/14 TI - Understanding the Views of Health Care Professionals on the Usability and Utility of Virtual Reality Multidisciplinary Team Meetings: Usability and Utility Study JO - JMIR XR Spatial Comput SP - e60651 VL - 2 KW - knowledge sharing KW - multidisciplinary team meetings KW - artificial intelligence KW - heuristic evaluation KW - usability KW - virtual reality KW - VR KW - simulation KW - virtual environments KW - digital environments N2 - Background: Multidisciplinary team (MDT) meetings are one of the facilitators that enhance knowledge sharing among health care professionals. However, organizing a face-to-face MDT meeting to discuss patient treatment plans can be time-consuming. Virtual reality software is widely used in health care nowadays to save time and protect lives. Therefore, the use of virtual reality multidisciplinary team (VRMDT) meeting software may help enhance knowledge sharing between health care professionals and make meetings more efficient. Objective: The objectives of this study were to introduce VRMDT software for enhancing knowledge sharing and to evaluate the feasibility and usability of the VRMDT for use by professionals in health care institutions. Methods: We invited participants from The University of Manchester Faculty for Biology, Medicine, and Health who had a health care background. As this was the first stage of software development, individuals who did not usually attend MDT meetings were also invited via email to participate in this study. Participants evaluated VRMDT using a Meta Quest 3 headset, and software developed using the Unity platform. The software contained an onboarding tutorial that taught the participants how to select items, load and rotate 3D Digital Imaging and Communications in Medicine files, talk to a generative artificial intelligence?supported avatar, and make notes. After the evaluation (approximately 15 min), participants received an electronic survey using the Qualtrics survey tool (Qualtrics International Inc) to score the usability and feasibility of the software by responding to the 10-item system usability scale, and 12-point heuristic evaluation questions with Neilsen severity rating. Results: A total of 12 participants, including 4 health informatics, 3 with a nursing background, 2 medical doctors, 1 radiologist, and 2 biostatisticians, participated in the study. The most common age bracket of participants was 20?30 years (6/12, 50%). Most of the respondents had no experience with virtual reality, either in educational or entertainment settings. The VRMDT received a mean usability score of 72.7 (range between 68 and 80.3), earning an overall ?good? rating grade. The mean score of single items in the heuristic evaluation questionnaires was less than 1 out of 4 (the overall mean was 0.6), which indicates that only minor problems were encountered when using this software. Overall, the participant?s feedback was good with highlighted issues including a poor internet connection and the quality of the generative artificial intelligence response. Conclusions: VRMDT software (developed by SentiraXR) was developed with several functions aimed at helping health care professionals to discuss medical conditions efficiently. Participants found that the VRMDT is a powerful, and useful tool for enhancing knowledge sharing among professionals who are involved in MDT meetings due to its functionality and multiuser interactive environments. Additionally, there may be the possibility of using it to train junior professionals to interpret medical reports. UR - https://xr.jmir.org/2025/1/e60651 UR - http://dx.doi.org/10.2196/60651 ID - info:doi/10.2196/60651 ER - TY - JOUR AU - Koivisto, Jaana-Maija AU - Kämäräinen, Sanna AU - Mattsson, Katri AU - Jumisko-Pyykkö, Satu AU - Ikonen, Riikka AU - Haavisto, Elina PY - 2025/2/13 TI - Exploring Nursing Students? Experiences of Empathy and User Experiences in an Immersive Virtual Reality Simulation Game: Cross-Sectional Study JO - JMIR Serious Games SP - e62688 VL - 13 KW - education KW - nursing KW - learning KW - empathy KW - virtual reality KW - simulation KW - user experience KW - cross sectional N2 - Background: Empathy is associated with better clinical outcomes and patient-care experiences, and it has been demonstrated that training can improve nursing students? empathy. The use of virtual reality (VR) as an experiential learning strategy may increase the empathetic behavior of caregivers. Although much research exists on the use of VR in education, there is still little research on learning empathy in nursing education through immersive VR games that include a head-mounted display and hand controllers. In addition, it is important to study both learning and user experiences in nursing education that utilizes VR technology. Objective: This study aims to explore nursing students? experiences of empathy and user experiences in an immersive VR simulation game. Methods: A cross-sectional design was used. A total of 52 graduating nursing students from 3 universities of applied sciences in Finland participated in the study. The immersive VR simulation game employed in the study was played with a head-mounted display and hand controllers. The instruments used were the Basic Empathy Scale in Adults (BES-A) before the VR simulation gaming session and the Comprehensive State Empathy Scale (CSES) and AttrakDiff 2.0 Scale after the session. Results: The students? overall level of empathy experienced in the immersive VR simulation game was favorable (CSES; mean 2.9, SD 0.57). Participants who had a higher level of empathy (BES-A) before playing the immersive VR simulation game also experienced slightly more feelings of empathy after playing (CSES). However, the association between the measures was not statistically significant (r=0.187, P=.18). The overall empathy (CSES) experienced in the immersive VR simulation game was positively correlated with its subscales. The use of the VR simulation provided a positive user experience in all 4 factors of the AttrakDiff 2.0 Scale. Overall User Experience and Emotion Sharing correlated negatively (r=?0.248, P=.042), as did Attractiveness and Emotion Sharing (r=?0.327, P=.018). Hedonic Quality Stimulation correlated negatively with Cognitive Empathy (r=?0.279, P=.045). Conclusions: The results of this study indicate that the use of an immersive VR simulation game in nursing education as a means of increasing empathy seems promising and justified. The immersive VR simulation game offered positive user experiences, which further supported the idea of implementing it in education. However, more research is needed on what kinds of VR environments are the most effective in promoting empathy among nursing students. Furthermore, when using VR technology in learning, one should consider that the VR setting must not be too technical but rather simple, straightforward, and predictable. UR - https://games.jmir.org/2025/1/e62688 UR - http://dx.doi.org/10.2196/62688 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62688 ER - TY - JOUR AU - Hoyt, Garrik AU - Bakshi, Shekhar Chandra AU - Basu, Paramita PY - 2025/2/11 TI - Integration of an Audiovisual Learning Resource in a Podiatric Medical Infectious Disease Course: Multiple Cohort Pilot Study JO - JMIR Med Educ SP - e55206 VL - 11 KW - learning retention KW - preclinical education KW - podiatric medical education KW - audiovisual learning resources KW - multimedia-based learning resource KW - animation-supported learning tools KW - mnemonics KW - spaced repetition N2 - Background: Improved long-term learning retention leads to higher exam scores and overall course grades, which is crucial for success in preclinical coursework in any podiatric medicine curriculum. Audiovisual mnemonics, in conjunction with text-based materials and an interactive user interface, have been shown to increase memory retention and higher order thinking. Objective: This pilot study aims to evaluate the effectiveness of integrating web-based multimedia learning resources for improving student engagement and increasing learning retention. Methods: A quasi-experimental study was conducted with 2 cohorts totaling 158 second-year podiatric medical students. The treatment group had access to Picmonic?s audiovisual resources, while the control group followed traditional instruction methods. Exam scores, final course grades, and user interactions with Picmonic were analyzed. Logistic regression and correlation analyses were conducted to examine the relationships between Picmonic access, performance outcomes, and student engagement. Results: The treatment group (n=91) had significantly higher average exam scores (P<.001) and final course grades (P<.001) than the control group (n=67). Effect size for the average final grades (d=0.96) indicated the practical significance of these differences. Logistic regression analysis revealed a positive association between Picmonic access with an odds ratio of 2.72 with a 95% confidence interval, indicating that it is positively associated with the likelihood of achieving high final grades. Correlation analysis revealed a positive relationship (r=0.25, P=.02) between the number of in-video questions answered and students? final grades. Survey responses reflected increased student engagement, comprehension, and higher user satisfaction (3.71 out of 5 average rating) with the multimedia-based resources compared to traditional instructional resources. Conclusions: This pilot study underscores the positive impact of animation-supported web-based instruction on preclinical medical education. The treatment group, equipped with Picmonic, exhibited improved learning outcomes, enhanced engagement, and high satisfaction. These results contribute to the discourse on innovative educational methods and highlight the potential of multimedia-based learning resources to enrich medical curricula. Despite certain limitations, this research suggests that animation-supported audiovisual instruction offers a valuable avenue for enhancing student learning experiences in medical education. UR - https://mededu.jmir.org/2025/1/e55206 UR - http://dx.doi.org/10.2196/55206 ID - info:doi/10.2196/55206 ER - TY - JOUR AU - Chang, Wen AU - Lin, Chun-Chih AU - Crilly, Julia AU - Lee, Hui-Ling AU - Chen, Li-Chin AU - Han, Chin-Yen PY - 2025/2/11 TI - Virtual Reality Simulation for Undergraduate Nursing Students for Care of Patients With Infectious Diseases: Mixed Methods Study JO - JMIR Med Educ SP - e64780 VL - 11 KW - virtual reality KW - infection control KW - learning motivation KW - learning attitudes KW - nursing education N2 - Background: Virtual reality simulation (VRS) teaching offers nursing students a safe, immersive learning environment with immediate feedback, enhancing learning outcomes. Before the COVID-19 pandemic, nursing students had limited training and opportunities to care for patients in isolation units with infectious diseases. However, the pandemic highlighted the ongoing global priority of providing care for patients with infectious diseases. Objective: This study aims to (1) examine the effectiveness of VRS in preparing nursing students to care for patients with infectious diseases by assessing its impact on their theoretical knowledge, learning motivation, and attitudes; and (2) evaluate their experiences with VRS. Methods: This 2-phased mixed methods study recruited third-year undergraduate nursing students enrolled in the Integrated Emergency and Critical Care course at a university in Taiwan. Phase 1 used a quasi-experimental design to address objective 1 by comparing the learning outcomes of students in the VRS teaching program (experimental group) with those in the traditional teaching program (control group). Tools included an infection control written test, the Instructional Materials Motivation Survey, and a learning attitude questionnaire. The experimental group participated in a VRS lesson titled ?Caring for a Patient with COVID-19 in the Negative Pressure Unit? as part of the infection control unit. In phase 2, semistructured interviews were conducted to address objective 2, exploring students? learning experiences. Results: A total of 107 students participated in phase 1, and 18 students participated in phase 2. Both the VRS and control groups showed significant improvements in theoretical knowledge scores (for the VRS group t46=?7.47; P<.001, for the control group t59=?4.04; P<.001). However, compared with the control group, the VRS group achieved significantly higher theoretical knowledge scores (t98.13=2.70; P=.008) and greater learning attention (t105=2.30; P=.02) at T1. Additionally, the VRS group demonstrated a statistically significant higher regression coefficient for learning confidence compared with the control group (?=.29; P=.03). The students? learning experiences in the VRS group were categorized into 4 themes: Applying Professional Knowledge to Patient Care, Enhancing Infection Control Skills, Demonstrating Patient Care Confidence, and Engaging in Real Clinical Cases. The core theme identified was Strengthening Clinical Patient Care Competencies. Conclusions: The findings suggest that VRS teaching significantly enhanced undergraduate nursing students? infection control knowledge, learning attention, and confidence. Qualitative insights reinforced the quantitative results, highlighting the holistic benefits of VRS teaching in nursing education, including improved learning outcomes. The positive impact on student motivation and attitudes indicates a potentially transformative approach to nursing education, particularly in the post?COVID-19 era, where digital and remote learning tools play an increasingly vital role. UR - https://mededu.jmir.org/2025/1/e64780 UR - http://dx.doi.org/10.2196/64780 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64780 ER - TY - JOUR AU - Bloomfield, Lauren AU - Boston, Julie AU - Masek, Martin AU - Andrew, Lesley AU - Barwood, Donna AU - Devine, Amanda PY - 2025/2/11 TI - Evaluating the Efficacy of a Serious Game to Deliver Health Education About Invasive Meningococcal Disease: Clustered Randomized Controlled Equivalence Trial JO - JMIR Serious Games SP - e60755 VL - 13 KW - serious games KW - meningococcal disease KW - immersive digital applications KW - health promotion KW - gaming KW - meningitis KW - infection KW - bacteria KW - contagious KW - infectious KW - immersive KW - education KW - mHealth KW - mobile health KW - applications KW - youth KW - adolescents N2 - Background: Invasive meningococcal disease (IMD) is a serious, vaccine-preventable infectious disease that can be life-threatening. Teaching adolescents about the early detection and prevention of IMD can be challenging in a school environment, with educators reporting they lack confidence or expertise to cover this in the classroom environment. Professional guest educators are an alternative to cover specialist topics such as IMD; however, time and resourcing constraints can mean that these educators are not always available. Serious games may be an alternative to face-to-face education, where complex health information may be delivered via self-directed gameplay. Objective: This study aims to develop a serious game that can replace a face-to-face educator in a classroom setting to educate adolescents aged 12 years to 15 years. This study evaluates the efficacy of the Meningococcal Immunisation Awareness, Prevention and Protection app (MIApp), a serious game designed to replicate the information provided in a 30-minute face-to-face presentation provided by a trained educator. Methods: This clustered, randomized controlled equivalence trial involved students (Years 7-10) from 6 secondary schools across metropolitan Western Australia who completed pre- and postintervention questionnaires with a follow-up at 3 months postintervention to measure the primary outcome of IMD knowledge acquisition following this self-guided intervention. The findings were compared with changes in an active control (comparison) group who received an in-class educational presentation about IMD transmission and protection. A questionnaire was developed to assess 9 key areas of knowledge. Median scores for knowledge pre- and postintervention were collected from a self-administered assessment of this questionnaire and, at 3 months postintervention, were compared between groups. A knowledge score of +/?2/16 was determined a priori to meet the criteria for equivalence. Participants who used MIApp were also asked a series of questions to assess the enjoyment of and engagement with the game. Results: Of the 788 participating students, the median postintervention correct score in both the MIApp and control cohorts was 14/16 (87.5% correct responses), compared with the median pre-intervention correct score of 6/16 (37.5% correct responses), representing a significant (P<.001) increase in IMD knowledge in both groups. Improvements were retained in both groups 3 months after the initial intervention (median correct score: 11/16 in the intervention group; 12/16 in the control group; P=.86), demonstrating the efficacy of MIApp to deliver health education about IMD transmission and protection, although response rates in the follow-up cohort were low (255/788, 32.4%). Conclusions: MIApp met the predetermined threshold for equivalence, demonstrating similar improvements in knowledge posttrial and at the 3-month follow-up. Participating adolescents considered the MIApp game more enjoyable than a presentation, with equivalent improvements in knowledge. Serious games could represent a constructive tool to help teachers impart specialized health education. UR - https://games.jmir.org/2025/1/e60755 UR - http://dx.doi.org/10.2196/60755 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932769 ID - info:doi/10.2196/60755 ER - TY - JOUR AU - Davoody, Nadia AU - Stathakarou, Natalia AU - Swain, Cara AU - Bonacina, Stefano PY - 2025/2/10 TI - Exploring the Impact of the COVID-19 Pandemic on Learning Experience, Mental Health, Adaptability, and Resilience Among Health Informatics Master?s Students: Focus Group Study JO - JMIR Med Educ SP - e63708 VL - 11 KW - COVID-19 pandemic KW - eHealth KW - blended learning KW - health informatics KW - higher education adaptation N2 - Background: The shift to online education due to the COVID-19 pandemic posed significant challenges and opportunities for students, affecting their academic performance, mental well-being, and engagement. Objective: This study aimed to explore the overall learning experience among health informatics master?s students at Karolinska Institutet, Sweden, and the strategies they used to overcome learning challenges posed by the COVID-19 pandemic. Methods: Through 3 structured focus groups, this study explored health informatics master?s students? experiences of shifting learning environments for classes that started in 2019, 2020, and 2021. All focus group sessions were recorded and transcribed verbatim. Inductive content analysis was used to analyze the data. Results: The results highlight the benefits of increased autonomy and flexibility and identify challenges such as technical difficulties, diminished social interactions, and psychological impacts. This study underscores the importance of effective online educational strategies, technological preparedness, and support systems to enhance student learning experiences during emergencies. The findings of this study highlight implications for educators, students, and higher education institutions to embrace adaptation and foster innovation. Implications for educators, students, and higher education institutions include the need for educators to stay current with the latest educational technologies and design teaching strategies and pedagogical approaches suited to both online and in-person settings to effectively foster student engagement. Students must be informed about the technological requirements for online learning and adequately prepared to meet them. Institutions play a critical role in ensuring equitable access to technology, guiding and supporting educators in adopting innovative tools and methods, and offering mental health resources to assist students in overcoming the challenges of evolving educational environments. Conclusions: This research contributes to understanding the complexities of transitioning to online learning in urgent circumstances and offers insights for better preparing educational institutions for future pandemics. UR - https://mededu.jmir.org/2025/1/e63708 UR - http://dx.doi.org/10.2196/63708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63708 ER - TY - JOUR AU - Gil-Hernández, Eva AU - Carrillo, Irene AU - Martin-Delgado, Jimmy AU - García-Torres, Daniel AU - Mira, Joaquín José PY - 2025/2/5 TI - Development of a Web-Based Intervention for Middle Managers to Enhance Resilience at the Individual, Team, and Organizational Levels in Health Care Systems: Multiphase Study JO - JMIR Hum Factors SP - e67263 VL - 12 KW - resilience KW - health care professionals KW - web-based intervention KW - middle management KW - well-being KW - patient safety N2 - Background: Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams. Objective: This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience. Methods: An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador. Results: The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points. Conclusions: The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings. UR - https://humanfactors.jmir.org/2025/1/e67263 UR - http://dx.doi.org/10.2196/67263 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67263 ER - TY - JOUR AU - Polat, Halil Yunus AU - Cankurtaran, Eren Rasim PY - 2025/2/4 TI - Assessment of Reliability and Validity of Celiac Disease?Related YouTube Videos: Content Analysis JO - JMIR Infodemiology SP - e58615 VL - 5 KW - gastroenterology KW - celiac KW - YouTube KW - internet-based information KW - medical information KW - health-related KW - reliability KW - validity KW - quality KW - videos KW - celiac sprue KW - sprue KW - gluten enteropathy KW - cross-sectional N2 - Background: YouTube is an increasingly used platform for medical information. However, the reliability and validity of health-related information on celiac disease (CD) on YouTube have not been determined. Objective: This study aimed to analyze the reliability and validity of CD-related YouTube videos. Methods: On November 15, 2023, a search was performed on YouTube using the keyword ?celiac disease.? This search resulted in a selection of videos, which were then reviewed by 2 separate evaluators for content, origin, and specific features. The evaluators assessed the reliability and quality of these videos using a modified DISCERN (mDISCERN) score, the Journal of the American Medical Association (JAMA) benchmark criteria score, the usefulness score, video power index (VPI), and the Global Quality Scale (GQS) score. Results: In the analysis of 120 initially screened CD videos, 85 met the criteria for inclusion in the study after certain videos were excluded based on predefined criteria. While the duration of the videos uploaded by health care professionals was significantly longer than the other group (P=.009), it was concluded that the median scores for mDISCERN (4, IQR 4-5 vs 2, IQR 2-3; P<.001), GQS (4, IQR 4-5 vs 3, IQR 2-3; P<.001), JAMA (4, IQR 3-4 vs 2, IQR 2-3; P<.001), and usefulness (8, IQR 7-9 vs 6, IQR 3-6; P<.001) of the videos from this group were significantly higher than those from non?health care professionals. Video interaction parameters, including the median number of views, views per day, likes, dislikes, comments, and VPI, demonstrated no significant difference between the 2 groups. Conclusions: This study showed that YouTube videos about CD vary significantly in reliability and quality depending on their source. Increasing the production of reliable videos by health care professionals may help to improve patient education and make YouTube a more reliable resource. UR - https://infodemiology.jmir.org/2025/1/e58615 UR - http://dx.doi.org/10.2196/58615 UR - http://www.ncbi.nlm.nih.gov/pubmed/39756057 ID - info:doi/10.2196/58615 ER - TY - JOUR AU - Berentsen, Birgitte AU - Thuen, Camilla AU - Hillestad, Randulff Eline Margrete AU - Steinsvik, Kjelsvik Elisabeth AU - Hausken, Trygve AU - Hatlebakk, Gunnar Jan PY - 2025/2/3 TI - The Effects of Digital eHealth Versus Onsite 2-Day Group-Based Education in 255 Patients With Irritable Bowel Syndrome: Cohort Study JO - JMIR Hum Factors SP - e43618 VL - 12 KW - irritable bowel syndrome KW - IBS KW - eHealth KW - internet-guided KW - patient education KW - self-management KW - self-reported KW - patient behavior KW - quality of life KW - QOL KW - anxiety KW - depression KW - gastrointestinal KW - physiotherapist KW - kinesiology KW - cognitive behavioural therapy KW - CBT KW - Hospital Anxiety and Depression Scale KW - HADS KW - client satisfaction questionnaire KW - CSQ KW - Mann-Whitney U test KW - nonparametric KW - Wilcoxon test KW - neurogastroenterology N2 - Background: Irritable bowel syndrome (IBS) has a high worldwide prevalence and there are few effective treatment options. Patient education can influence patient behavior that subsequently may lead to changes in attitudes and skills necessary for maintenance or improvement in management of symptom severity and quality of life. However, as postdiagnostic patient education can be resource demanding, assessment of digital approaches and verification of their effectiveness is warranted. Objective: This cohort study aimed to investigate the effects of a digital web-based multidisciplinary eHealth program on the domains of symptom severity (Irritable Bowel Syndrome Symptom Severity Scale [IBS-SSS]), quality of life (irritable bowel syndrome quality of life [IBS-QOL]), anxiety and depression (Hospital Anxiety and Depression Scale), and a measure of general client satisfaction (client satisfaction questionnaire), compared with an onsite multidisciplinary 2-day group-based education program (?IBS-school?), in 2 cohorts of 255 patients with IBS. Methods: Patients diagnosed with IBS, aged 15-70 years, were enrolled after referral to the Section of Gastroenterology at Haukeland University Hospital, Norway. In total, 132 patients were recruited to the eHealth program and 123 to the IBS-school group for comparison. Data were self-reported and collected digitally at enrollment and after 3 months, between 2017 and 2019. Furthermore, 71 attending the eHealth program and 49 attending the IBS-school completed the questionnaires at 3 months. Intervention response was defined as a reduction of ?50 points on the IBS-SSS. Results: Patients attending the eHealth program reported a significant reduction in IBS symptom severity 3 months after treatment (n=71), compared with patients attending the IBS-school (n=50). Overall, patients categorized as intervention responders in both programs showed a significant reduction in symptom severity at 3 months. Here, 41% (29/71) of patients attending the eHealth program reported a mean IBS-SSS reduction of 103 (SD 72.0) points (P<.001). In addition, these patients reported reduced anxiety (P>.001) and depression (P=.002) and enhanced quality of life (P=.03), especially the degrees of dysphoria, body image, food avoidance, health worry, interference with activity, relations, and social relations. Patients responding to the IBS-school intervention (18/50, 36%) reported a mean IBS-SSS reduction of 119 (SD 86.2) points (P<.001), and reduced depression scores (P=.046), but no difference in overall quality of life. Both groups reported the respective interventions as ?good? quality health care programs, scoring them 23.5 (SD 4)?the eHealth program 23.5 (SD 4), and the IBS-school 24.2 (SD 4)?on the client satisfaction questionnaire. Conclusions: We conclude that the digital multidisciplinary eHealth program has a significant effect on IBS symptom severity in a portion of patients; it is useful as a tool in disease self-management and does not result in worse symptom scores than an onsite multidisciplinary 2-day group-based education program after 3 months. We believe these results indicate that a digital eHealth approach is preferable to an onsite multidisciplinary 2-day group-based education program covering the same topics. UR - https://humanfactors.jmir.org/2025/1/e43618 UR - http://dx.doi.org/10.2196/43618 ID - info:doi/10.2196/43618 ER - TY - JOUR AU - Shikino, Kiyoshi AU - Yamauchi, Kazuyo AU - Araki, Nobuyuki AU - Shimizu, Ikuo AU - Kasai, Hajime AU - Tsukamoto, Tomoko AU - Tajima, Hiroshi AU - Li, Yu AU - Onodera, Misaki AU - Ito, Shoichi PY - 2025/1/31 TI - Understanding Community Health Care Through Problem-Based Learning With Real-Patient Videos: Single-Arm Pre-Post Mixed Methods Study JO - JMIR Med Educ SP - e68743 VL - 11 KW - community health care KW - community-oriented medical education KW - mixed method KW - problem-based learning KW - real-patient video N2 - Background: Japan faces a health care delivery challenge due to physician maldistribution, with insufficient physicians practicing in rural areas. This issue impacts health care access in remote areas and affects patient outcomes. Educational interventions targeting students? career decision-making can potentially address this problem by promoting interest in rural medicine. We hypothesized that community-based problem-based learning (PBL) using real-patient videos could foster students? understanding of community health care and encourage positive attitudes toward rural health care. Objective: This study investigated the impact of community-based PBL on medical students? understanding and engagement with rural health care, focusing on their knowledge, skills, and career orientation. Methods: Participants were 113 fourth-year medical students from Chiba University, engaged in a transition course between preclinical and clinical clerkships from October 24 to November 2, 2023. The students were randomly divided into 16 groups (7-8 participants per group). Each group participated in two 3-hour PBL sessions per week over 2 consecutive weeks. Quantitative data were collected using pre- and postintervention questionnaires, comprehension tests, and tutor-assessed rubrics. Self-assessment questionnaires evaluated the students? interest in community health care and their ability to envision community health care settings before and after the intervention. Qualitative data from the students? semistructured interviews after the PBL sessions assessed the influence of PBL experience on clinical clerkship in community hospitals. Statistical analysis included median (IQR), effect sizes, and P values for quantitative outcomes. Thematic analysis was used for qualitative data. Results: Of the 113 participants, 71 (62.8%) were male and 42 (37.2%) female. The total comprehension test scores improved significantly (pretest: median 4.0, IQR 2.5-5.0; posttest: median 5, IQR 4-5; P<.001; effect size r=0.528). Rubric-based assessments showed increased knowledge application (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.494) and self-directed learning (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.553). Self-assessment questionnaires revealed significant improvements in the students? interest in community health care (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001) and their ability to envision community health care settings (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001). Thematic analysis revealed key themes, such as ?empathy in patient care,? ?challenges in home health care,? and ?professional identity formation.? Conclusions: Community-based PBL with real-patient videos effectively enhances medical students? understanding of rural health care settings, clinician roles, and the social needs of rural patients. This approach holds potential as an educational strategy to address physician maldistribution. Although this study suggests potential for fostering positive attitudes toward rural health care, further research is needed to assess its long-term impact on students? career trajectories. UR - https://mededu.jmir.org/2025/1/e68743 UR - http://dx.doi.org/10.2196/68743 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68743 ER - TY - JOUR AU - Celdrán, Javier Francisco AU - Jiménez-Ruescas, Javier AU - Lobato, Carlos AU - Salazar, Lucía AU - Sánchez-Margallo, Alberto Juan AU - Sánchez-Margallo, M. Francisco AU - González, Pascual PY - 2025/1/28 TI - Use of Augmented Reality for Training Assistance in Laparoscopic Surgery: Scoping Literature Review JO - J Med Internet Res SP - e58108 VL - 27 KW - laparoscopic surgery KW - surgical training KW - surgical simulator KW - augmented reality?based laparoscopic simulator KW - AR-based laparoscopic simulator KW - augmented reality KW - mobile phone N2 - Background: Laparoscopic surgery training is a demanding process requiring technical and nontechnical skills. Surgical training has evolved from traditional approaches to the use of immersive digital technologies such as virtual, augmented, and mixed reality. These technologies are now integral to laparoscopic surgery training. Objective: This scoping literature review aimed to analyze the current augmented reality (AR) solutions used in laparoscopic surgery training. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using 4 databases: Scopus, IEEE Xplore, PubMed, and ACM. Inclusion and exclusion criteria were applied to select relevant articles. Exclusion criteria were studies not using AR, not focused on laparoscopic surgery, not focused on training, written in a language other than English, or not providing relevant information on the topics studied. After selecting the articles, research questions (RQs) were formulated to guide the review. In total, 2 independent reviewers then extracted relevant data, and a descriptive analysis of the results was conducted. Results: Of 246 initial records, 172 (69.9%) remained after removing duplicates. After applying the exclusion criteria, 76 articles were selected, with 25 (33%) later excluded for not meeting quality standards, leaving 51 (67%) in the final review. Among the devices analyzed (RQ 1), AR video?based devices were the most prevalent (43/51, 84%). The most common information provided by AR devices (RQ 1) focused on task execution and patient-related data, both appearing in 20% (10/51) of studies. Regarding sensorization (RQ 2), most studies (46/51, 90%) incorporated some form of sensorized environment, with computer vision being the most used technology (21/46, 46%) and the trainee the most frequently sensorized element (41/51, 80%). Regarding training setups (RQ 3), 39% (20/51) of the studies used commercial simulators, and 51% (26/51) made use of artificial models. Concerning the evaluation methods (RQ 4), objective evaluation was the most used, featured in 71% (36/51) of the studies. Regarding tasks (RQ 5), 43% (22/51) of studies focused on full surgical procedures, whereas 57% (29/51) focused on simple training tasks, with suturing being the most common among the latter (11/29, 38%). Conclusions: This scoping review highlights the evolving role of AR technologies in laparoscopic surgery training, although the impact of optical see-through devices remains unclear due to their limited use. It underscores the potential of emerging technologies such as haptic feedback, computer vision, and eye tracking to further enhance laparoscopic skill acquisition. While most relevant articles from other databases were included, some studies may have been missed due to the specific databases and search strategies used. Moreover, the need for standardized evaluation metrics is emphasized, paving the way for future research into AR?s full potential in laparoscopic skill acquisition. UR - https://www.jmir.org/2025/1/e58108 UR - http://dx.doi.org/10.2196/58108 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58108 ER - TY - JOUR AU - Baetzner, Sabine Anke AU - Hill, Yannick AU - Roszipal, Benjamin AU - Gerwann, Solène AU - Beutel, Matthias AU - Birrenbach, Tanja AU - Karlseder, Markus AU - Mohr, Stefan AU - Salg, Alexander Gabriel AU - Schrom-Feiertag, Helmut AU - Frenkel, Ottilie Marie AU - Wrzus, Cornelia PY - 2025/1/27 TI - Mass Casualty Incident Training in Immersive Virtual Reality: Quasi-Experimental Evaluation of Multimethod Performance Indicators JO - J Med Internet Res SP - e63241 VL - 27 KW - prehospital decision-making KW - disaster medicine KW - emergency medicine KW - mass casualty incident KW - medical education KW - eye tracking KW - emergency simulation KW - virtual reality N2 - Background: Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. Objective: This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. Methods: A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking?based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51% MFRs vs 37/76, 49% non-MFRs) and a knowledge test with patient vignettes. Results: Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman ?=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. Conclusions: iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers? feedback and provide trainees with guidance on evaluating and reflecting on their own performance. UR - https://www.jmir.org/2025/1/e63241 UR - http://dx.doi.org/10.2196/63241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63241 ER - TY - JOUR AU - Brown, Joan AU - De-Oliveira, Sophia AU - Mitchell, Christopher AU - Cesar, Carmen Rachel AU - Ding, Li AU - Fix, Melissa AU - Stemen, Daniel AU - Yacharn, Krisda AU - Wong, Fum Se AU - Dhillon, Anahat PY - 2025/1/24 TI - Barriers to and Facilitators of Implementing Team-Based Extracorporeal Membrane Oxygenation Simulation Study: Exploratory Analysis JO - JMIR Med Educ SP - e57424 VL - 11 KW - intensive care unit KW - ICU KW - teamwork in the ICU KW - team dynamics KW - collaboration KW - interprofessional collaboration KW - simulation KW - simulation training KW - ECMO KW - extracorporeal membrane oxygenation KW - life support KW - cardiorespiratory dysfunction KW - cardiorespiratory KW - cardiology KW - respiratory KW - heart KW - lungs N2 - Introduction: Extracorporeal membrane oxygenation (ECMO) is a critical tool in the care of severe cardiorespiratory dysfunction. Simulation training for ECMO has become standard practice. Therefore, Keck Medicine of the University of California (USC) holds simulation-training sessions to reinforce and improve providers knowledge. Objective: This study aimed to understand the impact of simulation training approaches on interprofessional collaboration. We believed simulation-based ECMO training would improve interprofessional collaboration through increased communication and enhance teamwork. Methods: This was a single-center, mixed methods study of the Cardiac and Vascular Institute Intensive Care Unit at Keck Medicine of USC conducted from September 2021 to April 2023. Simulation training was offered for 1 hour monthly to the clinical team focused on the collaboration and decision-making needed to evaluate the initiation of ECMO therapy. Electronic surveys were distributed before, after, and 3 months post training. The survey evaluated teamwork and the effectiveness of training, and focus groups were held to understand social environment factors. Additionally, trainee and peer evaluation focus groups were held to understand socioenvironmental factors. Results: In total, 37 trainees attended the training simulation from August 2021 to August 2022. Using 27 records for exploratory factor analysis, the standardized Cronbach ? was 0.717. The survey results descriptively demonstrated a positive shift in teamwork ability. Qualitative themes identified improved confidence and decision-making. Conclusions: The study design was flawed, indicating improvement opportunities for future research on simulation training in the clinical setting. The paper outlines what to avoid when designing and implementing studies that assess an educational intervention in a complex clinical setting. The hypothesis deserves further exploration and is supported by the results of this study. UR - https://mededu.jmir.org/2025/1/e57424 UR - http://dx.doi.org/10.2196/57424 ID - info:doi/10.2196/57424 ER - TY - JOUR AU - Teng, Peng AU - Xu, Youran AU - Qian, Kaoliang AU - Lu, Ming AU - Hu, Jun PY - 2025/1/17 TI - Case-Based Virtual Reality Simulation for Severe Pelvic Trauma Clinical Skill Training in Medical Students: Design and Pilot Study JO - JMIR Med Educ SP - e59850 VL - 11 KW - case-based learning KW - virtual reality KW - pelvic fracture KW - severe pelvic trauma KW - hemodynamic instability KW - clinical skill training KW - VR KW - pelvic trauma KW - medical student KW - pilot study KW - orthopedic surgery KW - theoretical teaching KW - acceptability N2 - Background: Teaching severe pelvic trauma poses a significant challenge in orthopedic surgery education due to the necessity of both clinical reasoning and procedural operational skills for mastery. Traditional methods of instruction, including theoretical teaching and mannequin practice, face limitations due to the complexity, the unpredictability of treatment scenarios, the scarcity of typical cases, and the abstract nature of traditional teaching, all of which impede students? knowledge acquisition. Objective: This study aims to introduce a novel experimental teaching methodology for severe pelvic trauma, integrating virtual reality (VR) technology as a potent adjunct to existing teaching practices. It evaluates the acceptability, perceived ease of use, and perceived usefulness among users and investigates its impact on knowledge, skills, and confidence in managing severe pelvic trauma before and after engaging with the software. Methods: A self-designed questionnaire was distributed to 40 students, and qualitative interviews were conducted with 10 teachers to assess the applicability and acceptability. A 1-group pretest-posttest design was used to evaluate learning outcomes across various domains, including diagnosis and treatment, preliminary diagnosis, disease treatment sequencing, emergency management of hemorrhagic shock, and external fixation of pelvic fractures. Results: A total of 40 students underwent training, with 95% (n=38) affirming that the software effectively simulated real-patient scenarios. All participants (n=40, 100%) reported that completing the simulation necessitated making the same decisions as doctors in real life and found the VR simulation interesting and useful. Teacher interviews revealed that 90% (9/10) recognized the VR simulation?s ability to replicate complex clinical cases, resulting in enhanced training effectiveness. Notably, there was a significant improvement in the overall scores for managing hemorrhagic shock (t39=37.6; 95% CI 43.6-48.6; P<.001) and performing external fixation of pelvic fractures (t39=24.1; 95% CI 53.4-63.3; P<.001) from pre- to postsimulation. Conclusions: The introduced case-based VR simulation of skill-training methodology positively influences medical students? clinical reasoning, operative skills, and self-confidence. It offers an efficient strategy for conserving resources while providing quality education for both educators and learners. UR - https://mededu.jmir.org/2025/1/e59850 UR - http://dx.doi.org/10.2196/59850 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59850 ER - TY - JOUR AU - Vogel, Niklas Jann AU - Letzin, Jaqueline AU - Schmidt, Stefan PY - 2025/1/17 TI - Digital Teaching and Learning Media for Nursing and Health Care Courses in Germany: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e60427 VL - 14 KW - digital education KW - digital learning KW - digital teaching KW - e-learning KW - nursing KW - health care KW - digital transformation KW - digital technology KW - online learning KW - distance learning KW - health care education N2 - Background: In Germany, digital transformation and legal regulations are leading to the need to integrate digital technologies into the nursing profession. In addition, to nursing practice, they are also being incorporated into nursing training. Despite comprehensive regulations regarding the use of digital teaching and learning media in nursing education, their specific applicability and implementation vary. Objective: This study aims to map evidence and identify the main concepts, theories, sources, and knowledge gaps in the use of digital teaching and learning formats in nursing and health care education in Germany. Methods: The study is planned as a scoping review. The reporting of the study is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. The sources of information for the review include six bibliographic databases (MEDLINE via PubMed, Cochrane Library, Web of Science Core Collection, ERIC, PROSPERO, and APA PsycInfo). The search results will be presented in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The eligibility of studies is based on the population, concept, and context criteria: (1) learners of nursing and health care professions, (2) digital teaching and learning formats, and (3) forms of implementation in Germany since 2007. Results: The literature search is planned for January 2025. The selection of titles, the coding of the data, and the data analysis are expected to be completed by March 2025. Conclusions: In Germany, there is a growing interest in integrating digital teaching and learning formats into nursing and health care education. Our scoping review will map applications of digital teaching and learning media in the education of nursing and health care professions in Germany. In this way, the scoping review provides relevant impulses for fields of application and design aspects of digital teaching or learning media for nursing and health care education. International Registered Report Identifier (IRRID): PRR1-10.2196/60427 UR - https://www.researchprotocols.org/2025/1/e60427 UR - http://dx.doi.org/10.2196/60427 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60427 ER - TY - JOUR AU - Zhang, Dandan AU - Fu, MuLi AU - Zhang, Jianzhong AU - Li, Yuxuan AU - Chen, Li AU - Chen, Yong-Jun AU - Zhong, Zhefeng AU - Zhang, Yin-Ping PY - 2025/1/17 TI - Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial JO - J Med Internet Res SP - e63131 VL - 27 KW - virtual reality simulation KW - isolation ward KW - preparedness KW - pandemic KW - nurse N2 - Background: During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses? clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited. Objective: This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings. Methods: This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments. Results: After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=?0.30, P=.75; Cohen d=?0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks. Conclusions: This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses? practical skills and pandemic preparedness. Trial Registration: Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0 UR - https://www.jmir.org/2025/1/e63131 UR - http://dx.doi.org/10.2196/63131 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63131 ER - TY - JOUR AU - Wei, Boxiong PY - 2025/1/16 TI - Performance Evaluation and Implications of Large Language Models in Radiology Board Exams: Prospective Comparative Analysis JO - JMIR Med Educ SP - e64284 VL - 11 KW - large language models KW - LLM KW - artificial intelligence KW - AI KW - GPT-4 KW - radiology exams KW - medical education KW - diagnostics KW - medical training KW - radiology KW - ultrasound N2 - Background: Artificial intelligence advancements have enabled large language models to significantly impact radiology education and diagnostic accuracy. Objective: This study evaluates the performance of mainstream large language models, including GPT-4, Claude, Bard, Tongyi Qianwen, and Gemini Pro, in radiology board exams. Methods: A comparative analysis of 150 multiple-choice questions from radiology board exams without images was conducted. Models were assessed on their accuracy for text-based questions and were categorized by cognitive levels and medical specialties using ?2 tests and ANOVA. Results: GPT-4 achieved the highest accuracy (83.3%, 125/150), significantly outperforming all other models. Specifically, Claude achieved an accuracy of 62% (93/150; P<.001), Bard 54.7% (82/150; P<.001), Tongyi Qianwen 70.7% (106/150; P=.009), and Gemini Pro 55.3% (83/150; P<.001). The odds ratios compared to GPT-4 were 0.33 (95% CI 0.18?0.60) for Claude, 0.24 (95% CI 0.13?0.44) for Bard, and 0.25 (95% CI 0.14?0.45) for Gemini Pro. Tongyi Qianwen performed relatively well with an accuracy of 70.7% (106/150; P=0.02) and had an odds ratio of 0.48 (95% CI 0.27?0.87) compared to GPT-4. Performance varied across question types and specialties, with GPT-4 excelling in both lower-order and higher-order questions, while Claude and Bard struggled with complex diagnostic questions. Conclusions: GPT-4 and Tongyi Qianwen show promise in medical education and training. The study emphasizes the need for domain-specific training datasets to enhance large language models? effectiveness in specialized fields like radiology. UR - https://mededu.jmir.org/2025/1/e64284 UR - http://dx.doi.org/10.2196/64284 ID - info:doi/10.2196/64284 ER - TY - JOUR AU - Kim, Minha AU - Son, Hi Meong AU - Moon, Suhyeon AU - Cha, Chul Won AU - Jo, Joon Ik AU - Yoon, Hee PY - 2025/1/16 TI - A Mixed Reality?Based Telesupervised Ultrasound Education Platform on 5G Network Compared to Direct Supervision: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e63448 VL - 13 KW - ultrasonography KW - telemedicine KW - medical education KW - distance learning KW - fifth-generation network KW - mixed reality KW - ultrasound education KW - hospital KW - randomized pilot trial KW - pilot study KW - doctor KW - telesupervision KW - head-mounted display KW - primary outcomes KW - user experience KW - self-confidence KW - image quality KW - educational intervention KW - training experience KW - South Korea KW - telehealth N2 - Background: Ultrasound education is transitioning from in-person training to remote methods using mixed reality (MR) and 5G networks. Previous studies are mainly experimental, lacking randomized controlled trials in direct training scenarios. Objective: This study aimed to compare an MR-based telesupervised ultrasound education platform on private 5G networks with traditional in-person training for novice doctors. Methods: Conducted at a tertiary academic hospital from November to December 2023, the prospective unblinded randomized controlled pilot study assigned doctors without prior abdominal ultrasound education experience to either the telesupervision group (TG; n=20) or direct supervision group (DG; n=20). Participants received a 15-minute video lecture, conducted ultrasound on a phantom, and had 18 images scored by 2 blinded experts. Additionally, the TG received 5 minutes of training on the basic operation of a head-mounted display. Communication between doctors in the TG and supervisors was facilitated through a head-mounted display, whereas those in the DG interacted directly with supervisors. Primary outcomes were image quality scores, while secondary outcomes included procedure time, number of supervisor interventions, user experience using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), System Usability Scale (SUS), and self-confidence through pre- and postsurveys. Results: Image quality scores and procedure times showed no significant differences between the groups (TG: 66.8 [SD 10.3] vs DG: 66.8 [SD 10.4], P=.84; TG: 23.8 [SD 8.0] min vs DG: 24.0 [SD 8.1] min, P=.95, respectively). However, the TG engaged in more educational interventions (TG: 4.0 [SD 2.5] vs DG: 0.8 [SD 1.1], P<.001), reflecting a more interactive training environment. TG participants reported lower NASA-TLX scores for mental demand (43.8 [SD 24.8] vs 60.6 [SD 22.4], P=.03), effort (43.1 [SD 22.9] vs 67.9 [SD 17], P<.001), and frustration (26.9 [SD 20.3] vs 45.2 [SD 27.8], P=.02), indicating a reduced cognitive load compared to the DG. The mean SUS score was also higher in the TG (66.6 [SD 9.1] vs 60.2 [SD 10.4], P=.046), suggesting better usability. Both groups showed significant improvements in confidence, with the TG showing notably greater improvement in abdominal ultrasound proficiency (pre-education TG: 1.6 [SD 0.9] vs DG: 1.7 [SD 0.9], P=.73; post-education TG: 3.8 [SD 0.9] vs DG: 2.8 [SD 1.0], P=.006). Conclusions: Although no significant differences in image quality scores were observed between groups, considerable differences in positive educational interactions, workload, and usability were evident. These findings emphasize the platform?s potential to enhance the ultrasound training experience, suggesting more interactive and efficient learning. Trial Registration: ClinicalTrials.gov NCT06171828; https://clinicaltrials.gov/study/NCT06171828 UR - https://games.jmir.org/2025/1/e63448 UR - http://dx.doi.org/10.2196/63448 ID - info:doi/10.2196/63448 ER - TY - JOUR AU - Walzer, Stefan AU - Barthel, Carolin AU - Pazouki, Ronja AU - Marx, Helga AU - Ziegler, Sven AU - Koenig, Peter AU - Kugler, Christiane AU - Jobst, Stefan PY - 2025/1/15 TI - Teaching in the Digital Age?Developing a Support Program for Nursing Education Providers: Design-Based Research JO - JMIR Form Res SP - e66109 VL - 9 KW - digital competencies KW - nursing education KW - support program KW - needs assessment KW - design-based research KW - feasibility study KW - nursing education provider KW - qualitative research KW - nurse KW - health care KW - focus group KW - digital age KW - expert consultation KW - thematic content analysis KW - feasibility test KW - satisfaction KW - competency-based approach KW - workplace barrier KW - health care digitalization KW - digital technology N2 - Background: Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. Objective: This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. Methods: We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Results: Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Conclusions: Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts. UR - https://formative.jmir.org/2025/1/e66109 UR - http://dx.doi.org/10.2196/66109 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66109 ER - TY - JOUR AU - Nowell, Lorelli AU - Johnston, Sonja AU - Dolan, Sara AU - Jacobsen, Michele AU - Lorenzetti, L. Diane AU - Oddone Paolucci, Elizabeth PY - 2025/1/15 TI - Exploring Educators? Perceptions and Experiences of Online Teaching to Foster Caring Profession Students? Development of Virtual Caring Skills: Sequential Explanatory Mixed Methods Study JO - JMIR Nursing SP - e64548 VL - 8 KW - health care education KW - virtual care KW - telehealth KW - online teaching KW - mixed methods study KW - student KW - teaching KW - virtual caring skills KW - cross-sectional survey KW - interview N2 - Background: Professionals in caring disciplines have been pivotal in advancing virtual care, which leverages remote technologies to deliver effective support and services from a distance. Educators in these caring professions are required to teach students the skills and competencies needed to provide high-quality and effective care. As virtual care becomes more integral, educators must equip students in these fields with both interpersonal and technological skills, bridging traditional hands-on learning with digital literacy. However, there is a gap in evidence exploring educators? perceptions and experiences of teaching caring profession students about virtual caring skills within online environments. Objective: This study aims to better understand caring profession educators? online teaching experiences to foster student development of virtual caring skills and competencies. Methods: We used a sequential explanatory mixed methods approach that integrated a cross-sectional survey and individual interviews with educators from caring professions to better understand caring professional educators? online teaching experiences to foster student development of virtual caring skills and competencies. The survey?s primary objectives were to examine the various elements of existing e-learning opportunities, delve into educators? perspectives and encounters with these opportunities, and identify the factors that either facilitated or hindered online teaching practices to support students in developing virtual caring skills and competencies. The individual interview guides were based on survey findings and a systematic review of the evidence to gain deeper insights into educators? experiences and perspectives. Results: A total of 82 survey participants and 8 interview participants were drawn from educators in the fields of education, medicine, nursing, and social work. Various instructional methods were used to help students develop virtual caring skills, including reflections on learning, online modules, online discussion boards, demonstrations of remote care, and consultation with clients. There was a statistically significant difference between educators? level of experience teaching online and their satisfaction with online teaching and learning technologies (P<.001) and between educators? faculties (departments) and their satisfaction with online teaching and learning technologies (P=.001). Participants identified barriers (time constraints, underdeveloped curriculum, decreased student engagement, and limited access to virtual caring equipment and technology), facilitators (clearly defined learning objectives, technology software and support, teaching support, stakeholder engagement, and flexibility), and principles of teaching virtual caring skills in online environments (connection, interaction, compassion, empathy, care, and vulnerability). Conclusions: Our study identifies the barriers, facilitators, and principles in teaching virtual caring skills, offering practical strategies for educators in caring professions. This study contributes to the growing body of educational research on virtual caring skills by offering educator insights and suggestions for improved teaching and learning strategies in caring professions? programs. As educational practices evolve, future research should explore how traditionally in-person educators can effectively teach virtual caring skills across diverse contexts. UR - https://nursing.jmir.org/2025/1/e64548 UR - http://dx.doi.org/10.2196/64548 UR - http://www.ncbi.nlm.nih.gov/pubmed/39608377 ID - info:doi/10.2196/64548 ER - TY - JOUR AU - Dushyanthen, Sathana AU - Zamri, Izzati Nadia AU - Chapman, Wendy AU - Capurro, Daniel AU - Lyons, Kayley PY - 2025/1/14 TI - Evaluation of an Interdisciplinary Educational Program to Foster Learning Health Systems: Education Evaluation JO - JMIR Med Educ SP - e54152 VL - 11 KW - continuing professional development KW - learning health system KW - flipped classroom KW - digital health informatics KW - data science KW - health professions education KW - interdisciplinary education KW - foster KW - foster learning KW - health data KW - design KW - innovative KW - innovative solution KW - health care workforce KW - Australia KW - real time KW - teaching model N2 - Background: Learning health systems (LHS) have the potential to use health data in real time through rapid and continuous cycles of data interrogation, implementing insights to practice, feedback, and practice change. However, there is a lack of an appropriately skilled interprofessional informatics workforce that can leverage knowledge to design innovative solutions. Therefore, there is a need to develop tailored professional development training in digital health, to foster skilled interprofessional learning communities in the health care workforce in Australia. Objective: This study aimed to explore participants? experiences and perspectives of participating in an interprofessional education program over 13 weeks. The evaluation also aimed to assess the benefits, barriers, and opportunities for improvements and identify future applications of the course materials. Methods: We developed a wholly online short course open to interdisciplinary professionals working in digital health in the health care sector. In a flipped classroom model, participants (n=400) undertook 2 hours of preclass learning online and then attended 2.5 hours of live synchronous learning in interactive weekly Zoom workshops for 13 weeks. Throughout the course, they collaborated in small, simulated learning communities (n=5 to 8), engaging in various activities and problem-solving exercises, contributing their unique perspectives and diverse expertise. The course covered a number of topics including background on LHS, establishing learning communities, the design thinking process, data preparation and machine learning analysis, process modeling, clinical decision support, remote patient monitoring, evaluation, implementation, and digital transformation. To evaluate the purpose of the program, we undertook a mixed methods evaluation consisting of pre- and postsurveys rating scales for usefulness, engagement, value, and applicability for various aspects of the course. Participants also completed identical measures of self-efficacy before and after (n=200), with scales mapped to specific skills and tasks that should have been achievable following each of the topics covered. Further, they undertook voluntary weekly surveys to provide feedback on which aspects to continue and recommendations for improvements, via free-text responses. Results: From the evaluation, it was evident that participants found the teaching model engaging, useful, valuable, and applicable to their work. In the self-efficacy component, we observed a significant increase (P<.001) in perceived confidence for all topics, when comparing pre- and postcourse ratings. Overall, it was evident that the program gave participants a framework to organize their knowledge and a common understanding and shared language to converse with other disciplines, changed the way they perceived their role and the possibilities of data and technologies, and provided a toolkit through the LHS framework that they could apply in their workplaces. Conclusions: We present a program to educate the health workforce on integrating the LHS model into standard practice. Interprofessional collaborative learning was a major component of the value of the program. This evaluation shed light on the multifaceted challenges and expectations of individuals embarking on a digital health program. Understanding the barriers and facilitators of the audience is crucial for creating an inclusive and supportive learning environment. Addressing these challenges will not only enhance participant engagement but also contribute to the overall success of the program and, by extension, the broader integration of digital health solutions into health care practice and, ultimately, patient outcomes. UR - https://mededu.jmir.org/2025/1/e54152 UR - http://dx.doi.org/10.2196/54152 ID - info:doi/10.2196/54152 ER - TY - JOUR AU - Kaewboonlert, Naritsaret AU - Poontananggul, Jiraphon AU - Pongsuwan, Natthipong AU - Bhakdisongkhram, Gun PY - 2025/1/13 TI - Factors Associated With the Accuracy of Large Language Models in Basic Medical Science Examinations: Cross-Sectional Study JO - JMIR Med Educ SP - e58898 VL - 11 KW - accuracy KW - performance KW - artificial intelligence KW - AI KW - ChatGPT KW - large language model KW - LLM KW - difficulty index KW - basic medical science examination KW - cross-sectional study KW - medical education KW - datasets KW - assessment KW - medical science KW - tool KW - Google N2 - Background: Artificial intelligence (AI) has become widely applied across many fields, including medical education. Content validation and its answers are based on training datasets and the optimization of each model. The accuracy of large language model (LLMs) in basic medical examinations and factors related to their accuracy have also been explored. Objective: We evaluated factors associated with the accuracy of LLMs (GPT-3.5, GPT-4, Google Bard, and Microsoft Bing) in answering multiple-choice questions from basic medical science examinations. Methods: We used questions that were closely aligned with the content and topic distribution of Thailand?s Step 1 National Medical Licensing Examination. Variables such as the difficulty index, discrimination index, and question characteristics were collected. These questions were then simultaneously input into ChatGPT (with GPT-3.5 and GPT-4), Microsoft Bing, and Google Bard, and their responses were recorded. The accuracy of these LLMs and the associated factors were analyzed using multivariable logistic regression. This analysis aimed to assess the effect of various factors on model accuracy, with results reported as odds ratios (ORs). Results: The study revealed that GPT-4 was the top-performing model, with an overall accuracy of 89.07% (95% CI 84.76%?92.41%), significantly outperforming the others (P<.001). Microsoft Bing followed with an accuracy of 83.69% (95% CI 78.85%?87.80%), GPT-3.5 at 67.02% (95% CI 61.20%?72.48%), and Google Bard at 63.83% (95% CI 57.92%?69.44%). The multivariable logistic regression analysis showed a correlation between question difficulty and model performance, with GPT-4 demonstrating the strongest association. Interestingly, no significant correlation was found between model accuracy and question length, negative wording, clinical scenarios, or the discrimination index for most models, except for Google Bard, which showed varying correlations. Conclusions: The GPT-4 and Microsoft Bing models demonstrated equal and superior accuracy compared to GPT-3.5 and Google Bard in the domain of basic medical science. The accuracy of these models was significantly influenced by the item?s difficulty index, indicating that the LLMs are more accurate when answering easier questions. This suggests that the more accurate models, such as GPT-4 and Bing, can be valuable tools for understanding and learning basic medical science concepts. UR - https://mededu.jmir.org/2025/1/e58898 UR - http://dx.doi.org/10.2196/58898 ID - info:doi/10.2196/58898 ER - TY - JOUR AU - Mühling, Tobias AU - Schreiner, Verena AU - Appel, Marc AU - Leutritz, Tobias AU - König, Sarah PY - 2025/1/10 TI - Comparing Virtual Reality?Based and Traditional Physical Objective Structured Clinical Examination (OSCE) Stations for Clinical Competency Assessments: Randomized Controlled Trial JO - J Med Internet Res SP - e55066 VL - 27 KW - virtual reality KW - VR KW - objective structured clinical examination KW - OSCE KW - medical education KW - technological proficiency KW - assessment KW - clinical competence KW - item characteristics KW - discrimination power KW - acceptance KW - technical feasibility KW - effectiveness KW - comparative study KW - physical stations KW - medical students KW - standardized patients KW - cost-effectiveness N2 - Background: Objective structured clinical examinations (OSCEs) are a widely recognized and accepted method to assess clinical competencies but are often resource-intensive. Objective: This study aimed to evaluate the feasibility and effectiveness of a virtual reality (VR)?based station (VRS) compared with a traditional physical station (PHS) in an already established curricular OSCE. Methods: Fifth-year medical students participated in an OSCE consisting of 10 stations. One of the stations, emergency medicine, was offered in 2 modalities: VRS and PHS. Students were randomly assigned to 1 of the 2 modalities. We used 2 distinct scenarios to prevent content leakage among participants. Student performance and item characteristics were analyzed, comparing the VRS with PHS as well as with 5 other case-based stations. Student perceptions of the VRS were collected through a quantitative and qualitative postexamination online survey, which included a 5-point Likert scale ranging from 1 (minimum) to 5 (maximum), to evaluate the acceptance and usability of the VR system. Organizational and technical feasibility as well as cost-effectiveness were also evaluated. Results: Following randomization and exclusions of invalid data sets, 57 and 66 participants were assessed for the VRS and PHS, respectively. The feasibility evaluation demonstrated smooth implementation of both VR scenarios (septic and anaphylactic shock) with 93% (53/57) of students using the VR technology without issues. The difficulty levels of the VRS scenarios (septic shock: P=.67; anaphylactic shock: P=.58) were comparable to the average difficulty of all stations (P=.68) and fell within the reference range (0.4-0.8). In contrast, VRS demonstrated above-average values for item discrimination (septic shock: r'=0.40; anaphylactic shock: r'=0.33; overall r'=0.30; with values >0.3 considered good) and discrimination index (septic shock: D=0.25; anaphylactic shock: D=0.26; overall D=0.16, with 0.2-0.3 considered mediocre and <0.2 considered poor). Apart from some hesitancy toward its broader application in future practical assessments (mean 3.07, SD 1.37 for VRS vs mean 3.65, SD 1.18 for PHS; P=.03), there were no other differences in perceptions between VRS and PHS. Thematic analysis highlighted the realistic portrayal of medical emergencies and fair assessment conditions provided by the VRS. Regarding cost-effectiveness, initial development of the VRS can be offset by long-term savings in recurring expenses like standardized patients and consumables. Conclusions: Integration of the VRS into the current OSCE framework proved feasible both technically and organizationally, even within the strict constraints of short examination phases and schedules. The VRS was accepted and positively received by students across various levels of technological proficiency, including those with no prior VR experience. Notably, the VRS demonstrated comparable or even superior item characteristics, particularly in terms of discrimination power. Although challenges remain, such as technical reliability and some acceptance concerns, VR remains promising in applications of clinical competence assessment. UR - https://www.jmir.org/2025/1/e55066 UR - http://dx.doi.org/10.2196/55066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55066 ER - TY - JOUR AU - Johnston, Sewan Jamie AU - Skinner, Ann Nadine AU - Tokar, Anna AU - Arabi, Elham AU - Ndiaye, Yabsa Ngouille AU - Strehlow, Charles Matthew AU - Utunen, Heini PY - 2025/1/10 TI - Global Use, Adaptation, and Sharing of Massive Open Online Courses for Emergency Health on the OpenWHO Platform: Survey Study JO - J Med Internet Res SP - e52591 VL - 27 KW - MOOCs KW - online learning KW - global health education KW - digital health KW - health worker training KW - health emergencies KW - outbreak KW - COVID-19 N2 - Background: The COVID-19 pandemic demonstrated the global need for accessible content to rapidly train health care workers during health emergencies. The massive open access online course (MOOC) format is a broadly embraced strategy for widespread dissemination of trainings. Yet, barriers associated with technology access, language, and cultural context limit the use of MOOCs, particularly in lower-resource communities. There is tremendous potential for MOOC developers to increase the global scale and contextualization of learning; however, at present, few studies examine the adaptation and sharing of health MOOCs to address these challenges. Objective: The World Health Organization?s Health Emergencies Programme Learning and Capacity Development Unit and the Stanford Center for Health Education collaborated to survey learners from 4 emergency health MOOCs on the OpenWHO platform to examine differences in course use by World Bank country income classification across three dimensions: (1) how health education MOOCs are used and shared, (2) how health workers adapt MOOC content to meet local training and information needs, and (3) how content adaptations help frontline health workers overcome barriers to using MOOCs. Methods: This study draws upon two sources of data: (1) course enrollment data collected from the 4 emergency health MOOCs (N=96,395) and (2) survey data collected from learners who participated in at least 1 of the 4 MOOCs (N=926). Descriptive statistics are used to summarize learner characteristics. Differences in enrollment, sharing, and adaptation by country income classification are examined using Pearson chi-square test. Results: Of the enrollees who indicated their country of residence, half were from lower-middle-income countries (LMICs; 43,168/85,882, 50%) and another 9% (7146/85,882) from low-income countries. The majority of all respondents shared content (819/926, 88%) and used content in official trainings (563/926, 61%). Respondents were more likely to share and use content for trainings in LMICs than in high-income countries (91% vs 81%; P=.001). Learners in LMICs also shared content with more people on average compared with high-income country learners although the difference is not statistically significant (9.48 vs 6.73 people; P=.084). Compared with learners in high-income countries, learners in LMICs were more likely to adapt materials to distribute via offline formats or technologies, such as WhatsApp or text message (31% vs 8%; P<.001); to address cultural, linguistic, or other contextual needs (20% vs 12%; P=.076); and to meet local guidelines (20% vs 9%; P=.010). Learners in LMICs indicated greater accessibility challenges due to technological and linguistic barriers. Conclusions: Learners commonly share content from MOOCs about public health emergencies; this is especially true in low-income countries and LMICs. However, content is often adapted and shared via alternative formats. Our findings identify a critical opportunity to improve MOOC design and dramatically scale the impact of MOOCs to better meet diverse global needs. UR - https://www.jmir.org/2025/1/e52591 UR - http://dx.doi.org/10.2196/52591 UR - http://www.ncbi.nlm.nih.gov/pubmed/39792445 ID - info:doi/10.2196/52591 ER - TY - JOUR AU - Zhang, Yong AU - Lu, Xiao AU - Luo, Yan AU - Zhu, Ying AU - Ling, Wenwu PY - 2025/1/9 TI - Performance of Artificial Intelligence Chatbots on Ultrasound Examinations: Cross-Sectional Comparative Analysis JO - JMIR Med Inform SP - e63924 VL - 13 KW - chatbots KW - ChatGPT KW - ERNIE Bot KW - performance KW - accuracy rates KW - ultrasound KW - language KW - examination N2 - Background: Artificial intelligence chatbots are being increasingly used for medical inquiries, particularly in the field of ultrasound medicine. However, their performance varies and is influenced by factors such as language, question type, and topic. Objective: This study aimed to evaluate the performance of ChatGPT and ERNIE Bot in answering ultrasound-related medical examination questions, providing insights for users and developers. Methods: We curated 554 questions from ultrasound medicine examinations, covering various question types and topics. The questions were posed in both English and Chinese. Objective questions were scored based on accuracy rates, whereas subjective questions were rated by 5 experienced doctors using a Likert scale. The data were analyzed in Excel. Results: Of the 554 questions included in this study, single-choice questions comprised the largest share (354/554, 64%), followed by short answers (69/554, 12%) and noun explanations (63/554, 11%). The accuracy rates for objective questions ranged from 8.33% to 80%, with true or false questions scoring highest. Subjective questions received acceptability rates ranging from 47.62% to 75.36%. ERNIE Bot was superior to ChatGPT in many aspects (P<.05). Both models showed a performance decline in English, but ERNIE Bot?s decline was less significant. The models performed better in terms of basic knowledge, ultrasound methods, and diseases than in terms of ultrasound signs and diagnosis. Conclusions: Chatbots can provide valuable ultrasound-related answers, but performance differs by model and is influenced by language, question type, and topic. In general, ERNIE Bot outperforms ChatGPT. Users and developers should understand model performance characteristics and select appropriate models for different questions and languages to optimize chatbot use. UR - https://medinform.jmir.org/2025/1/e63924 UR - http://dx.doi.org/10.2196/63924 ID - info:doi/10.2196/63924 ER - TY - JOUR AU - Mun, Michelle AU - Byrne, Samantha AU - Shaw, Louise AU - Lyons, Kayley PY - 2025/1/8 TI - Digital Dentists: A Curriculum for the 21st Century JO - JMIR Med Educ SP - e54153 VL - 11 KW - digital health KW - digital transformation KW - informatics KW - ehealth KW - dentistry KW - dental informatics KW - curriculum KW - competence KW - capability KW - dental education UR - https://mededu.jmir.org/2025/1/e54153 UR - http://dx.doi.org/10.2196/54153 ID - info:doi/10.2196/54153 ER - TY - JOUR AU - Burrell, Joanna AU - Baker, Felicity AU - Bennion, Russell Matthew PY - 2025/1/6 TI - Resilience Training Web App for National Health Service Keyworkers: Pilot Usability Study JO - JMIR Med Educ SP - e51101 VL - 11 KW - resilience KW - workplace stress KW - National Health Service KW - NHS keyworker KW - digital learning KW - digital health KW - usability KW - feasibility KW - mental health KW - pilot study KW - learning KW - training KW - exercise KW - primary care provider KW - health care professional KW - occupational health KW - worker KW - hospital KW - emergency KW - survey KW - questionnaire KW - mobile phone N2 - Background: It is well established that frontline health care staff are particularly at risk of stress. Resilience is important to help staff to manage daily challenges and to protect against burnout. Objective: This study aimed to assess the usability and user perceptions of a resilience training web app developed to support health care keyworkers in understanding their own stress response and to help them put into place strategies to manage stress and to build resilience. Methods: Nurses (n=7) and other keyworkers (n=1), the target users for the resilience training web app, participated in the usability evaluation. Participants completed a pretraining questionnaire capturing basic demographic information and then used the training before completing a posttraining feedback questionnaire exploring the impact and usability of the web app. Results: From a sample of 8 keyworkers, 6 (75%) rated their current role as ?sometimes? stressful. All 8 (100%) keyworkers found the training easy to understand, and 5 of 7 (71%) agreed that the training increased their understanding of both stress and resilience. Further, 6 of 8 (75%) agreed that the resilience model had helped them to understand what resilience is. Many of the keyworkers (6/8, 75%) agreed that the content was relevant to them. Furthermore, 6 of 8 (75%) agreed that they were likely to act to develop their resilience following completion of the training. Conclusions: This study tested the usability of a web app for resilience training specifically targeting National Health Service keyworkers. This work preceded a larger scale usability study, and it is hoped this study will help guide other studies to develop similar programs in clinical settings. UR - https://mededu.jmir.org/2025/1/e51101 UR - http://dx.doi.org/10.2196/51101 ID - info:doi/10.2196/51101 ER - TY - JOUR AU - Bland, Tyler PY - 2025/1/6 TI - Enhancing Medical Student Engagement Through Cinematic Clinical Narratives: Multimodal Generative AI?Based Mixed Methods Study JO - JMIR Med Educ SP - e63865 VL - 11 KW - artificial intelligence KW - cinematic clinical narratives KW - cinemeducation KW - medical education KW - narrative learning KW - AI KW - medical student KW - pharmacology KW - preclinical education KW - long-term retention KW - AI tools KW - GPT-4 KW - image KW - applicability N2 - Background: Medical students often struggle to engage with and retain complex pharmacology topics during their preclinical education. Traditional teaching methods can lead to passive learning and poor long-term retention of critical concepts. Objective: This study aims to enhance the teaching of clinical pharmacology in medical school by using a multimodal generative artificial intelligence (genAI) approach to create compelling, cinematic clinical narratives (CCNs). Methods: We transformed a standard clinical case into an engaging, interactive multimedia experience called ?Shattered Slippers.? This CCN used various genAI tools for content creation: GPT-4 for developing the storyline, Leonardo.ai and Stable Diffusion for generating images, Eleven Labs for creating audio narrations, and Suno for composing a theme song. The CCN integrated narrative styles and pop culture references to enhance student engagement. It was applied in teaching first-year medical students about immune system pharmacology. Student responses were assessed through the Situational Interest Survey for Multimedia and examination performance. The target audience comprised first-year medical students (n=40), with 18 responding to the Situational Interest Survey for Multimedia survey (n=18). Results: The study revealed a marked preference for the genAI-enhanced CCNs over traditional teaching methods. Key findings include the majority of surveyed students preferring the CCN over traditional clinical cases (14/18), as well as high average scores for triggered situational interest (mean 4.58, SD 0.53), maintained interest (mean 4.40, SD 0.53), maintained-feeling interest (mean 4.38, SD 0.51), and maintained-value interest (mean 4.42, SD 0.54). Students achieved an average score of 88% on examination questions related to the CCN material, indicating successful learning and retention. Qualitative feedback highlighted increased engagement, improved recall, and appreciation for the narrative style and pop culture references. Conclusions: This study demonstrates the potential of using a multimodal genAI-driven approach to create CCNs in medical education. The ?Shattered Slippers? case effectively enhanced student engagement and promoted knowledge retention in complex pharmacological topics. This innovative method suggests a novel direction for curriculum development that could improve learning outcomes and student satisfaction in medical education. Future research should explore the long-term retention of knowledge and the applicability of learned material in clinical settings, as well as the potential for broader implementation of this approach across various medical education contexts. UR - https://mededu.jmir.org/2025/1/e63865 UR - http://dx.doi.org/10.2196/63865 ID - info:doi/10.2196/63865 ER - TY - JOUR AU - Wang, Heng AU - Zheng, Danni AU - Wang, Mengying AU - Ji, Hong AU - Han, Jiangli AU - Wang, Yan AU - Shen, Ning AU - Qiao, Jie PY - 2025/1/3 TI - Artificial Intelligence?Powered Training Database for Clinical Thinking: App Development Study JO - JMIR Form Res SP - e58426 VL - 9 KW - artificial intelligence KW - clinical thinking ability KW - virtual medical records KW - distance education KW - medical education KW - online learning N2 - Background: With the development of artificial intelligence (AI), medicine has entered the era of intelligent medicine, and various aspects, such as medical education and talent cultivation, are also being redefined. The cultivation of clinical thinking abilities poses a formidable challenge even for seasoned clinical educators, as offline training modalities often fall short in bridging the divide between current practice and the desired ideal. Consequently, there arises an imperative need for the expeditious development of a web-based database, tailored to empower physicians in their quest to learn and hone their clinical reasoning skills. Objective: This study aimed to introduce an app named ?XueYiKu,? which includes consultations, physical examinations, auxiliary examinations, and diagnosis, incorporating AI and actual complete hospital medical records to build an online-learning platform using human-computer interaction. Methods: The ?XueYiKu? app was designed as a contactless, self-service, trial-and-error system application based on actual complete hospital medical records and natural language processing technology to comprehensively assess the ?clinical competence? of residents at different stages. Case extraction was performed at a hospital?s case data center, and the best-matching cases were differentiated through natural language processing, word segmentation, synonym conversion, and sorting. More than 400 teaching cases covering 65 kinds of diseases were released for students to learn, and the subjects covered internal medicine, surgery, gynecology and obstetrics, and pediatrics. The difficulty of learning cases was divided into four levels in ascending order. Moreover, the learning and teaching effects were evaluated using 6 dimensions covering systematicness, agility, logic, knowledge expansion, multidimensional evaluation indicators, and preciseness. Results: From the app?s first launch on the Android platform in May 2019 to the last version updated in May 2023, the total number of teacher and student users was 6209 and 1180, respectively. The top 3 subjects most frequently learned were respirology (n=606, 24.1%), general surgery (n=506, 20.1%), and urinary surgery (n=390, 15.5%). For diseases, pneumonia was the most frequently learned, followed by cholecystolithiasis (n=216, 14.1%), benign prostate hyperplasia (n=196, 12.8%), and bladder tumor (n=193, 12.6%). Among 479 students, roughly a third (n=168, 35.1%) scored in the 60 to 80 range, and half of them scored over 80 points (n=238, 49.7%). The app enabled medical students? learning to become more active and self-motivated, with a variety of formats, and provided real-time feedback through assessments on the platform. The learning effect was satisfactory overall and provided important precedence for establishing scientific models and methods for assessing clinical thinking skills in the future. Conclusions: The integration of AI and medical education will undoubtedly assist in the restructuring of education processes; promote the evolution of the education ecosystem; and provide new convenient ways for independent learning, interactive communication, and educational resource sharing. UR - https://formative.jmir.org/2025/1/e58426 UR - http://dx.doi.org/10.2196/58426 ID - info:doi/10.2196/58426 ER - TY - JOUR AU - Tang, Shuhan PY - 2025/1/3 TI - Enhancing Methodological Rigor in Mobile Health Care Research JO - JMIR Hum Factors SP - e68243 VL - 12 KW - letter to the editor KW - health care professionals KW - mobile health care KW - technical training KW - cross-sectional survey KW - mobile KW - China KW - web-based questionnaire KW - logistic regression KW - mhealth KW - mobile health UR - https://humanfactors.jmir.org/2025/1/e68243 UR - http://dx.doi.org/10.2196/68243 ID - info:doi/10.2196/68243 ER - TY - JOUR AU - Wang, Chenxu AU - Li, Shuhan AU - Lin, Nuoxi AU - Zhang, Xinyu AU - Han, Ying AU - Wang, Xiandi AU - Liu, Di AU - Tan, Xiaomei AU - Pu, Dan AU - Li, Kang AU - Qian, Guangwu AU - Yin, Rong PY - 2025/1/1 TI - Application of Large Language Models in Medical Training Evaluation?Using ChatGPT as a Standardized Patient: Multimetric Assessment JO - J Med Internet Res SP - e59435 VL - 27 KW - ChatGPT KW - artificial intelligence KW - standardized patient KW - health care KW - prompt engineering KW - accuracy KW - large language models KW - performance evaluation KW - medical training KW - inflammatory bowel disease N2 - Background: With the increasing interest in the application of large language models (LLMs) in the medical field, the feasibility of its potential use as a standardized patient in medical assessment is rarely evaluated. Specifically, we delved into the potential of using ChatGPT, a representative LLM, in transforming medical education by serving as a cost-effective alternative to standardized patients, specifically for history-taking tasks. Objective: The study aims to explore ChatGPT?s viability and performance as a standardized patient, using prompt engineering to refine its accuracy and use in medical assessments. Methods: A 2-phase experiment was conducted. The first phase assessed feasibility by simulating conversations about inflammatory bowel disease (IBD) across 3 quality groups (good, medium, and bad). Responses were categorized based on their relevance and accuracy. Each group consisted of 30 runs, with responses scored to determine whether they were related to the inquiries. For the second phase, we evaluated ChatGPT?s performance against specific criteria, focusing on its anthropomorphism, clinical accuracy, and adaptability. Adjustments were made to prompts based on ChatGPT?s response shortcomings, with a comparative analysis of ChatGPT?s performance between original and revised prompts. A total of 300 runs were conducted and compared against standard reference scores. Finally, the generalizability of the revised prompt was tested using other scripts for another 60 runs, together with the exploration of the impact of the used language on the performance of the chatbot. Results: The feasibility test confirmed ChatGPT?s ability to simulate a standardized patient effectively, differentiating among poor, medium, and good medical inquiries with varying degrees of accuracy. Score differences between the poor (74.7, SD 5.44) and medium (82.67, SD 5.30) inquiry groups (P<.001), between the poor and good (85, SD 3.27) inquiry groups (P<.001) were significant at a significance level (?) of .05, while the score differences between the medium and good inquiry groups were not statistically significant (P=.16). The revised prompt significantly improved ChatGPT?s realism, clinical accuracy, and adaptability, leading to a marked reduction in scoring discrepancies. The score accuracy of ChatGPT improved 4.926 times compared to unrevised prompts. The score difference percentage drops from 29.83% to 6.06%, with a drop in SD from 0.55 to 0.068. The performance of the chatbot on a separate script is acceptable with an average score difference percentage of 3.21%. Moreover, the performance differences between test groups using various language combinations were found to be insignificant. Conclusions: ChatGPT, as a representative LLM, is a viable tool for simulating standardized patients in medical assessments, with the potential to enhance medical training. By incorporating proper prompts, ChatGPT?s scoring accuracy and response realism significantly improved, approaching the feasibility of actual clinical use. Also, the influence of the adopted language is nonsignificant on the outcome of the chatbot. UR - https://www.jmir.org/2025/1/e59435 UR - http://dx.doi.org/10.2196/59435 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59435 ER - TY - JOUR AU - Zong, Hui AU - Wu, Rongrong AU - Cha, Jiaxue AU - Wang, Jiao AU - Wu, Erman AU - Li, Jiakun AU - Zhou, Yi AU - Zhang, Chi AU - Feng, Weizhe AU - Shen, Bairong PY - 2024/12/27 TI - Large Language Models in Worldwide Medical Exams: Platform Development and Comprehensive Analysis JO - J Med Internet Res SP - e66114 VL - 26 KW - large language models KW - LLMs KW - generative pretrained transformer KW - ChatGPT KW - medical exam KW - medical education KW - artifical intelligence KW - AI N2 - Background: Large language models (LLMs) are increasingly integrated into medical education, with transformative potential for learning and assessment. However, their performance across diverse medical exams globally has remained underexplored. Objective: This study aims to introduce MedExamLLM, a comprehensive platform designed to systematically evaluate the performance of LLMs on medical exams worldwide. Specifically, the platform seeks to (1) compile and curate performance data for diverse LLMs on worldwide medical exams; (2) analyze trends and disparities in LLM capabilities across geographic regions, languages, and contexts; and (3) provide a resource for researchers, educators, and developers to explore and advance the integration of artificial intelligence in medical education. Methods: A systematic search was conducted on April 25, 2024, in the PubMed database to identify relevant publications. Inclusion criteria encompassed peer-reviewed, English-language, original research articles that evaluated at least one LLM on medical exams. Exclusion criteria included review articles, non-English publications, preprints, and studies without relevant data on LLM performance. The screening process for candidate publications was independently conducted by 2 researchers to ensure accuracy and reliability. Data, including exam information, data process information, model performance, data availability, and references, were manually curated, standardized, and organized. These curated data were integrated into the MedExamLLM platform, enabling its functionality to visualize and analyze LLM performance across geographic, linguistic, and exam characteristics. The web platform was developed with a focus on accessibility, interactivity, and scalability to support continuous data updates and user engagement. Results: A total of 193 articles were included for final analysis. MedExamLLM comprised information for 16 LLMs on 198 medical exams conducted in 28 countries across 15 languages from the year 2009 to the year 2023. The United States accounted for the highest number of medical exams and related publications, with English being the dominant language used in these exams. The Generative Pretrained Transformer (GPT) series models, especially GPT-4, demonstrated superior performance, achieving pass rates significantly higher than other LLMs. The analysis revealed significant variability in the capabilities of LLMs across different geographic and linguistic contexts. Conclusions: MedExamLLM is an open-source, freely accessible, and publicly available online platform providing comprehensive performance evaluation information and evidence knowledge about LLMs on medical exams around the world. The MedExamLLM platform serves as a valuable resource for educators, researchers, and developers in the fields of clinical medicine and artificial intelligence. By synthesizing evidence on LLM capabilities, the platform provides valuable insights to support the integration of artificial intelligence into medical education. Limitations include potential biases in the data source and the exclusion of non-English literature. Future research should address these gaps and explore methods to enhance LLM performance in diverse contexts. UR - https://www.jmir.org/2024/1/e66114 UR - http://dx.doi.org/10.2196/66114 UR - http://www.ncbi.nlm.nih.gov/pubmed/39729356 ID - info:doi/10.2196/66114 ER - TY - JOUR AU - Zucca, Alison AU - Bryant, Jamie AU - Purse, Jeffrey AU - Szwec, Stuart AU - Sanson-Fisher, Robert AU - Leigh, Lucy AU - Richer, Mike AU - Morrison, Alan PY - 2024/12/24 TI - Evaluation of the Effectiveness of Advanced Technology Clinical Simulation Manikins in Improving the Capability of Australian Paramedics to Deliver High-Quality Cardiopulmonary Resuscitation: Pre- and Postintervention Study JO - JMIR Cardio SP - e49895 VL - 8 KW - paramedicine KW - cardiopulmonary resuscitation KW - clinical simulation KW - professional development KW - manikins KW - effectiveness KW - technology KW - paramedics KW - patient care KW - simulation-based training KW - deployment N2 - Background: Emergency medical services attend out-of-hospital cardiac arrests all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. Consequently, for paramedics working in areas with low out-of-hospital cardiac arrest case volumes, ambulance services and professional bodies recognize the importance of alternative ways to maintain resuscitation skills. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills. Objective: The aim of the study is to examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high-quality patient care, as measured by external cardiac compression (ECC) performance. Methods: A pre- and postintervention study design without a control group was used. Data were collected at the start of the manikin training forum (baseline), immediately following the training forum (time 2), and 6 to 11 months after the training forum (time 3). The study was conducted with paramedics from 95 NSW Ambulance locations (75 regional locations and 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (N=106; 100% consent rate). As part of the intervention, paramedics attended a training session on the use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measure was an overall compression score that was automatically recorded and calculated by the simulator manikin in 2-minute cycles. This score was derived from compressions that were fully released and with the correct hand position, adequate depth, and adequate rate. Results: A total of 106 (100% consent rate) paramedics participated, primarily representing regional ambulance locations (n= 75, 78.9%). ECC compression scores were on average 95% or above at all time points, suggesting high performance. No significant differences over time (P>.05) were identified for the overall ECC performance score, compressions fully released, compressions with adequate depth, or compressions with the correct hand position. However, paramedics had significantly lower odds (odds ratio 0.30, 95% CI 0.12-0.78) of achieving compressions with adequate rate at time 3 compared to time 2 (P=.01). Compressions were of a slower rate, with an average difference of 2.1 fewer compressions every minute. Conclusions: Despite this difference in compression rate over time, this did not cause significant detriment to overall ECC performance. Training and deployment of simulator manikins did not significantly change paramedics? overall ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance. UR - https://cardio.jmir.org/2024/1/e49895 UR - http://dx.doi.org/10.2196/49895 ID - info:doi/10.2196/49895 ER - TY - JOUR AU - Ogundiya, Oluwadamilola AU - Rahman, Jasmine Thahmina AU - Valnarov-Boulter, Ioan AU - Young, Michael Tim PY - 2024/12/19 TI - Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review JO - J Med Internet Res SP - e60312 VL - 26 KW - digital health KW - digital medical education KW - health education KW - medical education KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: The last 25 years have seen enormous progression in digital technologies across the whole of the health service, including health education. The rapid evolution and use of web-based and digital techniques have been significantly transforming this field since the beginning of the new millennium. These advancements continue to progress swiftly, even more so after the COVID-19 pandemic. Objective: This narrative review aims to outline and discuss the developments that have taken place in digital medical education across the defined time frame. In addition, evidence for potential opportunities and challenges facing digital medical education in the near future was collated for analysis. Methods: Literature reviews were conducted using PubMed, Web of Science Core Collection, Scopus, Google Scholar, and Embase. The participants and learners in this study included medical students, physicians in training or continuing professional development, nurses, paramedics, and patients. Results: Evidence of the significant steps in the development of digital medical education in the past 25 years was presented and analyzed in terms of application, impact, and implications for the future. The results were grouped into the following themes for discussion: learning management systems; telemedicine (in digital medical education); mobile health; big data analytics; the metaverse, augmented reality, and virtual reality; the COVID-19 pandemic; artificial intelligence; and ethics and cybersecurity. Conclusions: Major changes and developments in digital medical education have occurred from around the start of the new millennium. Key steps in this journey include technical developments in teleconferencing and learning management systems, along with a marked increase in mobile device use for accessing learning over this time. While the pace of evolution in digital medical education accelerated during the COVID-19 pandemic, further rapid progress has continued since the resolution of the pandemic. Many of these changes are currently being widely used in health education and other fields, such as augmented reality, virtual reality, and artificial intelligence, providing significant future potential. The opportunities these technologies offer must be balanced against the associated challenges in areas such as cybersecurity, the integrity of web-based assessments, ethics, and issues of digital privacy to ensure that digital medical education continues to thrive in the future. UR - https://www.jmir.org/2024/1/e60312 UR - http://dx.doi.org/10.2196/60312 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60312 ER - TY - JOUR AU - Nicolau, Abel AU - Jorge, Inês AU - Vieira-Marques, Pedro AU - Sa-Couto, Carla PY - 2024/12/19 TI - Influence of Training With Corrective Feedback Devices on Cardiopulmonary Resuscitation Skills Acquisition and Retention: Systematic Review and Meta-Analysis JO - JMIR Med Educ SP - e59720 VL - 10 KW - cardiopulmonary resuscitation KW - CPR quality KW - resuscitation training KW - corrective feedback devices KW - skills acquisition KW - skills retention KW - systematic review KW - evidence-based research KW - meta-analysis KW - feedback devices KW - PRISMA N2 - Background: Several studies related to the use of corrective feedback devices in cardiopulmonary resuscitation training, with different populations, training methodologies, and equipment, present distinct results regarding the influence of this technology. Objective: This systematic review and meta-analysis aimed to examine the impact of corrective feedback devices in cardiopulmonary resuscitation skills acquisition and retention for laypeople and health care professionals. Training duration was also studied. Methods: The search was conducted in PubMed, Web of Science, and Scopus from January 2015 to December 2023. Eligible randomized controlled trials compared technology-based training incorporating corrective feedback with standard training. Outcomes of interest were the quality of chest compression?related components. The risk of bias was assessed using the Cochrane tool. A meta-analysis was used to explore the heterogeneity of the selected studies. Results: In total, 20 studies were included. Overall, it was reported that corrective feedback devices used during training had a positive impact on both skills acquisition and retention. Medium to high heterogeneity was observed. Conclusions: This systematic review and meta-analysis suggest that corrective feedback devices enhance skills acquisition and retention over time. Considering the medium to high heterogeneity observed, these findings should be interpreted with caution. More standardized, high-quality studies are needed. Trial Registration: PROSPERO CRD42021240953; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=240953 UR - https://mededu.jmir.org/2024/1/e59720 UR - http://dx.doi.org/10.2196/59720 UR - http://www.ncbi.nlm.nih.gov/pubmed/39699935 ID - info:doi/10.2196/59720 ER - TY - JOUR AU - Al-Jayyousi, Fakhri Ghadir AU - Alsayed Hassan, Diana AU - Abdul Rahim, Hanan AU - E Abdel-Rahman, Manar AU - Ferreira, Isabel AU - Mukhalalati, Banan AU - O'Hara, Lily AU - Khalil, Hanan AU - Tayyem, Reema AU - S Abu Alhaija, Elham AU - Abidia, Randa AU - Zolezzi, Monica AU - El-Awaisi, Alla AU - Al-Wattary, Noor AU - Mahmood Al Saady, Rafif AU - Saffouh El Hajj, Maguy AU - Shraim, Mujahed AU - K Abouhanian, Arpi AU - Saeb, Hatoun AU - Mohammed, Mustapha AU - PY - 2024/12/18 TI - Health and Well-Being in the Context of Health-Promoting University Initiatives: Protocol for a Mixed Methods Needs Assessment Study at Qatar University JO - JMIR Res Protoc SP - e58860 VL - 13 KW - college students KW - needs assessment KW - qualitative KW - lifestyle behaviors KW - environmental scan N2 - Background: Health-promoting universities are dedicated to fostering learning environments and organizational cultures that support the physical and mental well-being of students, faculty, and staff. As students constitute the largest group within the university community, any policy intervention targeting them is likely to have a significant impact on the university as a whole. Objective: This study aims to assess the health status and needs of Qatar University (QU) students using a comprehensive and holistic definition of health, informed by the perspectives of students, faculty members, and key informants. The ultimate goal is to inform evidence-based policies and services designed to improve students? physical and mental well-being. Methods: An explanatory sequential mixed-methods research design will be used to conduct a comprehensive assessment of students? health status and needs. This assessment will consist of a quantitative component (a web-based health survey) administered to a convenience sample of students, and a qualitative component, including focus groups with students and faculty members, as well as interviews with key informants. Priority health issues and their determinants, identified through the quantitative assessment, will inform and guide the qualitative assessment to provide a deeper understanding of the various contexts and factors shaping them. Descriptive analyses (eg, proportions or means with SDs), comparative analyses (eg, t tests or chi-square tests), and association analyses (eg, linear, logistic, or Poisson regression models) will be used to analyze the quantitative data. Thematic analysis will be used in the qualitative assessments. Additionally, an environmental scan will be conducted to assess relevant facilities, services, and programs at the QU campus and the QU Primary Healthcare Corporation Center, as well as to review university policies and regulations that may affect students? health and well-being. Together, the needs assessment and environmental scan will inform the design of multilevel interventions, including health education and promotion programs, health services orientation, and proposed policy changes. Results: Between March and December 2022, 812 students completed the web-based health survey. Data have been extracted, cleaned, and harmonized. Analyses to assess the extent of selection bias and the calculation of weights to account for this in all subsequent analyses have been completed (by December 2023). Following the completion of all quantitative data analyses (expected by the end of 2024), focus groups, interviews, and the environmental scan will begin in January-December 2025. Conclusions: This project will help identify and prioritize the health needs of QU students and their determinants, and inform relevant services and policies targeting these needs. By using comprehensive and context-appropriate methods, this project will contribute to QU?s strategic efforts to become a Health-Promoting University. International Registered Report Identifier (IRRID): DERR1-10.2196/58860 UR - https://www.researchprotocols.org/2024/1/e58860 UR - http://dx.doi.org/10.2196/58860 UR - http://www.ncbi.nlm.nih.gov/pubmed/39693145 ID - info:doi/10.2196/58860 ER - TY - JOUR AU - Roos, Jonas AU - Martin, Ron AU - Kaczmarczyk, Robert PY - 2024/12/17 TI - Evaluating Bard Gemini Pro and GPT-4 Vision Against Student Performance in Medical Visual Question Answering: Comparative Case Study JO - JMIR Form Res SP - e57592 VL - 8 KW - medical education KW - visual question answering KW - image analysis KW - large language model KW - LLM KW - student KW - performance KW - comparative KW - case study KW - artificial intelligence KW - AI KW - ChatGPT KW - effectiveness KW - diagnostic KW - training KW - accuracy KW - utility KW - image-based KW - question KW - image KW - AMBOSS KW - English KW - German KW - question and answer KW - Python KW - AI in health care KW - health care N2 - Background: The rapid development of large language models (LLMs) such as OpenAI?s ChatGPT has significantly impacted medical research and education. These models have shown potential in fields ranging from radiological imaging interpretation to medical licensing examination assistance. Recently, LLMs have been enhanced with image recognition capabilities. Objective: This study aims to critically examine the effectiveness of these LLMs in medical diagnostics and training by assessing their accuracy and utility in answering image-based questions from medical licensing examinations. Methods: This study analyzed 1070 image-based multiple-choice questions from the AMBOSS learning platform, divided into 605 in English and 465 in German. Customized prompts in both languages directed the models to interpret medical images and provide the most likely diagnosis. Student performance data were obtained from AMBOSS, including metrics such as the ?student passed mean? and ?majority vote.? Statistical analysis was conducted using Python (Python Software Foundation), with key libraries for data manipulation and visualization. Results: GPT-4 1106 Vision Preview (OpenAI) outperformed Bard Gemini Pro (Google), correctly answering 56.9% (609/1070) of questions compared to Bard?s 44.6% (477/1070), a statistically significant difference (?2?=32.1, P<.001). However, GPT-4 1106 left 16.1% (172/1070) of questions unanswered, significantly higher than Bard?s 4.1% (44/1070; ?2?=83.1, P<.001). When considering only answered questions, GPT-4 1106?s accuracy increased to 67.8% (609/898), surpassing both Bard (477/1026, 46.5%; ?2?=87.7, P<.001) and the student passed mean of 63% (674/1070, SE 1.48%; ?2?=4.8, P=.03). Language-specific analysis revealed both models performed better in German than English, with GPT-4 1106 showing greater accuracy in German (282/465, 60.65% vs 327/605, 54.1%; ?2?=4.4, P=.04) and Bard Gemini Pro exhibiting a similar trend (255/465, 54.8% vs 222/605, 36.7%; ?2?=34.3, P<.001). The student majority vote achieved an overall accuracy of 94.5% (1011/1070), significantly outperforming both artificial intelligence models (GPT-4 1106: ?2?=408.5, P<.001; Bard Gemini Pro: ?2?=626.6, P<.001). Conclusions: Our study shows that GPT-4 1106 Vision Preview and Bard Gemini Pro have potential in medical visual question-answering tasks and to serve as a support for students. However, their performance varies depending on the language used, with a preference for German. They also have limitations in responding to non-English content. The accuracy rates, particularly when compared to student responses, highlight the potential of these models in medical education, yet the need for further optimization and understanding of their limitations in diverse linguistic contexts remains critical. UR - https://formative.jmir.org/2024/1/e57592 UR - http://dx.doi.org/10.2196/57592 ID - info:doi/10.2196/57592 ER - TY - JOUR AU - Semple, Jane Cherith AU - O'Neill, Carla AU - Sheehan, Sarah AU - McCance, Tanya AU - Drury, Amanda AU - Hanna, R. Jeffrey PY - 2024/12/10 TI - An e-Learning Intervention for Professionals to Promote Family-Centered Cancer Care When a Significant Caregiver for Children Is at End of Life: Mixed Methods Evaluation Study JO - J Med Internet Res SP - e65619 VL - 26 KW - e-learning KW - intervention evaluation KW - mixed methods KW - end-of-life care KW - educational intervention KW - professionals KW - self-efficacy KW - cancer KW - family-centered care KW - cancer care KW - person-based approach KW - qualitative KW - evidence-based KW - parent KW - adverse outcome KW - eHealth N2 - Background: Families are often unsure how best to prepare dependent children for the death of a significant caregiver with a poor cancer prognosis and seek guidance and support from health care teams. Health and social care professionals (hereafter referred to as professionals) often lack educational opportunities to gain the desired knowledge, skills, and confidence to provide family-centered supportive cancer care. e-Learning has positively impacted access and reach, improving educational opportunities in health care. Objective: We aimed to evaluate the acceptability, usability, and effectiveness of an evidence-based, theory-driven e-learning intervention to equip and promote professionals? self-efficacy to deliver family-centered supportive cancer care when a significant caregiving member for dependent children is at the end of life. Methods: Guided by the ?person-based approach,? a mixed methods outcome evaluation was used. To determine the effect on self-efficacy, participants completed a validated pretest and posttest 12-item self-efficacy survey. The use of one-on-one, remote semistructured interviews and single-item questions determined the usability by professionals of the e-learning intervention and the acceptability of perceived learning in clinical practice. To generate enhanced insights, quantitative and qualitative data were integrated through a 4-stage, modified pillar integration process. Results: Overall, 158 participants completed the pretest survey for the e-learning resource, with 99 (62.7%) completing the posttest survey. Semistructured interviews were conducted with 12 professionals at least 1 month after the intervention. Findings highlighted a statistically significant improvement in posttest self-efficacy (99/158, 62.7%; P<.001). Usability of the e-learning intervention was positive, with participants reporting that it was clear and organized (mean 4.84, SD 0.373), the layout was appealing (mean 4.71, SD 0.539), the language was easy to understand (mean 4.71, SD 0.407), and graphics and media were purposeful (mean 4.76, SD 0.495) and engaging (mean 4.67, SD 0.703). Determining acceptability, participants considered that the intervention would positively impact practice (mean 4.60, SD 0.589) and increase knowledge (mean 4.56, SD 0.677), with appropriate practical examples to support learning (mean 4.58, SD 0.610). Following engagement with the e-learning intervention, professionals reported preparedness to deliver supportive adult-professional end-of-life cancer care, when an adult with significant caregiving responsibilities is dying. Findings demonstrated transferable learning to additional contexts, such as other close adult-child relational bonds (grandparents) and to life-limiting conditions. Conclusions: The systematic and iterative person-based approach optimized the acceptability of a novel e-learning intervention, having the potential to promote family-centered supportive end-of-life cancer care. This accessible e-learning intervention makes an important contribution to the recognized global gap of educational interventions in this field. Equipping professionals with family-centered supportive end-of-life care improves self-efficacy and preparedness to engage in challenging conversations, with the potential to promote better outcomes for affected adults and children and mediate adverse outcomes for adults and children before and after bereavement. UR - https://www.jmir.org/2024/1/e65619 UR - http://dx.doi.org/10.2196/65619 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65619 ER - TY - JOUR AU - Oliveira, de Nathalia Hanany Silva AU - Oliveira, de Renata Fonsêca Sousa AU - Soares, Pontes Juliana AU - Castro, de Janete Lima PY - 2024/12/9 TI - Sustainability of Interprofessional Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e60763 VL - 13 KW - college education KW - health training KW - interprofessional education KW - IPE KW - sustainability KW - collaborative practice KW - training of human resources in health KW - undergraduate medical education KW - students KW - student learners KW - professional development KW - health care professional training N2 - Background: Interprofessional education (IPE) is an approach that can improve health care quality, contribute to the qualification of health care professionals, and train undergraduate students. Although this strategy has made significant progress in the last decade, integration, sustainability, and institutional growth are still priorities worldwide. Thus, maintaining strategies is essential for their full development and evolution. Objective: This study aimed to identify discussions about the sustainability of IPE and map its actions or strategies (or both). Methods: The scoping review will follow the Joanna Briggs Institute methodology. This scoping review protocol follows the JBI Reviewers? Manual, with 6 stages: identifying the research question; identifying relevant studies; study selection; data extraction and coding; analysis and interpretation of results; and consultation with stakeholders. Two independent and blind reviewers will evaluate and select studies available in English, Portuguese, and Spanish based on the eligibility criteria. Searches will be conducted on LILACS, Embase, Scopus, PubMed/MEDLINE, ERIC, Web of Science, CINAHL, Google Scholar databases; ProQuest Dissertations & Theses Global, and Brazilian Digital Library of Theses and Dissertations. The main research question is as follows: What have been the sustainability strategies for IPE actions? This scoping review will incorporate studies (empirical or theoretical-reflective) that address strategies or actions (or both) for IPE sustainability. They must present a quantitative, qualitative, or mixed methods approach and be available in full text. Data on strategies or actions for IPE sustainability will be extracted and inserted into a spreadsheet for analysis. Quantitative data will be analyzed using descriptive statistics, while qualitative analysis will identify meanings and patterns through thematic analysis. Thus, the aim is to present the compiled findings in tables and charts. Results: The database search was conducted on March 22, 2024. In April and May 2024, duplicate studies were excluded. From July to November 2024, study selection will be carried out. In December 2024, data extraction and tabulation will take place, as well as consultation with stakeholders. The aim is to publish the results in scientific journals in January 2025. Conclusions: This protocol will guide this scoping review to identify discussions on the sustainability of IPE and map its actions or strategies (or both); summarize the definitions and institutions that develop or promote IPE; and present the main recommendations for the area under study. Additionally, possible research gaps can be identified to guide future studies. This review will shed light on existing knowledge gaps and the current state of research, which could provide support for future research, programs, and policy responses to foster collaboration and interprofessional practice and, consequently, improve the quality of user care. This information will be useful in supporting decision-making by government officials, managers, teachers, facilitators, and students in the implementation, maintenance, and development of IPE. Trial Registration: Open Science Framework 5VNJS; https://osf.io/5vnjs/ International Registered Report Identifier (IRRID): DERR1-10.2196/60763 UR - https://www.researchprotocols.org/2024/1/e60763 UR - http://dx.doi.org/10.2196/60763 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60763 ER - TY - JOUR AU - Vanderhout, Shelley AU - Bird, Marissa AU - Giannarakos, Antonia AU - Panesar, Balpreet AU - Whitmore, Carly PY - 2024/12/6 TI - Evaluation Methods, Indicators, and Outcomes in Learning Health Systems: Protocol for a Jurisdictional Scan JO - JMIR Res Protoc SP - e57929 VL - 13 KW - learning health systems KW - evaluation KW - jurisdictional scan KW - counterfactuals KW - LHS KW - health system KW - real-time evidence KW - informatics KW - organizational culture KW - learning cycles KW - benchmark KW - patient care KW - gaps KW - health care KW - inequities KW - development KW - implementation KW - intervention KW - new approach N2 - Background: In learning health systems (LHSs), real-time evidence, informatics, patient-provider partnerships and experiences, and organizational culture are combined to conduct ?learning cycles? that support improvements in care. Although the concept of LHSs is fairly well established in the literature, evaluation methods, mechanisms, and indicators are less consistently described. Furthermore, LHSs often use ?usual care? or ?status quo? as a benchmark for comparing new approaches to care, but disentangling usual care from multifarious care modalities found across settings is challenging. There is a need to identify which evaluation methods are used within LHSs, describe how LHS growth and maturity are conceptualized, and determine what tools and measures are being used to evaluate LHSs at the system level. Objective: This study aimed to (1) identify international examples of LHSs and describe their evaluation approaches, frameworks, indicators, and outcomes; and (2) describe common characteristics, emphases, assumptions, or challenges in establishing counterfactuals in LHSs. Methods: A jurisdictional scan, which is a method used to explore, understand, and assess how problems have been framed by others in a given field, will be conducted according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. LHSs will be identified through a search of peer-reviewed and gray literature using Ovid MEDLINE, EBSCO CINAHL, Ovid Embase, Clarivate Web of Science, PubMed non-MEDLINE databases, and the web. We will describe evaluation approaches used both at the LHS learning cycle and system levels. To gain a comprehensive understanding of each LHS, including details specific to evaluation, self-identified LHSs will be included if they are described according to at least 4 of 11 prespecified criteria (core functionalities, analytics, use of evidence, co-design or implementation, evaluation, change management or governance structures, data sharing, knowledge sharing, training or capacity building, equity, and sustainability). Search results will be screened, extracted, and analyzed to inform a descriptive review pertaining to our main objectives. Evaluation methods and approaches, both within learning cycles and at the system level, as well as frameworks, indicators, and target outcomes, will be identified and summarized descriptively. Across evaluations, common challenges, assumptions, contextual factors, and mechanisms will be described. Results: As of October 2024, the database searches described above yielded 3503 citations after duplicate removal. Full-text screening of 117 articles is complete, and 49 articles are under analysis. Results are expected in early 2025. Conclusions: This research will characterize the current landscape of LHS evaluation approaches and provide a foundation for developing consistent and scalable metrics of LHS growth, maturity, and success. This work will also serve to identify opportunities for improving the alignment of current evaluation approaches and metrics with population health needs, community priorities, equity, and health system strategic aims. Trial Registration: Open Science Framework b5u7e; https://osf.io/b5u7e International Registered Report Identifier (IRRID): DERR1-10.2196/57929 UR - https://www.researchprotocols.org/2024/1/e57929 UR - http://dx.doi.org/10.2196/57929 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57929 ER - TY - JOUR AU - Sun, Wan-Na AU - Hsieh, Min-Chai AU - Wang, Wei-Fang PY - 2024/12/5 TI - Nurses? Knowledge and Skills After Use of an Augmented Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial JO - J Med Internet Res SP - e57327 VL - 26 KW - augmented reality KW - technology intervention KW - randomized controlled trial KW - advanced cardiac life support KW - nursing education N2 - Background: Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. Objective: This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. Methods: This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. Results: All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). Conclusions: AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. Trial Registration: ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285 UR - https://www.jmir.org/2024/1/e57327 UR - http://dx.doi.org/10.2196/57327 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57327 ER - TY - JOUR AU - Jiang, Nan AU - Zhang, Yuelun AU - Liang, Siyu AU - Lyu, Xiaohong AU - Chen, Shi AU - Huang, Xiaoming AU - Pan, Hui PY - 2024/12/5 TI - Effectiveness of Virtual Simulations Versus Mannequins and Real Persons in Medical and Nursing Education: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e56195 VL - 26 KW - artificial intelligence KW - clinical virtual simulation KW - medical education KW - meta-analysis KW - nursing education KW - virtual patient KW - virtual reality N2 - Background: Virtual simulation (VS) is a developing education approach with the recreation of reality using digital technology. The teaching effectiveness of VSs compared to mannequins and real persons (RPs) has never been investigated in medical and nursing education. Objective: This study aims to compare VSs and mannequins or RPs in improving the following clinical competencies: knowledge, procedural skills, clinical reasoning, and communication skills. Methods: Following Cochrane methodology, a meta-analysis was conducted on the effectiveness of VSs in pre- and postregistration medical or nursing participants. The Cochrane Library, PubMed, Embase, and Educational Resource Information Centre databases were searched to identify English-written randomized controlled trials up to August 2024. Two authors independently selected studies, extracted data, and assessed the risk of bias. All pooled estimates were based on random-effects models and assessed by trial sequential analyses. Leave-one-out, subgroup, and univariate meta-regression analyses were performed to explore sources of heterogeneity. Results: A total of 27 studies with 1480 participants were included. Overall, there were no significant differences between VSs and mannequins or RPs in improving knowledge (standard mean difference [SMD]=0.08; 95% CI ?0.30 to 0.47; I2=67%; P=.002), procedural skills (SMD=?0.12; 95% CI ?0.47 to 0.23; I2=75%; P<.001), clinical reasoning (SMD=0.29; 95% CI ?0.26 to 0.85; I2=88%; P<.001), and communication skills (SMD=?0.02; 95% CI: ?0.62 to 0.58; I2=86%; P<.001). Trial sequential analysis for clinical reasoning indicated an insufficient sample size for a definitive judgment. For procedural skills, subgroup analyses showed that VSs were less effective among nursing participants (SMD=?0.55; 95% CI ?1.07 to ?0.03; I2=69%; P=.04). Univariate meta-regression detected a positive effect of publication year (?=.09; P=.02) on communication skill scores. Conclusions: Given favorable cost-utility plus high flexibility regarding time and space, VSs are viable alternatives to traditional face-to-face learning modalities. The comparative effectiveness of VSs deserves to be followed up with the emergence of new technology. In addition, further investigation of VSs with different design features will provide novel insights to drive education reform. Trial Registration: PROSPERO CRD42023466622; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466622 UR - https://www.jmir.org/2024/1/e56195 UR - http://dx.doi.org/10.2196/56195 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56195 ER - TY - JOUR AU - Benjamin, Jennifer AU - Pillow, Tyson AU - MacNeill, Heather AU - Masters, Ken AU - Agrawal, Anoop AU - Mehta, Neil PY - 2024/12/3 TI - Reflections From the Pandemic: Is Connectivism the Panacea for Clinicians? JO - J Med Internet Res SP - e53344 VL - 26 KW - learning theory KW - learning framework KW - connectivism KW - panacea KW - COVID-19 KW - generative artificial intelligence KW - GAI KW - health care community KW - clinician KW - health care KW - airborne disease KW - learning KW - information KW - misinformation KW - autonomy KW - diversity UR - https://www.jmir.org/2024/1/e53344 UR - http://dx.doi.org/10.2196/53344 UR - http://www.ncbi.nlm.nih.gov/pubmed/39625749 ID - info:doi/10.2196/53344 ER - TY - JOUR AU - Preibisch, Joshua AU - Tabriz, Navid AU - Kaluschke, Maximilian AU - Weyhe, Dirk AU - Uslar, Verena PY - 2024/11/27 TI - Virtual Reality in Clinical Teaching and Diagnostics for Liver Surgery: Prospective Cohort Study JO - JMIR XR Spatial Comput SP - e60383 VL - 1 KW - VR KW - virtual reality KW - multiple-choice test KW - anatomy KW - patient-specific 3D visualization KW - MRI-based segmentation KW - liver KW - cohort study KW - visualization KW - tool KW - medical diagnostic KW - questionnaire KW - usability KW - diagnostics KW - surgery KW - 3D KW - MRI KW - magnetic resonance imaging N2 - Background: Learning and applying anatomy are essential but are studied and done through 2D tools and imaging techniques. This study aims to verify the usefulness of an additional 3D technique and ensure an improvement in the visualization of anatomical structures and pathological findings. Objective: The study aims to examine the usefulness of virtual reality (VR) technology as an additional tool in medical diagnostics. Groups of students, residents, and specialists in surgery, radiology, and internal medicine evaluated magnetic resonance imaging (MRI) by answering a multiple-choice questionnaire. Subsequently, a virtual 3D display was used for processing. The questionnaire focused on topographical conditions and the transfer of academic knowledge into clinical application. The main objective was to determine anatomical understanding in a comparison between sectional image (2D) presentation and additional VR (3D) presentation, measured through correctly answered questions and processing time. The system usability scale (SUS) was integrated as another criterion for VR usability. Methods: The cross-over study assessed 63 participants regarding their knowledge of liver anatomy and pathologies based on an interindividual comparison. Group formation according to the respective level of medical training was as follows: students (n=35), residents (n=15), and specialists (n=13). Participants answered 25 multiple-choice questions first using sectional imaging (MRI) in a 2D environment (computer screen) and afterward with the respective segmented 3D model visualized in a VR simulation. The main criteria for the analyses were the number of correctly answered questions and processing time. A customized SUS was used to analyze VR usability. Missing data analysis showed that there were no accounted missing data. Results: The rate of correct answers improved significantly with the additional use of VR (F1,59=314.376; P<.001). Using MRI, a significant difference was observed between students and residents (P=.04) and between students and specialists (P<.001). In the VR condition, no significant differences between groups were found. In the MRI condition, significant differences in processing time were observed between students and specialists (P=.02) and between residents and specialists (P=.04). No differences existed between students and residents. With VR, processing time decreased significantly in all groups (F1,59=280.700; P<.001). Significant differences between students and specialists (P=.02) and between students and residents (P=.004) remained. No notable differences between residents and specialists (P=.72) were found. The SUS showed a subjectively simplified answerability of the questions with additional use of VR. The usefulness and benefits for an additional use of VR were stated. Conclusions: The additional use of VR suggests statistically significant improvements across all groups. VR seems to enable students and residents to participate in diagnostics and create treatment plans at an early stage. Transferred to clinical practice, this may lead to improvement in diagnostics and interventions. The lack of randomization and a potential learning effect are the main limitations to be addressed in future studies. Trial Registration: German Register of Clinical Studies DRKS00030024; https://drks.de/search/de/trial/DRKS00030024 UR - https://xr.jmir.org/2024/1/e60383 UR - http://dx.doi.org/10.2196/60383 ID - info:doi/10.2196/60383 ER - TY - JOUR AU - Bonnin, Gabriel AU - Kröber, Svea AU - Schneider, Silvia AU - Margraf, Jürgen AU - Pflug, Verena AU - Gerlach, L. Alexander AU - Slotta, Timo AU - Christiansen, Hanna AU - Albrecht, Björn AU - Chavanon, Mira-Lynn AU - Hirschfeld, Gerrit AU - In-Albon, Tina AU - Thielsch, T. Meinald AU - von Brachel, Ruth PY - 2024/11/27 TI - A Blended Learning Course on the Diagnostics of Mental Disorders: Multicenter Cluster Randomized Noninferiority Trial JO - J Med Internet Res SP - e54176 VL - 26 KW - diagnosis KW - structured clinical interviews KW - blended learning KW - dissemination KW - therapist training KW - clinical interview KW - clinical diagnosis KW - clinical practice KW - psychology students KW - diagnostic test KW - health personnel KW - mental health services KW - mental health N2 - Background: Clinical diagnoses determine if and how therapists treat their patients. As misdiagnoses can have severe adverse effects, disseminating evidence-based diagnostic skills into clinical practice is highly important. Objective: This study aimed to develop and evaluate a blended learning course in a multicenter cluster randomized controlled trial. Methods: Undergraduate psychology students (N=350) enrolled in 18 university courses at 3 universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants? performances in a clinical diagnostic interview after the courses. The secondary outcomes were diagnostic knowledge and participants? reactions to the courses. All outcomes were analyzed on the individual participant level using noninferiority testing. Results: Compared with the synchronous course (74.6% pass rate), participation in the blended learning course (89% pass rate) increased the likelihood of successfully passing the behavioral test (odds ratio 2.77, 95% CI 1.55-5.13), indicating not only noninferiority but superiority of the blended learning course. Furthermore, superiority of the blended learning over the synchronous course could be found regarding diagnostic knowledge (?=.13, 95% CI 0.01-0.26), course clarity (?=.40, 95% CI 0.27-0.53), course structure (?=.18, 95% CI 0.04-0.32), and informativeness (?=.19, 95% CI 0.06-0.32). Conclusions: Blended learning can help to improve the diagnostic skills and knowledge of (future) clinicians and thus make an important contribution to improving mental health care. Trial Registration: ClinicalTrials.gov NCT05294094; https://clinicaltrials.gov/study/NCT05294094 UR - https://www.jmir.org/2024/1/e54176 UR - http://dx.doi.org/10.2196/54176 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54176 ER - TY - JOUR AU - Busca, Erica AU - Caristia, Silvia AU - Bidone, Palmira Sara AU - Bolamperti, Alessia AU - Campagna, Sara AU - Cattaneo, Arianna AU - Lea, Rosaria AU - Montani, Doriana AU - Scalogna, Antonio AU - Bassi, Erika AU - Dal Molin, Alberto PY - 2024/11/26 TI - Serious Game for the Nursing Assessment of Home-Dwelling Older Adults: Development and Validation Study JO - JMIR Serious Games SP - e52644 VL - 12 KW - nursing education KW - serious game KW - simulation training KW - validation study KW - home-dwelling older adults KW - continuing education KW - nursing students KW - Family and Community Nursing KW - validity N2 - Background: The use of serious games (SGs) in nursing education is increasing, with the COVID-19 pandemic significantly accelerating their development. A key feature of SGs is their flexibility, allowing students to train at any place and time as needed. Recently, there has been a shift from developing disease-specific SGs to games focused on broader health issues. However, there has been a lack of proposals to enhance nursing interventions in home and frail care settings. The REACtion project developed a SG to improve students? understanding and clinical reasoning in caring for home-dwelling older adults. Objective: This study aims to describe the development of ?REACtion Game? (RG) and explore its validity as an educational tool. A multidisciplinary team created a SG that simulates the assessment process of older adults in home settings by nurses. It features web-based scenarios, clickable objects, and a menu with tools, and medical records to enhance nursing students? knowledge and clinical reasoning skills. Methods: A prospective, observational study was conducted using the Dutch Society for Simulation in Healthcare?s framework to validate the game. Further, 5 experts in home health care nursing evaluated content validity, while 30 students assessed construct validity, face validity, concurrent validity (by comparing game scores with those from the Nursing Clinical Reasoning Scale), game quality, and usability. Data were collected through self-administered web-based questionnaires and the debriefings of each match played. The students were enrolled in 2 postgraduate nursing programs: a master of science in nursing degree and a first-level continuing education in family and community nursing. Results: Experts rated the content validity highly after revisions (universal agreement calculation method of scale-level content validity index=0.97). The sample consisted of 30 students, predominantly women (n=20, 67%) and aged younger than 45 years (n=23, 77%) with no prior experience in SG. Almost all students had a positive impression of RG as an attractive and useful method for learning new knowledge. Participants found the cases, scenarios, and dialogues realistic (face validity) and of high quality, though usability aspects such as instructions clarity and intelligibility of game progression were less favored. Construct validity showed general agreement on the game?s educational value, with family and community nursing students reporting more consistent alignment with educational goals. Overall, RG scores correlated positively with time spent playing but showed limited correlation with Nursing Clinical Reasoning Scale scores. Conclusions: This study developed and validated a nursing education game, especially valuable as simulation is underused in some curricula. Created during the pandemic, it offered a digital learning environment. Although the game shows potential, further testing is needed for usability, concurrent validity, and functional improvements. Future research should involve larger samples to fully validate the game and assess its impact on academic achievement. UR - https://games.jmir.org/2024/1/e52644 UR - http://dx.doi.org/10.2196/52644 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52644 ER - TY - JOUR AU - Keicher, Franca AU - Thomann, Julia AU - Erlenwein, Jana AU - Schottdorf, Mara AU - Reiter, Lennart Nils AU - Scholz-Schwärzler, Patricia Nadine AU - Vogel, Barbara AU - Warlitz, Cordula AU - Stojanov, Silvia AU - Augustin, Silvia AU - Goldbrunner, Lola AU - Schanz, Linda AU - Dodel, Veronika AU - Zipper, Charlotte AU - Schiweck, Nicole AU - Jaeschke, Robert AU - Saramandic, Milica AU - Wiejaczka, Karolina AU - Eberhartinger, Maria AU - Dettmer, Kristina AU - Hattesohl, Ricardo Daniel Bruno AU - Englbrecht, Stephanie AU - Behrends, Uta AU - Spiegler, Juliane PY - 2024/11/21 TI - Development and Implementation of an Online Patient Education Program for Children and Adolescents With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Their Parents, Siblings, and School Personnel: Protocol for the Prospective BAYNET FOR ME/CFS Study JO - JMIR Res Protoc SP - e54679 VL - 13 KW - patient education KW - ME/CFS KW - children KW - adolescents KW - ModuS KW - parents KW - teachers KW - siblings KW - training N2 - Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) presents significant challenges for affected children and adolescents, their social environment, and treating physicians, due to its profound impact on quality of life and the lack of causal therapeutic approaches. One crucial aspect of care that has been missing for these patients is comprehensive education for both them and their social circles. Objective: This study protocol aims to outline the goals, study design, execution, and evaluation of the subproject within the BAYNET FOR ME/CFS project. The focus is on developing online education programs for children and adolescents with ME/CFS, as well as for their parents, siblings, and school staff. These programs are designed to improve independent disease management, increase knowledge, and promote interaction with other affected individuals. Methods: In phase I, the group-based online education programs were developed by a multidisciplinary team based on the ModuS concept created by the Competence Network for Patient Education (KomPaS). These programs were then piloted and finalized. Phase II involved recruiting participants and implementing the finalized programs. Given the restricted physical and cognitive capacities of the affected individuals, the patient education programs were exclusively designed in a digital format to facilitate participation. In phase III, the programs will be evaluated for acceptance, completeness, and participant satisfaction. The qualitative assessment will focus on individual expectations and benefits derived from the training. Phase IV will further assess the programs in terms of improvements in disease knowledge, health-related quality of life, life satisfaction, and family burden. Results: The programs were developed, piloted, and finalized during phase I, which ran from December 2022 to May 2023. The pilot phase, from March to May 2023, led to adaptations in the program concept. In total, 8 patients and their parents, 5 siblings, and 59 school staff participated in the piloting. Adjustments were made to the format, content, duration, and schedule to better meet the needs of the affected individuals and their social circles. In phase II, participant recruitment for the patient education program took place from January to July 2023. The study successfully recruited 24 young patients with ME/CFS and their parents, along with 8 siblings and 51 school staff. Two program blocks for patients and parents and 2-3 blocks for siblings and school staff commenced in May 2023 and were completed within the same year. Phase III began after phase II and involves the evaluation of the programs, with the process expected to conclude by the end of 2024. Phase IV, planned for 2025-2026, will involve the rollout of the program to 150 children and their caretakers. This phase will focus on evaluating disease knowledge, health-related quality of life, life satisfaction, and family burden, as well as include longitudinal assessments. Conclusions: The data aim to support the development of a comprehensive, interprofessional care model for children and adolescents with ME/CFS. International Registered Report Identifier (IRRID): DERR1-10.2196/54679 UR - https://www.researchprotocols.org/2024/1/e54679 UR - http://dx.doi.org/10.2196/54679 UR - http://www.ncbi.nlm.nih.gov/pubmed/39570662 ID - info:doi/10.2196/54679 ER - TY - JOUR AU - Lee, Allison AU - Goodman, Stephanie AU - Chen, Miao Chen AU - Landau, Ruth AU - Chatterji, Madhabi PY - 2024/11/19 TI - Electronic Feedback Alone Versus Electronic Feedback Plus in-Person Debriefing for a Serious Game Designed to Teach Novice Anesthesiology Residents to Perform General Anesthesia for Cesarean Delivery: Randomized Controlled Trial JO - JMIR Serious Games SP - e59047 VL - 12 KW - general anesthesia KW - cesarean delivery KW - multiple choice questions KW - serious game KW - debriefing KW - feedback KW - anesthesia KW - anesthesiology KW - anesthesiologist KW - anesthetist KW - cesarean KW - EmergenCSim KW - randomized controlled trial N2 - Background: EmergenCSim is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia for emergent cesarean delivery for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared with using electronic feedback alone. Objective: We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. Methods: Novice first-year anesthesiology residents (CA-1; n=51) (1) watched a recorded lecture on general anesthesia for emergent cesarean delivery, (2) took a 26-item multiple-choice question pretest, and (3) played EmergenCSim (maximum score of 196.5). They were randomized to either the control group that experienced the electronic feedback alone (group EF, n=26) or the intervention group that experienced the SG-embedded electronic feedback and an in-person debriefing (group IPD+EF, n=25). All participants played the SG a second time, with instructions to try to increase their score, and then they took a 26-item multiple-choice question posttest. Pre- and posttests (maximum score of 26 points each) were validated parallel forms. Results: For groups EF and IPD+EF, respectively, mean pretest scores were 18.6 (SD 2.5) and 19.4 (SD 2.3), and mean posttest scores were 22.6 (SD 2.2) and 22.1 (SD 1.6; F1,49=1.8, P=.19). SG scores for groups EF and IPD+EF, respectively, were?mean first play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean second play SG scores of 163.1 (SE 2.9) and 173.3 (SE 2.9; F1,49=137.7, P<.001). Conclusions: Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools. UR - https://games.jmir.org/2024/1/e59047 UR - http://dx.doi.org/10.2196/59047 ID - info:doi/10.2196/59047 ER - TY - JOUR AU - Hamarash, Qadir Mariwan AU - Ibrahim, Radhwan AU - Yaas, Hussein Marghoob AU - Abdulghani, Faris Mohammed AU - Al Mushhadany, Osama PY - 2024/11/19 TI - Comparative Effectiveness of Health Communication Strategies in Nursing: A Mixed Methods Study of Internet, mHealth, and Social Media Versus Traditional Methods JO - JMIR Nursing SP - e55744 VL - 7 KW - nursing education KW - nursing KW - nursing students KW - communication modalities KW - internet-based resources KW - nursing curriculum KW - mHealth clinical learning KW - mHealth KW - mobile health KW - social media N2 - Background: Effective communication is vital in health care, especially for nursing students who are the future of health care delivery. In Iraq?s nursing education landscape, characterized by challenges such as resource constraints and infrastructural limitations, understanding communication modalities is crucial. Objective: This mixed methods study conducted in 2 nursing colleges aims to explore and compare the effectiveness of health communication on the web, through mobile health (mHealth) applications, and via social media among nursing students in Iraq. The research addresses a gap in understanding communication modalities specific to Iraq and explores the perspectives, experiences, and challenges faced by nursing students. Methods: Qualitative interviews were conducted with a purposive sample (n=30), and a structured survey was distributed to a larger sample (n=300) representing diverse educational programs. The study used a nuanced approach to gather insights into the preferences and usage patterns of nursing students regarding communication modalities. The study was conducted between January 12, 2023, and May 5, 2023. Results: Qualitative findings highlighted nursing students? reliance on the web for educational materials, the significant role of mHealth applications in clinical skill development, and the emergence of social media platforms as community-building tools. Quantitative results revealed high-frequency web use (276/300, 92%) for educational purposes, regular mHealth application usage (204/300, 68%) in clinical settings, and active engagement on social media platforms (240/300, 80%). Traditional methods such as face-to-face interactions (216/300, 72%) and practical experiences (255/300, 85%) were preferred for developing essential skills. Conclusions: The study underscores nursing students? preference for an integrated approach, recognizing the complementary strengths of traditional and digital methods. Challenges include concerns about information accuracy and ethical considerations in digital spaces. The findings emphasize the need for curriculum adjustments that seamlessly integrate diverse communication modalities to create a dynamic learning environment. Educators play a crucial role in shaping this integration, emphasizing the enduring value of face-to-face interactions and practical experiences while harnessing the benefits of digital resources. Clear guidelines on professional behavior online are essential. Overall, the study expands the understanding of communication modalities among nursing students in Iraq and provides valuable insights for health care education stakeholders globally. UR - https://nursing.jmir.org/2024/1/e55744 UR - http://dx.doi.org/10.2196/55744 ID - info:doi/10.2196/55744 ER - TY - JOUR AU - Mørk, Gry AU - Bonsaksen, Tore AU - Larsen, Sønnik Ole AU - Kunnikoff, Martin Hans AU - Lie, Stangeland Silje PY - 2024/11/19 TI - Virtual Reality Simulation in Undergraduate Health Care Education Programs: Usability Study JO - JMIR Med Educ SP - e56844 VL - 10 KW - 360° videos KW - health professions education KW - virtual reality KW - usability study KW - undergraduates KW - university KW - students KW - simulation N2 - Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360° videos in VR headsets, followed by peer debrief and group discussions, may strengthen students? social and emotional learning. Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway. Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions. Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60%), while occupational therapy students less often had prior experience (37%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers. Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking. UR - https://mededu.jmir.org/2024/1/e56844 UR - http://dx.doi.org/10.2196/56844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56844 ER - TY - JOUR AU - Waldock, J. William AU - Zhang, Joe AU - Guni, Ahmad AU - Nabeel, Ahmad AU - Darzi, Ara AU - Ashrafian, Hutan PY - 2024/11/5 TI - The Accuracy and Capability of Artificial Intelligence Solutions in Health Care Examinations and Certificates: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e56532 VL - 26 KW - large language model KW - LLM KW - artificial intelligence KW - AI KW - health care exam KW - narrative medical response KW - health care examination KW - clinical commissioning KW - health services KW - safety N2 - Background: Large language models (LLMs) have dominated public interest due to their apparent capability to accurately replicate learned knowledge in narrative text. However, there is a lack of clarity about the accuracy and capability standards of LLMs in health care examinations. Objective: We conducted a systematic review of LLM accuracy, as tested under health care examination conditions, as compared to known human performance standards. Methods: We quantified the accuracy of LLMs in responding to health care examination questions and evaluated the consistency and quality of study reporting. The search included all papers up until September 10, 2023, with all LLMs published in English journals that report clear LLM accuracy standards. The exclusion criteria were as follows: the assessment was not a health care exam, there was no LLM, there was no evaluation of comparable success accuracy, and the literature was not original research.The literature search included the following Medical Subject Headings (MeSH) terms used in all possible combinations: ?artificial intelligence,? ?ChatGPT,? ?GPT,? ?LLM,? ?large language model,? ?machine learning,? ?neural network,? ?Generative Pre-trained Transformer,? ?Generative Transformer,? ?Generative Language Model,? ?Generative Model,? ?medical exam,? ?healthcare exam,? and ?clinical exam.? Sensitivity, accuracy, and precision data were extracted, including relevant CIs. Results: The search identified 1673 relevant citations. After removing duplicate results, 1268 (75.8%) papers were screened for titles and abstracts, and 32 (2.5%) studies were included for full-text review. Our meta-analysis suggested that LLMs are able to perform with an overall medical examination accuracy of 0.61 (CI 0.58-0.64) and a United States Medical Licensing Examination (USMLE) accuracy of 0.51 (CI 0.46-0.56), while Chat Generative Pretrained Transformer (ChatGPT) can perform with an overall medical examination accuracy of 0.64 (CI 0.6-0.67). Conclusions: LLMs offer promise to remediate health care demand and staffing challenges by providing accurate and efficient context-specific information to critical decision makers. For policy and deployment decisions about LLMs to advance health care, we proposed a new framework called RUBRICC (Regulatory, Usability, Bias, Reliability [Evidence and Safety], Interoperability, Cost, and Codesign?Patient and Public Involvement and Engagement [PPIE]). This presents a valuable opportunity to direct the clinical commissioning of new LLM capabilities into health services, while respecting patient safety considerations. Trial Registration: OSF Registries osf.io/xqzkw; https://osf.io/xqzkw UR - https://www.jmir.org/2024/1/e56532 UR - http://dx.doi.org/10.2196/56532 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56532 ER - TY - JOUR AU - Enich, Michael AU - Morton, Cory AU - Jermyn, Richard PY - 2024/10/28 TI - Naloxone Coprescribing and the Prevention of Opioid Overdoses: Quasi-Experimental Metacognitive Assessment of a Novel Education Initiative JO - JMIR Med Educ SP - e54280 VL - 10 KW - naloxone KW - coprescribing KW - prescription KW - academic detailing KW - metacognition KW - metacognitive evaluation KW - pharmacotherapy KW - pharmaceutic KW - pharmaceutical KW - education KW - educational intervention KW - opioid KW - opioid overdose KW - harm reduction N2 - Background: Critical evaluation of naloxone coprescription academic detailing programs has been positive, but little research has focused on how participant thinking changes during academic detailing. Objective: The dual purposes of this study were to (1) present a metacognitive evaluation of a naloxone coprescription academic detailing intervention and (2) describe the application of a metacognitive evaluation for future medical education interventions. Methods: Data were obtained from a pre-post knowledge assessment of a web-based, self-paced intervention designed to increase knowledge of clinical and organizational best practices for the coprescription of naloxone. To assess metacognition, items were designed with confidence-weighted true-false scoring. Multiple metacognitive scores were calculated: 3 content knowledge scores and 5 confidence-weighted true-false scores. Statistical analysis examined whether there were significant differences in scores before and after intervention. Analysis of overall content knowledge showed significant improvement at posttest. Results: There was a significant positive increase in absolute accuracy of participant confidence judgments, confidence in correct probability, and confidence in incorrect probability (all P values were <.05). Overall, results suggest an improvement in content knowledge scores after intervention and, metacognitively, suggest that individuals were more confident in their answer choices, regardless of correctness. Conclusions: Implications include the potential application of metacognitive evaluations to assess nuances in learner performance during academic detailing interventions and as a feedback mechanism to reinforce learning and guide curricular design. UR - https://mededu.jmir.org/2024/1/e54280 UR - http://dx.doi.org/10.2196/54280 ID - info:doi/10.2196/54280 ER - TY - JOUR AU - Sahyouni, Amal AU - Zoukar, Imad AU - Dashash, Mayssoon PY - 2024/10/28 TI - Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study JO - JMIR Med Educ SP - e53151 VL - 10 KW - effectiveness KW - online course KW - pediatric KW - malnutrition KW - essential competencies KW - e-learning KW - health professional KW - Syria KW - pilot study KW - acquisition knowledge N2 - Background: There is a shortage of competent health professionals in managing malnutrition. Online education may be a practical and flexible approach to address this gap. Objective: This study aimed to identify essential competencies and assess the effectiveness of an online course on pediatric malnutrition in improving the knowledge of pediatricians and health professionals. Methods: A focus group (n=5) and Delphi technique (n=21 health professionals) were used to identify 68 essential competencies. An online course consisting of 4 educational modules in Microsoft PowerPoint (Microsoft Corp) slide form with visual aids (photos and videos) was designed and published on the Syrian Virtual University platform website using an asynchronous e-learning system. The course covered definition, classification, epidemiology, anthropometrics, treatment, and consequences. Participants (n=10) completed a pretest of 40 multiple-choice questions, accessed the course, completed a posttest after a specified period, and filled out a questionnaire to measure their attitude and assess their satisfaction. Results: A total of 68 essential competencies were identified, categorized into 3 domains: knowledge (24 competencies), skills (29 competencies), and attitudes (15 competencies). These competencies were further classified based on their focus area: etiology (10 competencies), assessment and diagnosis (21 competencies), and management (37 competencies). Further, 10 volunteers, consisting of 5 pediatricians and 5 health professionals, participated in this study over a 2-week period. A statistically significant increase in knowledge was observed among participants following completion of the online course (pretest mean 24.2, SD 6.1, and posttest mean 35.2, SD 3.3; P<.001). Pediatricians demonstrated higher pre- and posttest scores compared to other health care professionals (all P values were <.05). Prior malnutrition training within the past year positively impacted pretest scores (P=.03). Participants highly rated the course (mean satisfaction score >3.0 on a 5-point Likert scale), with 60% (6/10) favoring a blended learning approach. Conclusions: In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment. UR - https://mededu.jmir.org/2024/1/e53151 UR - http://dx.doi.org/10.2196/53151 ID - info:doi/10.2196/53151 ER - TY - JOUR AU - Tao, Wenjuan AU - Yang, Jinming AU - Qu, Xing PY - 2024/10/28 TI - Utilization of, Perceptions on, and Intention to Use AI Chatbots Among Medical Students in China: National Cross-Sectional Study JO - JMIR Med Educ SP - e57132 VL - 10 KW - medical education KW - artificial intelligence KW - UTAUT model KW - utilization KW - medical students KW - cross-sectional study KW - AI chatbots KW - China KW - acceptance KW - electronic survey KW - social media KW - medical information KW - risk KW - training KW - support N2 - Background: Artificial intelligence (AI) chatbots are poised to have a profound impact on medical education. Medical students, as early adopters of technology and future health care providers, play a crucial role in shaping the future of health care. However, little is known about the utilization of, perceptions on, and intention to use AI chatbots among medical students in China. Objective: This study aims to explore the utilization of, perceptions on, and intention to use generative AI chatbots among medical students in China, using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. By conducting a national cross-sectional survey, we sought to identify the key determinants that influence medical students? acceptance of AI chatbots, thereby providing a basis for enhancing their integration into medical education. Understanding these factors is crucial for educators, policy makers, and technology developers to design and implement effective AI-driven educational tools that align with the needs and expectations of future health care professionals. Methods: A web-based electronic survey questionnaire was developed and distributed via social media to medical students across the country. The UTAUT was used as a theoretical framework to design the questionnaire and analyze the data. The relationship between behavioral intention to use AI chatbots and UTAUT predictors was examined using multivariable regression. Results: A total of 693 participants were from 57 universities covering 21 provinces or municipalities in China. Only a minority (199/693, 28.72%) reported using AI chatbots for studying, with ChatGPT (129/693, 18.61%) being the most commonly used. Most of the participants used AI chatbots for quickly obtaining medical information and knowledge (631/693, 91.05%) and increasing learning efficiency (594/693, 85.71%). Utilization behavior, social influence, facilitating conditions, perceived risk, and personal innovativeness showed significant positive associations with the behavioral intention to use AI chatbots (all P values were <.05). Conclusions: Chinese medical students hold positive perceptions toward and high intentions to use AI chatbots, but there are gaps between intention and actual adoption. This highlights the need for strategies to improve access, training, and support and provide peer usage examples to fully harness the potential benefits of chatbot technology. UR - https://mededu.jmir.org/2024/1/e57132 UR - http://dx.doi.org/10.2196/57132 ID - info:doi/10.2196/57132 ER - TY - JOUR AU - Tang, Yan AU - Yang, Juan AU - Wang, Ni AU - Wang, Xin AU - Hu, Wenli PY - 2024/10/24 TI - The Use of Mobile Health Care Among Medical Professionals in the Sichuan-Chongqing Region: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e59153 VL - 11 KW - health care professionals KW - mobile health care KW - technical training KW - cross-sectional survey KW - utilization KW - mobile KW - usage KW - China KW - web-based questionnaire KW - logistic regression KW - training KW - support N2 - Background: The emergence and integration of mobile health care technology have fundamentally transformed the health care industry, providing unprecedented opportunities to improve health care services and professional practice. Despite its immense potential, the adoption of mobile health care technology among health care professionals remains uneven, particularly in resource-limited regions. Objective: This study aims to explore the use and influencing factors of mobile health care among health care professionals in the Sichuan-Chongqing region of China and make recommendations. Methods: Convenience sampling was used in a cross-sectional study conducted from November 8 to November 14, 2023, to survey frontline clinical health care professionals at 5 district-level secondary public hospitals in the Sichuan-Chongqing region. A web-based questionnaire was used to investigate the use of mobile health care and its influencing factors among the participants. Descriptive analysis and logistic regression analysis were used in the study. Results: A total of 550 valid questionnaires were completed. Among the surveyed health care professionals, only 18.7% (103/550) used mobile health care, with a satisfaction rate of only 50.5% (52/103). Around 81.3% (447/550) did not use any form of mobile health care. The age group of 30?39 years was found to be a significant factor influencing the use of mobile health care by health care professionals (P=.03). The main reasons for not using mobile health care among health care professionals were lack of appropriate technical training and support (266/447, 59.5%), lack of suitable management-specific apps (204/447, 45.6%), and concerns about increased workload (180/447, 40.3%). There were significant differences in the single-factor analysis of the reasons for the nonuse of mobile health care among health care professionals from different specialties (P=.04). Logistic regression analysis indicated that age was the only significant factor influencing the use of mobile health care by health care professionals (P=.04). Conclusions: The utilization rate of mobile health care among health care professionals in the Sichuan-Chongqing region is low. Age is a significant factor that influences whether health care professionals use mobile health care. Providing appropriate technical training and support may help improve the enthusiasm of health care professionals in using mobile health care. UR - https://humanfactors.jmir.org/2024/1/e59153 UR - http://dx.doi.org/10.2196/59153 ID - info:doi/10.2196/59153 ER - TY - JOUR AU - Clavier, Thomas AU - Chevalier, Emma AU - Demailly, Zoé AU - Veber, Benoit AU - Messaadi, Imad-Abdelkader AU - Popoff, Benjamin PY - 2024/10/22 TI - Social Media Usage for Medical Education and Smartphone Addiction Among Medical Students: National Web-Based Survey JO - JMIR Med Educ SP - e55149 VL - 10 KW - medical student KW - social network KW - social media KW - smartphone addiction KW - medical education KW - mobile addiction KW - social networks N2 - Background: Social media (SoMe) have taken a major place in the medical field, and younger generations are increasingly using them as their primary source to find information. Objective: This study aimed to describe the use of SoMe for medical education among French medical students and assess the prevalence of smartphone addiction in this population. Methods: A cross-sectional web-based survey was conducted among French medical students (second to sixth year of study). The questionnaire collected information on SoMe use for medical education and professional behavior. Smartphone addiction was assessed using the Smartphone Addiction Scale Short-Version (SAS-SV) score. Results: A total of 762 medical students responded to the survey. Of these, 762 (100%) were SoMe users, spending a median of 120 (IQR 60?150) minutes per day on SoMe; 656 (86.1%) used SoMe for medical education, with YouTube, Instagram, and Facebook being the most popular platforms. The misuse of SoMe in a professional context was also identified; 27.2% (207/762) of students posted hospital internship content, and 10.8% (82/762) searched for a patient?s name on SoMe. Smartphone addiction was prevalent among 29.1% (222/762) of respondents, with a significant correlation between increased SoMe use and SAS-SV score (r=0.39, 95% CI 0.33?0.45; P<.001). Smartphone-addicted students reported a higher impact on study time (211/222, 95% vs 344/540, 63.6%; P<.001) and a greater tendency to share hospital internship content on social networks (78/222, 35.1% vs 129/540, 23.8%; P=.002). Conclusions: Our findings reveal the extensive use of SoMe for medical education among French medical students, alongside a notable prevalence of smartphone addiction. These results highlight the need for medical schools and educators to address the responsible use of SoMe and develop strategies to mitigate the risks associated with excessive use and addiction. UR - https://mededu.jmir.org/2024/1/e55149 UR - http://dx.doi.org/10.2196/55149 ID - info:doi/10.2196/55149 ER - TY - JOUR AU - Flato, Prync Uri Adrian AU - Beffa dos Santos, José Emilio AU - Bispo Diaz T Martins, Isabella AU - Rossignoli, Gazin Vinicius AU - Dias Midega, Thais AU - Kallas-Silva, Lucas AU - Ferreira Mendes de Oliveira, Ricardo AU - do Socorro Lima Figueiredo Flato, Adriana AU - Vicente Guimarães, Mario AU - Penna Guimarães, Hélio PY - 2024/10/9 TI - Interactive Serious Game to Teach Basic Life Support Among Schoolchildren in Brazil: Design and Rationale JO - JMIR Serious Games SP - e55333 VL - 12 KW - cardiopulmonary resuscitation KW - basic life support KW - serious game KW - CPR training KW - usability KW - cardiopulmonary KW - emergency KW - life support KW - CPR KW - training KW - education KW - game KW - gaming KW - educational KW - resuscitation KW - survey KW - satisfaction KW - SUS KW - user experience KW - System Usability Scale UR - https://games.jmir.org/2024/1/e55333 UR - http://dx.doi.org/10.2196/55333 ID - info:doi/10.2196/55333 ER - TY - JOUR AU - Wu, Zelin AU - Gan, Wenyi AU - Xue, Zhaowen AU - Ni, Zhengxin AU - Zheng, Xiaofei AU - Zhang, Yiyi PY - 2024/10/3 TI - Performance of ChatGPT on Nursing Licensure Examinations in the United States and China: Cross-Sectional Study JO - JMIR Med Educ SP - e52746 VL - 10 KW - artificial intelligence KW - ChatGPT KW - nursing licensure examination KW - nursing KW - LLMs KW - large language models KW - nursing education KW - AI KW - nursing student KW - large language model KW - licensing KW - observation KW - observational study KW - China KW - USA KW - United States of America KW - auxiliary tool KW - accuracy rate KW - theoretical N2 - Background: The creation of large language models (LLMs) such as ChatGPT is an important step in the development of artificial intelligence, which shows great potential in medical education due to its powerful language understanding and generative capabilities. The purpose of this study was to quantitatively evaluate and comprehensively analyze ChatGPT?s performance in handling questions for the National Nursing Licensure Examination (NNLE) in China and the United States, including the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the NNLE. Objective: This study aims to examine how well LLMs respond to the NCLEX-RN and the NNLE multiple-choice questions (MCQs) in various language inputs. To evaluate whether LLMs can be used as multilingual learning assistance for nursing, and to assess whether they possess a repository of professional knowledge applicable to clinical nursing practice. Methods: First, we compiled 150 NCLEX-RN Practical MCQs, 240 NNLE Theoretical MCQs, and 240 NNLE Practical MCQs. Then, the translation function of ChatGPT 3.5 was used to translate NCLEX-RN questions from English to Chinese and NNLE questions from Chinese to English. Finally, the original version and the translated version of the MCQs were inputted into ChatGPT 4.0, ChatGPT 3.5, and Google Bard. Different LLMs were compared according to the accuracy rate, and the differences between different language inputs were compared. Results: The accuracy rates of ChatGPT 4.0 for NCLEX-RN practical questions and Chinese-translated NCLEX-RN practical questions were 88.7% (133/150) and 79.3% (119/150), respectively. Despite the statistical significance of the difference (P=.03), the correct rate was generally satisfactory. Around 71.9% (169/235) of NNLE Theoretical MCQs and 69.1% (161/233) of NNLE Practical MCQs were correctly answered by ChatGPT 4.0. The accuracy of ChatGPT 4.0 in processing NNLE Theoretical MCQs and NNLE Practical MCQs translated into English was 71.5% (168/235; P=.92) and 67.8% (158/233; P=.77), respectively, and there was no statistically significant difference between the results of text input in different languages. ChatGPT 3.5 (NCLEX-RN P=.003, NNLE Theoretical P<.001, NNLE Practical P=.12) and Google Bard (NCLEX-RN P<.001, NNLE Theoretical P<.001, NNLE Practical P<.001) had lower accuracy rates for nursing-related MCQs than ChatGPT 4.0 in English input. English accuracy was higher when compared with ChatGPT 3.5?s Chinese input, and the difference was statistically significant (NCLEX-RN P=.02, NNLE Practical P=.02). Whether submitted in Chinese or English, the MCQs from the NCLEX-RN and NNLE demonstrated that ChatGPT 4.0 had the highest number of unique correct responses and the lowest number of unique incorrect responses among the 3 LLMs. Conclusions: This study, focusing on 618 nursing MCQs including NCLEX-RN and NNLE exams, found that ChatGPT 4.0 outperformed ChatGPT 3.5 and Google Bard in accuracy. It excelled in processing English and Chinese inputs, underscoring its potential as a valuable tool in nursing education and clinical decision-making. UR - https://mededu.jmir.org/2024/1/e52746 UR - http://dx.doi.org/10.2196/52746 ID - info:doi/10.2196/52746 ER - TY - JOUR AU - Sahan, Fatma AU - Guthardt, Lisa AU - Panitz, Karin AU - Siegel-Kianer, Anna AU - Eichhof, Isabel AU - Schmitt, D. Björn AU - Apolinario-Hagen, Jennifer PY - 2024/9/20 TI - Enhancing Digital Health Awareness and mHealth Competencies in Medical Education: Proof-of-Concept Study and Summative Process Evaluation of a Quality Improvement Project JO - JMIR Med Educ SP - e59454 VL - 10 KW - medical students KW - digital health KW - design thinking KW - digital health literacy KW - medical education KW - digital health competencies KW - mobile phone N2 - Background: Currently, there is a need to optimize knowledge on digital transformation in mental health care, including digital therapeutics (eg, prescription apps), in medical education. However, in Germany, digital health has not yet been systematically integrated into medical curricula and is taught in a relatively small number of electives. Challenges for lecturers include the dynamic field as well as lacking guidance on how to efficiently apply innovative teaching formats for these new digital competencies. Quality improvement projects provide options to pilot-test novel educational offerings, as little is known about the acceptability of participatory approaches in conventional medical education. Objective: This quality improvement project addressed the gap in medical school electives on digital health literacy by introducing and evaluating an elective scoping study on the systematic development of different health app concepts designed by students to cultivate essential skills for future health care professionals (ie, mobile health [mHealth] competencies). Methods: This proof-of-concept study describes the development, optimization, implementation, and evaluation of a web-based elective on digital (mental) health competencies in medical education. Implemented as part of a quality improvement project, the elective aimed to guide medical students in developing app concepts applying a design thinking approach at a German medical school from January 2021 to January 2024. Topics included defining digital (mental) health, quality criteria for health apps, user perspective, persuasive design, and critical reflection on digitization in medical practice. The elective was offered 6 times within 36 months, with continuous evaluation and iterative optimization using both process and outcome measures, such as web-based questionnaires. We present examples of app concepts designed by students and summarize the quantitative and qualitative evaluation results. Results: In total, 60 students completed the elective and developed 25 health app concepts, most commonly targeting stress management and depression. In addition, disease management and prevention apps were designed for various somatic conditions such as diabetes and chronic pain. The results indicated high overall satisfaction across the 6 courses according to the evaluation questionnaire, with lower scores indicating higher satisfaction on a scale ranging from 1 to 6 (mean 1.70, SD 0.68). Students particularly valued the content, flexibility, support, and structure. While improvements in group work, submissions, and information transfer were suggested, the results underscore the usefulness of the web-based elective. Conclusions: This quality improvement project provides insights into relevant features for the successful user-centered and creative integration of mHealth competencies into medical education. Key factors for the satisfaction of students involved the participatory mindset, focus on competencies, discussions with app providers, and flexibility. Future efforts should define important learning objectives for digital health literacy and provide recommendations for integration rather than debating the need for digital health integration. UR - https://mededu.jmir.org/2024/1/e59454 UR - http://dx.doi.org/10.2196/59454 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59454 ER - TY - JOUR AU - Sari, Wulan Dianis AU - Kugai, Haruna AU - Igarashi, Ayumi AU - Takaoka, Manami AU - Matsumoto, Hiroshige AU - Suzuki, Haruno AU - Wu, Jinyan AU - Fitryasari, Rizki AU - Nasifah, Ayunda Ike AU - Has, M. Eka Mishbahatul AU - Yamamoto-Mitani, Noriko PY - 2024/9/18 TI - Education Program for Enhancing Health Care Students? Attitudes Toward People Living With Dementia: Protocol for a Single-Arm Pre-Post Study JO - JMIR Res Protoc SP - e62654 VL - 13 KW - ageism KW - dementia KW - health professional KW - education program KW - long-term care N2 - Background: Health care students are instrumental in shaping the future of dementia care. Cultivating a positive attitude and understanding toward people living with dementia is crucial for diminishing the stigma associated with the condition, providing effective and person-centered care, and enhancing the quality of life for people living with dementia. Educational programs about dementia are increasingly recognizing the potential of gaming tools. Objective: This study aimed to evaluate the effectiveness of gaming-based dementia educational programs in improving attitudes toward people living with dementia among health care students. Methods: This single-arm pre-post study will be conducted among health care students in Indonesian universities. This educational program based on gaming tools will consist of a lecture on dementia, the use of N-impro (gaming tool), and the enactment of short dramas depicting desirable and undesirable communication with people living with dementia behaviors. We will assess attitudes toward people living with dementia, intention to help people living with dementia, knowledge of dementia, and the stigma associated with people living with dementia. The gaming-based dementia education program will be integrated into the curriculum of the health care students. The program will be implemented once with a duration of 90 minutes. Results: Data collection will occur from August 2023 to March 2024. Analysis of the data will be finalized by May 2024, and the outcome will be determined by July 2024. The impact of the gaming-based dementia educational program on improving attitudes toward people living with dementia will be reported. The study findings will be published in a peer-reviewed journal. Conclusions: The gaming education program demonstrates significant potential in enhancing attitudes toward people living with dementia across various countries, introducing an innovative method for the community-based support of people living with dementia. Trial Registration: ClinicalTrials.gov NCT06122623; https://clinicaltrials.gov/study/NCT06122623 International Registered Report Identifier (IRRID): DERR1-10.2196/62654 UR - https://www.researchprotocols.org/2024/1/e62654 UR - http://dx.doi.org/10.2196/62654 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62654 ER - TY - JOUR AU - Livesay, Karen AU - Walter, Ruby AU - Petersen, Sacha AU - Abdolkhani, Robab AU - Zhao, Lin AU - Butler-Henderson, Kerryn PY - 2024/9/13 TI - Challenges and Needs in Digital Health Practice and Nursing Education Curricula: Gap Analysis Study JO - JMIR Med Educ SP - e54105 VL - 10 KW - nursing KW - digital health KW - capability KW - workforce KW - framework KW - nursing education KW - education KW - digital health practice KW - clinicians KW - nurse KW - nurse graduates KW - clinical nurses KW - nurses KW - nurse educators KW - teach KW - teaching KW - learning KW - nursing students KW - student KW - students N2 - Background: Australian nursing programs aim to introduce students to digital health requirements for practice. However, innovation in digital health is more dynamic than education providers? ability to respond. It is uncertain whether what is taught and demonstrated in nursing programs meets the needs and expectations of clinicians with regard to the capability of the nurse graduates. Objective: This study aims to identify gaps in the National Nursing and Midwifery Digital Health Capability Framework , based on the perspectives of clinical nurses, and in nurse educators? confidence and knowledge to teach. The findings will direct a future co-design process. Methods: This study triangulated the findings from 2 studies of the Digital Awareness in Simulated Health project and the National Nursing and Midwifery Digital Capability Framework. The first was a qualitative study that considered the experiences of nurses with digital health technologies during the COVID-19 pandemic, and the second was a survey of nurse educators who identified their confidence and knowledge to teach and demonstrate digital health concepts. Results: The results were categorized by and presented from the perspectives of nurse clinicians, nurse graduates, and nurse educators. Findings were listed against each of the framework capabilities, and omissions from the framework were identified. A series of statements and questions were formulated from the gap analysis to direct a future co-design process with nursing stakeholders to develop a digital health capability curriculum for nurse educators. Conclusions: Further work to evaluate nursing digital health opportunities for nurse educators is indicated by the gaps identified in this study. UR - https://mededu.jmir.org/2024/1/e54105 UR - http://dx.doi.org/10.2196/54105 ID - info:doi/10.2196/54105 ER - TY - JOUR AU - Huang, Zhilian AU - Ow, Teng Jing AU - Tang, Ee Wern AU - Chow, Angela PY - 2024/9/5 TI - An Evidence-Based Serious Game App for Public Education on Antibiotic Use and Resistance: Randomized Controlled Trial JO - JMIR Serious Games SP - e59848 VL - 12 KW - serious game application KW - randomized controlled trial KW - antimicrobial resistance KW - antibiotic use KW - public education KW - mobile phone N2 - Background: The misuse and overuse of antibiotics accelerate the development of antimicrobial resistance (AMR). Serious games, any form of games that serve a greater purpose other than entertainment, could augment public education above ongoing health promotion efforts. Hence, we developed an evidence-based educational serious game app?SteWARdS Antibiotic Defence?to educate players on good antibiotic use practices and AMR through a game quest comprising 3 minigames and interaction with the nonplayer characters. Objective: We aimed to evaluate the effectiveness of the SteWARdS Antibiotic Defence app in improving the knowledge of, attitude toward, and perceptions (KAP) of appropriate antibiotic use and AMR among the public in Singapore. Methods: We conducted a 2-arm parallel randomized controlled trial, recruiting visitors aged 18-65 years from 2 polyclinics in Singapore. Intervention group participants had to download the SteWARdS Antibiotic Defence app (available only in English and on the Android platform) on their smartphones and complete the quest in the app. Participants took half a day to 2 weeks to complete the quest. The control group received no intervention. Knowledge questions on antibiotic use and AMR (11 binary questions) were self-administered at baseline, immediately after the intervention, and 6-10 weeks post intervention, while attitudes and perception questions (14 three-point Likert-scale questions) were self-administered at baseline and 6-10 weeks post intervention. We also collected participants? feedback on app usage. Results: Participants (n=348; intervention: n=142, control: n=206) had a mean age of 36.9 years. Intervention group participants showed a statistically significant improvement in mean knowledge score (effect size: 0.58 [95% CI 0.28-0.87]) compared with controls after accounting for age, educational level, and exposure to advertisements on antibiotics and AMR. Intervention participants also showed a statistically significant improvement in mean attitude-perception scores (effect size: 0.98 (95% CI 0.44-1.52)) after adjusting for marital status and race. A majority of participants agreed that the ?SteWARdS Antibiotic Defence? app improved their awareness on antibiotic use (135/142, 95.1%) and AMR (136/142, 95.8%). About 73.9% (105/142) of the participants agreed that the app is easy to use, 70.4% (100/142) agreed that the app was enjoyable, and 85.2% (121/142) would recommend the app to others. Conclusions: Our educational serious game app improves participants? KAP on appropriate antibiotic use and AMR. Public education apps should be engaging, educational, easy to use, and have an attractive user interface. Future research should assess the effectiveness of interventions in facilitating long-term knowledge retention and long-lasting behavioral change. Trial Registration: ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414 International Registered Report Identifier (IRRID): RR2-10.2196/45833 UR - https://games.jmir.org/2024/1/e59848 UR - http://dx.doi.org/10.2196/59848 UR - http://www.ncbi.nlm.nih.gov/pubmed/39235853 ID - info:doi/10.2196/59848 ER - TY - JOUR AU - Halim, Freda AU - Widysanto, Allen AU - Wahjoepramono, Perdana Petra Octavian AU - Candrawinata, Siulinda Valeska AU - Budihardja, Setiawan Andi AU - Irawan, Andry AU - Sudirman, Taufik AU - Christina, Natalia AU - Koerniawan, Sutanto Heru AU - Tobing, Lumban Jephtah Furano AU - Sungono, Veli AU - Marlina, Mona AU - Wahjoepramono, Julianta Eka PY - 2024/8/30 TI - Objective Comparison of the First-Person?View Live Streaming Method Versus Face-to-Face Teaching Method in Improving Wound Suturing Skills for Skin Closure in Surgical Clerkship Students: Randomized Controlled Trial JO - JMIR Med Educ SP - e52631 VL - 10 KW - teaching method KW - live streaming KW - first-person view KW - face-to-face KW - simple wound suturing N2 - Background: The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person?view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills. Objective: This study aims to objectively assess the effectiveness of the first-person?view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students. Methods: A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed. Results: A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant?s pre-experiment and postexperiment DOPS scores revealed that the LS method?s outcome is comparable to the FTF method?s outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students? surgical skills. Conclusions: First-person?view LS training sessions could enhance students? ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method. Trial Registration: ClinicalTrials.gov NCT06221917; https://clinicaltrials.gov/study/NCT06221917 UR - https://mededu.jmir.org/2024/1/e52631 UR - http://dx.doi.org/10.2196/52631 ID - info:doi/10.2196/52631 ER - TY - JOUR AU - Alnuaim, Abeer PY - 2024/8/23 TI - The Impact and Acceptance of Gamification by Learners in a Digital Literacy Course at the Undergraduate Level: Randomized Controlled Trial JO - JMIR Serious Games SP - e52017 VL - 12 KW - gamification KW - games KW - technology integration KW - information literacy KW - technology acceptance N2 - Background: In recent years, the integration of technology in education has revolutionized traditional learning paradigms. Digital literacy, a crucial skill in the 21st century, has become a vital aspect of modern education, enabling students to navigate, critically assess, and effectively use digital tools. As educators strive to boost engagement and learning outcomes, gamification has appeared as an auspicious pedagogical approach. By applying game mechanics to nongame contexts, gamification seeks to create a more immersive and digital learning experience. Objective: This research paper aims to investigate the impact and acceptance of gamification by learners in a digital literacy course at the undergraduate level. Methods: In a pre-post intervention study, 168 undergraduate students were randomly assigned either to the experimental group (gamification based) or control group (conventional) learning condition. Both groups of participants learned the same topics in digital literacy. Results: Empirical findings showed that participants from the experimental group had better academic performance in digital literacy than those who were not exposed to the game-based learning environment. The participants? prior experience with gamification was not found to be a significant predictor of their acceptance of gamification in a digital literacy course. Conclusions: The study provides evidence supporting the potential benefits of gamification in enhancing digital literacy education and opens the door for further exploration and implementation of gamified learning approaches in higher education settings. UR - https://games.jmir.org/2024/1/e52017 UR - http://dx.doi.org/10.2196/52017 ID - info:doi/10.2196/52017 ER - TY - JOUR AU - Rahadiani, Pratiwi AU - Kekalih, Aria AU - Soemantri, Diantha AU - Krisnamurti, Budi Desak Gede PY - 2024/8/22 TI - Exploring HTML5 Package Interactive Content in Supporting Learning Through Self-Paced Massive Open Online Courses on Healthy Aging: Mixed Methods Study JO - JMIR Med Educ SP - e45468 VL - 10 KW - HTML5 package KW - H5P KW - students? perspectives KW - students? acceptance KW - massive open online courses KW - MOOCs KW - healthy aging KW - self-paced MOOC KW - student KW - perception KW - acceptance KW - opinion KW - attitude KW - MOOC KW - self-paced KW - self-guided KW - online course KW - online learning KW - geriatric KW - gerontology KW - gerontological KW - learning N2 - Background: The rapidly aging population and the growth of geriatric medicine in the field of internal medicine are not supported by sufficient gerontological training in many health care disciplines. There is rising awareness about the education and training needed to adequately prepare health care professionals to address the needs of the older adult population. Massive open online courses (MOOCs) might be the best alternative method of learning delivery in this context. However, the diversity of MOOC participants poses a challenge for MOOC providers to innovate in developing learning content that suits the needs and characters of participants. Objective: The primary outcome of this study was to explore students? perceptions and acceptance of HTML5 package (H5P) interactive content in self-paced MOOCs and its association with students? characteristics and experience in using MOOCs. Methods: This study used a cross-sectional design, combining qualitative and quantitative approaches. Participants, predominantly general practitioners from various regions of Indonesia with diverse educational backgrounds and age groups, completed pretests, engaged with H5P interactive content, and participated in forum discussions and posttests. Data were retrieved from the online questionnaire attached to a selected MOOC course. Students? perceptions and acceptance of H5P interactive content were rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Data were analyzed using SPSS (IBM Corp) to examine demographics, computer literacy, acceptance, and perceptions of H5P interactive content. Quantitative analysis explored correlations, while qualitative analysis identified recurring themes from open-ended survey responses to determine students? perceptions. Results: In total, 184 MOOC participants agreed to participate in the study. Students demonstrated positive perceptions and a high level of acceptance of integrating H5P interactive content within the self-paced MOOC. Analysis of mean (SD) value across all responses consistently revealed favorable scores (greater than 5), ranging from 5.18 (SD 0.861) to 5.45 (SD 0.659) and 5.28 (SD 0.728) to 5.52 (SD 0.627), respectively. This finding underscores widespread satisfaction and robust acceptance of H5P interactive content. Students found the H5P interactive content more satisfying and fun, easier to understand, more effective, and more helpful in improving learning outcomes than material in the form of common documents and learning videos. There is a significant correlation between computer literacy, students? acceptance, and students? perceptions. Conclusions: Students from various backgrounds showed a high level of acceptance and positive perceptions of leveraging H5P interactive content in the self-paced MOOC. The findings suggest potential new uses of H5P interactive content in MOOCs, such as interactive videos with pop-up questions, to substitute for synchronous learning. The study underscores the significance of tailored educational strategies in supporting the professional development of health care professionals. UR - https://mededu.jmir.org/2024/1/e45468 UR - http://dx.doi.org/10.2196/45468 UR - http://www.ncbi.nlm.nih.gov/pubmed/39049507 ID - info:doi/10.2196/45468 ER - TY - JOUR AU - Thomae, V. Anita AU - Witt, M. Claudia AU - Barth, Jürgen PY - 2024/8/22 TI - Integration of ChatGPT Into a Course for Medical Students: Explorative Study on Teaching Scenarios, Students? Perception, and Applications JO - JMIR Med Educ SP - e50545 VL - 10 KW - medical education KW - ChatGPT KW - artificial intelligence KW - information for patients KW - critical appraisal KW - evaluation KW - blended learning KW - AI KW - digital skills KW - teaching N2 - Background: Text-generating artificial intelligence (AI) such as ChatGPT offers many opportunities and challenges in medical education. Acquiring practical skills necessary for using AI in a clinical context is crucial, especially for medical education. Objective: This explorative study aimed to investigate the feasibility of integrating ChatGPT into teaching units and to evaluate the course and the importance of AI-related competencies for medical students. Since a possible application of ChatGPT in the medical field could be the generation of information for patients, we further investigated how such information is perceived by students in terms of persuasiveness and quality. Methods: ChatGPT was integrated into 3 different teaching units of a blended learning course for medical students. Using a mixed methods approach, quantitative and qualitative data were collected. As baseline data, we assessed students? characteristics, including their openness to digital innovation. The students evaluated the integration of ChatGPT into the course and shared their thoughts regarding the future of text-generating AI in medical education. The course was evaluated based on the Kirkpatrick Model, with satisfaction, learning progress, and applicable knowledge considered as key assessment levels. In ChatGPT-integrating teaching units, students evaluated videos featuring information for patients regarding their persuasiveness on treatment expectations in a self-experience experiment and critically reviewed information for patients written using ChatGPT 3.5 based on different prompts. Results: A total of 52 medical students participated in the study. The comprehensive evaluation of the course revealed elevated levels of satisfaction, learning progress, and applicability specifically in relation to the ChatGPT-integrating teaching units. Furthermore, all evaluation levels demonstrated an association with each other. Higher openness to digital innovation was associated with higher satisfaction and, to a lesser extent, with higher applicability. AI-related competencies in other courses of the medical curriculum were perceived as highly important by medical students. Qualitative analysis highlighted potential use cases of ChatGPT in teaching and learning. In ChatGPT-integrating teaching units, students rated information for patients generated using a basic ChatGPT prompt as ?moderate? in terms of comprehensibility, patient safety, and the correct application of communication rules taught during the course. The students? ratings were considerably improved using an extended prompt. The same text, however, showed the smallest increase in treatment expectations when compared with information provided by humans (patient, clinician, and expert) via videos. Conclusions: This study offers valuable insights into integrating the development of AI competencies into a blended learning course. Integration of ChatGPT enhanced learning experiences for medical students. UR - https://mededu.jmir.org/2024/1/e50545 UR - http://dx.doi.org/10.2196/50545 ID - info:doi/10.2196/50545 ER - TY - JOUR AU - Sekiguchi, Kenji AU - Kawano, Seiji AU - Chihara, Norio AU - Satomi-Kobayashi, Seimi AU - Maeda, Eiichi AU - Matsumoto, Riki PY - 2024/8/22 TI - Live Streaming of the Professor?s Ward Rounds in Undergraduate Neurology Education: Usability Study JO - JMIR Form Res SP - e50128 VL - 8 KW - live streaming KW - ward round KW - web conferencing software KW - neurological examination KW - undergraduate education KW - medical student KW - medical education KW - rounds KW - remote education KW - video-conferencing KW - residents KW - live-stream KW - neurology KW - neuroscience KW - web conferencing KW - distance education KW - technology enhanced learning KW - mobile phone N2 - Background: Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. Objective: The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients? personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. Methods: We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. Results: The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73% response rate) showed that the mean score of participants? satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32% (26/82) preferred remote rounds. Conclusions: Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship. UR - https://formative.jmir.org/2024/1/e50128 UR - http://dx.doi.org/10.2196/50128 UR - http://www.ncbi.nlm.nih.gov/pubmed/39172503 ID - info:doi/10.2196/50128 ER - TY - JOUR AU - Nowell, Lorelli AU - Dolan, Sara AU - Johnston, Sonja AU - Jacobsen, Michele AU - Lorenzetti, Diane AU - Oddone Paolucci, Elizabeth PY - 2024/8/21 TI - Exploring Student Perspectives and Experiences of Online Opportunities for Virtual Care Skills Development: Sequential Explanatory Mixed Methods Study JO - JMIR Nursing SP - e53777 VL - 7 KW - virtual care KW - online teaching and learning KW - mixed methods research KW - development KW - mixed method study KW - online KW - care KW - student KW - students KW - online learning KW - virtual learning KW - interview KW - experience KW - educational KW - technology KW - nursing KW - medicine KW - allied health KW - teaching N2 - Background: Caring profession students require skills and competencies to proficiently use information technologies for providing high-quality and effective care. However, there is a gap in exploring the perceptions and experiences of students in developing virtual care skills within online environments. Objective: This study aims to better understand caring professional students? online learning experiences with developing virtual care skills and competencies. Methods: A sequential explanatory mixed methods approach, integrating both a cross-sectional survey and individual interviews, was used to better understand caring professional students? online learning experiences with developing virtual care skills and competencies. Results: A total of 93 survey and 9 interview participants were drawn from various faculties, including students from education, nursing, medicine, and allied health. These participants identified the barriers, facilitators, principles, and skills related to learning about and delivering virtual care, including teaching methods and educational technologies. Conclusions: This study contributes to the growing body of educational research on virtual care skills by offering student insights and suggestions for improved teaching and learning strategies in caring professions? programs. UR - https://nursing.jmir.org/2024/1/e53777 UR - http://dx.doi.org/10.2196/53777 UR - http://www.ncbi.nlm.nih.gov/pubmed/39167789 ID - info:doi/10.2196/53777 ER - TY - JOUR AU - Gan, Wenyi AU - Ouyang, Jianfeng AU - Li, Hua AU - Xue, Zhaowen AU - Zhang, Yiming AU - Dong, Qiu AU - Huang, Jiadong AU - Zheng, Xiaofei AU - Zhang, Yiyi PY - 2024/8/20 TI - Integrating ChatGPT in Orthopedic Education for Medical Undergraduates: Randomized Controlled Trial JO - J Med Internet Res SP - e57037 VL - 26 KW - ChatGPT KW - medical education KW - orthopedics KW - artificial intelligence KW - large language model KW - natural language processing KW - randomized controlled trial KW - learning aid N2 - Background: ChatGPT is a natural language processing model developed by OpenAI, which can be iteratively updated and optimized to accommodate the changing and complex requirements of human verbal communication. Objective: The study aimed to evaluate ChatGPT?s accuracy in answering orthopedics-related multiple-choice questions (MCQs) and assess its short-term effects as a learning aid through a randomized controlled trial. In addition, long-term effects on student performance in other subjects were measured using final examination results. Methods: We first evaluated ChatGPT?s accuracy in answering MCQs pertaining to orthopedics across various question formats. Then, 129 undergraduate medical students participated in a randomized controlled study in which the ChatGPT group used ChatGPT as a learning tool, while the control group was prohibited from using artificial intelligence software to support learning. Following a 2-week intervention, the 2 groups? understanding of orthopedics was assessed by an orthopedics test, and variations in the 2 groups? performance in other disciplines were noted through a follow-up at the end of the semester. Results: ChatGPT-4.0 answered 1051 orthopedics-related MCQs with a 70.60% (742/1051) accuracy rate, including 71.8% (237/330) accuracy for A1 MCQs, 73.7% (330/448) accuracy for A2 MCQs, 70.2% (92/131) accuracy for A3/4 MCQs, and 58.5% (83/142) accuracy for case analysis MCQs. As of April 7, 2023, a total of 129 individuals participated in the experiment. However, 19 individuals withdrew from the experiment at various phases; thus, as of July 1, 2023, a total of 110 individuals accomplished the trial and completed all follow-up work. After we intervened in the learning style of the students in the short term, the ChatGPT group answered more questions correctly than the control group (ChatGPT group: mean 141.20, SD 26.68; control group: mean 130.80, SD 25.56; P=.04) in the orthopedics test, particularly on A1 (ChatGPT group: mean 46.57, SD 8.52; control group: mean 42.18, SD 9.43; P=.01), A2 (ChatGPT group: mean 60.59, SD 10.58; control group: mean 56.66, SD 9.91; P=.047), and A3/4 MCQs (ChatGPT group: mean 19.57, SD 5.48; control group: mean 16.46, SD 4.58; P=.002). At the end of the semester, we found that the ChatGPT group performed better on final examinations in surgery (ChatGPT group: mean 76.54, SD 9.79; control group: mean 72.54, SD 8.11; P=.02) and obstetrics and gynecology (ChatGPT group: mean 75.98, SD 8.94; control group: mean 72.54, SD 8.66; P=.04) than the control group. Conclusions: ChatGPT answers orthopedics-related MCQs accurately, and students using it excel in both short-term and long-term assessments. Our findings strongly support ChatGPT?s integration into medical education, enhancing contemporary instructional methods. Trial Registration: Chinese Clinical Trial Registry Chictr2300071774; https://www.chictr.org.cn/hvshowproject.html ?id=225740&v=1.0 UR - https://www.jmir.org/2024/1/e57037 UR - http://dx.doi.org/10.2196/57037 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57037 ER - TY - JOUR AU - Costa, Silva Carlos Dario da AU - Silva, Gouvea Gabriela AU - Santos, dos Emerson Roberto AU - Engel, Carvalho Ana Maria Rita Pedroso Vilela Torres de AU - Costa, Santos Ana Caroline dos AU - da Silva, Morete Taisa AU - da Conceição, Henrique Washington AU - Cristóvão, Helena AU - Lima, Abreu Alba Regina de AU - Brienze, MS Vânia AU - Bizotto, Gastardelo Thaís Santana AU - Oliani, Hélio Antonio AU - André, César Júlio PY - 2024/8/19 TI - Surgical Residents? Perception of Feedback on Their Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e56727 VL - 13 KW - medical education KW - occupational training KW - surgical residents KW - feedback KW - perception N2 - Background: Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner?s perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. Objective: The aim of this study is to identify and map out data from studies that report surgical residents? perception of the feedback received during their education. Methods: The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies? titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. Results: The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. Conclusions: Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents? learning progress. Trial Registration: Open Science Framework yexb; https://osf.io/yexkb. International Registered Report Identifier (IRRID): PRR1-10.2196/56727 UR - https://www.researchprotocols.org/2024/1/e56727 UR - http://dx.doi.org/10.2196/56727 UR - http://www.ncbi.nlm.nih.gov/pubmed/39158942 ID - info:doi/10.2196/56727 ER - TY - JOUR AU - Holderried, Friederike AU - Stegemann-Philipps, Christian AU - Herrmann-Werner, Anne AU - Festl-Wietek, Teresa AU - Holderried, Martin AU - Eickhoff, Carsten AU - Mahling, Moritz PY - 2024/8/16 TI - A Language Model?Powered Simulated Patient With Automated Feedback for History Taking: Prospective Study JO - JMIR Med Educ SP - e59213 VL - 10 KW - virtual patients communication KW - communication skills KW - technology enhanced education KW - TEL KW - medical education KW - ChatGPT KW - GPT: LLM KW - LLMs KW - NLP KW - natural language processing KW - machine learning KW - artificial intelligence KW - language model KW - language models KW - communication KW - relationship KW - relationships KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - history KW - histories KW - simulated KW - student KW - students KW - interaction KW - interactions N2 - Background: Although history taking is fundamental for diagnosing medical conditions, teaching and providing feedback on the skill can be challenging due to resource constraints. Virtual simulated patients and web-based chatbots have thus emerged as educational tools, with recent advancements in artificial intelligence (AI) such as large language models (LLMs) enhancing their realism and potential to provide feedback. Objective: In our study, we aimed to evaluate the effectiveness of a Generative Pretrained Transformer (GPT) 4 model to provide structured feedback on medical students? performance in history taking with a simulated patient. Methods: We conducted a prospective study involving medical students performing history taking with a GPT-powered chatbot. To that end, we designed a chatbot to simulate patients? responses and provide immediate feedback on the comprehensiveness of the students? history taking. Students? interactions with the chatbot were analyzed, and feedback from the chatbot was compared with feedback from a human rater. We measured interrater reliability and performed a descriptive analysis to assess the quality of feedback. Results: Most of the study?s participants were in their third year of medical school. A total of 1894 question-answer pairs from 106 conversations were included in our analysis. GPT-4?s role-play and responses were medically plausible in more than 99% of cases. Interrater reliability between GPT-4 and the human rater showed ?almost perfect? agreement (Cohen ?=0.832). Less agreement (?<0.6) detected for 8 out of 45 feedback categories highlighted topics about which the model?s assessments were overly specific or diverged from human judgement. Conclusions: The GPT model was effective in providing structured feedback on history-taking dialogs provided by medical students. Although we unraveled some limitations regarding the specificity of feedback for certain feedback categories, the overall high agreement with human raters suggests that LLMs can be a valuable tool for medical education. Our findings, thus, advocate the careful integration of AI-driven feedback mechanisms in medical training and highlight important aspects when LLMs are used in that context. UR - https://mededu.jmir.org/2024/1/e59213 UR - http://dx.doi.org/10.2196/59213 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59213 ER - TY - JOUR AU - Tong, Wenting AU - Zhang, Xiaowen AU - Zeng, Haiping AU - Pan, Jianping AU - Gong, Chao AU - Zhang, Hui PY - 2024/8/15 TI - Reforming China?s Secondary Vocational Medical Education: Adapting to the Challenges and Opportunities of the AI Era JO - JMIR Med Educ SP - e48594 VL - 10 KW - secondary vocational medical education KW - artificial intelligence KW - practical skills KW - critical thinking KW - AI UR - https://mededu.jmir.org/2024/1/e48594 UR - http://dx.doi.org/10.2196/48594 ID - info:doi/10.2196/48594 ER - TY - JOUR AU - Ming, Shuai AU - Guo, Qingge AU - Cheng, Wenjun AU - Lei, Bo PY - 2024/8/13 TI - Influence of Model Evolution and System Roles on ChatGPT?s Performance in Chinese Medical Licensing Exams: Comparative Study JO - JMIR Med Educ SP - e52784 VL - 10 KW - ChatGPT KW - Chinese National Medical Licensing Examination KW - large language models KW - medical education KW - system role KW - LLM KW - LLMs KW - language model KW - language models KW - artificial intelligence KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - exam KW - exams KW - examination KW - examinations KW - OpenAI KW - answer KW - answers KW - response KW - responses KW - accuracy KW - performance KW - China KW - Chinese N2 - Background: With the increasing application of large language models like ChatGPT in various industries, its potential in the medical domain, especially in standardized examinations, has become a focal point of research. Objective: The aim of this study is to assess the clinical performance of ChatGPT, focusing on its accuracy and reliability in the Chinese National Medical Licensing Examination (CNMLE). Methods: The CNMLE 2022 question set, consisting of 500 single-answer multiple choices questions, were reclassified into 15 medical subspecialties. Each question was tested 8 to 12 times in Chinese on the OpenAI platform from April 24 to May 15, 2023. Three key factors were considered: the version of GPT-3.5 and 4.0, the prompt?s designation of system roles tailored to medical subspecialties, and repetition for coherence. A passing accuracy threshold was established as 60%. The ?2 tests and ? values were employed to evaluate the model?s accuracy and consistency. Results: GPT-4.0 achieved a passing accuracy of 72.7%, which was significantly higher than that of GPT-3.5 (54%; P<.001). The variability rate of repeated responses from GPT-4.0 was lower than that of GPT-3.5 (9% vs 19.5%; P<.001). However, both models showed relatively good response coherence, with ? values of 0.778 and 0.610, respectively. System roles numerically increased accuracy for both GPT-4.0 (0.3%?3.7%) and GPT-3.5 (1.3%?4.5%), and reduced variability by 1.7% and 1.8%, respectively (P>.05). In subgroup analysis, ChatGPT achieved comparable accuracy among different question types (P>.05). GPT-4.0 surpassed the accuracy threshold in 14 of 15 subspecialties, while GPT-3.5 did so in 7 of 15 on the first response. Conclusions: GPT-4.0 passed the CNMLE and outperformed GPT-3.5 in key areas such as accuracy, consistency, and medical subspecialty expertise. Adding a system role insignificantly enhanced the model?s reliability and answer coherence. GPT-4.0 showed promising potential in medical education and clinical practice, meriting further study. UR - https://mededu.jmir.org/2024/1/e52784 UR - http://dx.doi.org/10.2196/52784 ID - info:doi/10.2196/52784 ER - TY - JOUR AU - Rohani, Narjes AU - Sowa, Stephen AU - Manataki, Areti PY - 2024/8/12 TI - Identifying Learning Preferences and Strategies in Health Data Science Courses: Systematic Review JO - JMIR Med Educ SP - e50667 VL - 10 KW - health data science KW - bioinformatics KW - learning approach KW - learning preference KW - learning tactic KW - learning strategy KW - interdisciplinary KW - systematic review KW - medical education N2 - Background: Learning and teaching interdisciplinary health data science (HDS) is highly challenging, and despite the growing interest in HDS education, little is known about the learning experiences and preferences of HDS students. Objective: We conducted a systematic review to identify learning preferences and strategies in the HDS discipline. Methods: We searched 10 bibliographic databases (PubMed, ACM Digital Library, Web of Science, Cochrane Library, Wiley Online Library, ScienceDirect, SpringerLink, EBSCOhost, ERIC, and IEEE Xplore) from the date of inception until June 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included primary studies written in English that investigated the learning preferences or strategies of students in HDS-related disciplines, such as bioinformatics, at any academic level. Risk of bias was independently assessed by 2 screeners using the Mixed Methods Appraisal Tool, and we used narrative data synthesis to present the study results. Results: After abstract screening and full-text reviewing of the 849 papers retrieved from the databases, 8 (0.9%) studies, published between 2009 and 2021, were selected for narrative synthesis. The majority of these papers (7/8, 88%) investigated learning preferences, while only 1 (12%) paper studied learning strategies in HDS courses. The systematic review revealed that most HDS learners prefer visual presentations as their primary learning input. In terms of learning process and organization, they mostly tend to follow logical, linear, and sequential steps. Moreover, they focus more on abstract information, rather than detailed and concrete information. Regarding collaboration, HDS students sometimes prefer teamwork, and sometimes they prefer to work alone. Conclusions: The studies? quality, assessed using the Mixed Methods Appraisal Tool, ranged between 73% and 100%, indicating excellent quality overall. However, the number of studies in this area is small, and the results of all studies are based on self-reported data. Therefore, more research needs to be conducted to provide insight into HDS education. We provide some suggestions, such as using learning analytics and educational data mining methods, for conducting future research to address gaps in the literature. We also discuss implications for HDS educators, and we make recommendations for HDS course design; for example, we recommend including visual materials, such as diagrams and videos, and offering step-by-step instructions for students. UR - https://mededu.jmir.org/2024/1/e50667 UR - http://dx.doi.org/10.2196/50667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50667 ER - TY - JOUR AU - Zhu, Siyue AU - Li, Zenan AU - Sun, Ying AU - Kong, Linghui AU - Yin, Ming AU - Yong, Qinge AU - Gao, Yuan PY - 2024/8/12 TI - A Serious Game for Enhancing Rescue Reasoning Skills in Tactical Combat Casualty Care: Development and Deployment Study JO - JMIR Form Res SP - e50817 VL - 8 KW - combat casualty care KW - simulation training KW - medical service support KW - virtual reality KW - military exercise KW - medical education N2 - Background: Serious games (SGs) have emerged as engaging and instructional digital simulation tools that are increasingly being used for military medical training. SGs are often compared with traditional media in terms of learning outcomes, but it remains unclear which of the 2 options is more efficient and better accepted in the process of knowledge acquisition. Objective: This study aimed to create and test a scenario-based system suitable for enhancing rescue reasoning skills in tactical combat casualty care. Methods: To evaluate the effectiveness of the SGs, a randomized, observational, comparative trial was conducted. A total of 148 members from mobile medical logistics teams were recruited for training. Pre- and posttraining assessments were conducted using 2 different formats: a video-based online course (n=78) and a game simulation (n=70). We designed 3 evaluation instruments based on the first 2 levels of the Kirkpatrick model (reaction and learning) to measure trainees? satisfaction, knowledge proficiency, and self-confidence. Results: There were 4 elements that made up the learning path for the SGs: microcourses (video-based online courses), self-test, game simulation, and record query. The knowledge test scores in both groups were significantly higher after the intervention (t154=?6.010 and t138=?7.867, respectively; P<.001). For 5 simulation cases, the average operation time was 13.6 (SD 3.3) minutes, and the average case score was 279.0 (SD 57.6) points (from a possible total of 500 points), with a score rate of only 44% (222/500 points) to 67% (336/500 points). The results indicated no significant difference in trainees? satisfaction between the 2 training methods (P=.04). However, the game simulation method outperformed the video-based online course in terms of learning proficiency (t146=?2.324, P=.02) and self-perception (t146=?5.492, P<.001). Conclusions: Despite the high satisfaction reported by trainees for both training methods, the game simulation approach demonstrated superior efficiency and acceptance in terms of knowledge acquisition, self-perception, and overall performance. The developed SG holds significant potential as an essential assessment tool for evaluating frontline rescue skills and rescue reasoning in mobile medical logistics teams. UR - https://formative.jmir.org/2024/1/e50817 UR - http://dx.doi.org/10.2196/50817 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50817 ER - TY - JOUR AU - Kapp, M. Julie AU - Dicke, Rachel AU - Quinn, Kathleen PY - 2024/8/7 TI - Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study JO - JMIR Pediatr Parent SP - e56722 VL - 7 KW - adverse childhood experiences KW - ACE KW - training KW - trauma-informed care KW - provider KW - rural KW - adverse KW - trauma KW - traumatic KW - providers KW - teaching KW - curriculum KW - curricula KW - education KW - educational KW - social work KW - social worker KW - social workers KW - psychologist KW - psychologists KW - counselor KW - counselors KW - interprofessional KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - child KW - children KW - experience KW - experiences KW - continuing education N2 - Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic?s importance and intention to translate knowledge into practice. UR - https://pediatrics.jmir.org/2024/1/e56722 UR - http://dx.doi.org/10.2196/56722 ID - info:doi/10.2196/56722 ER - TY - JOUR AU - Kitapcioglu, Dilek AU - Aksoy, Emin Mehmet AU - Ozkan, Ekin Arun AU - Usseli, Tuba PY - 2024/8/7 TI - Comparing Learning Outcomes of Machine-Guided Virtual Reality?Based Training With Educator-Guided Training in a Metaverse Environment: Randomized Controlled Trial JO - JMIR Serious Games SP - e58654 VL - 12 KW - metaverse KW - serious gaming KW - virtual reality KW - educator guidance KW - educator KW - learning KW - machine guided KW - VR KW - guided training KW - randomized controlled trial KW - mixed reality KW - training KW - training module KW - module KW - correlation KW - gaming KW - gaming module KW - serious game KW - game KW - games N2 - Background: Virtual reality (VR) modules are commonly used for health care training, such as adult advanced cardiac life support (ACLS), due to immersion and engagement. The metaverse differs from current VR serious gaming by enabling shared social connections, while current VR modules focus on computer-based content without social interaction. Educators in the metaverse can foster communication and collaboration during training sessions. Objective: This study aimed to compare learning outcomes of VR-based, machine-guided training with educator-guided, VR-based training in the metaverse environment. Methods: A total of 62 volunteered students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology were randomly divided into 2 groups of 31 participants each: one group received VR-based training with machine guidance (MG), and the other received VR-based training with educator guidance (EG) in the metaverse. The members of both groups undertook VR-based basic training for ACLS. Afterward, the MG group was trained with a VR-based advanced training module, which provides training with full MG, whereas the EG group attended the VR-based, educator-guided training in the metaverse. The primary outcome of the study was determined by the exam score of the VR-based training module. Descriptive statistics defined continuous variables such as VR exam scores and time spent on machine- or educator-guided training. The correlation between training time and VR exam scores was assessed with the Spearman rank correlation, and nonnormally distributed variables were compared using the Mann-Whitney U test. Statistical significance was set at P<.05, with analyses executed by MedCalc Statistical Software (version 12.7.7). Results: Comparing the VR test scores between the MG and EG groups revealed no statistically significant difference. The VR test scores for the EG group had a median of 86 (range 11-100). In contrast, the MG group scores had a median of 66 (range 13-100; P=.08). Regarding the correlation between the duration of machine-guided or educator-guided training and VR-based exam scores, for the MG group, =0.569 and P=.005 were obtained. For the EG group, this correlation was found to be =0.298 and P=.10. While this correlation is statistically significant for the MG group, it is not significant for the EG group. The post hoc power analysis (80%), considering the correlation between the time spent on training and exam scores, supported this finding. Conclusions: The results of this study suggest that a well-designed, VR-based serious gaming module with MG could provide comparable learning outcomes to VR training in the metaverse with EG for adult ACLS training. Future research with a larger sample size could explore whether social interaction with educators in a metaverse environment offers added benefits for learners. Trial Registration: ClinicalTrials.gov NCT06288087; https://clinicaltrials.gov/study/NCT06288087 UR - https://games.jmir.org/2024/1/e58654 UR - http://dx.doi.org/10.2196/58654 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110497 ID - info:doi/10.2196/58654 ER - TY - JOUR AU - Sendra-Portero, Francisco AU - Lorenzo-Álvarez, Rocío AU - Rudolphi-Solero, Teodoro AU - Ruiz-Gómez, José Miguel PY - 2024/8/6 TI - The Second Life Metaverse and Its Usefulness in Medical Education After a Quarter of a Century JO - J Med Internet Res SP - e59005 VL - 26 KW - medical education KW - medical students KW - postgraduate KW - computer simulation KW - virtual worlds KW - metaverse UR - https://www.jmir.org/2024/1/e59005 UR - http://dx.doi.org/10.2196/59005 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59005 ER - TY - JOUR AU - Hersh, William PY - 2024/8/6 TI - A Quarter-Century of Online Informatics Education: Learners Served and Lessons Learned JO - J Med Internet Res SP - e59066 VL - 26 KW - distance education KW - online learning KW - asynchronous education KW - biomedical and health informatics KW - learning KW - biomedical KW - health informatics KW - education KW - educational KW - educational technology KW - online program KW - online course KW - teaching KW - students UR - https://www.jmir.org/2024/1/e59066 UR - http://dx.doi.org/10.2196/59066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59066 ER - TY - JOUR AU - Lonati, Caterina AU - Wellhausen, Marie AU - Pennig, Stefan AU - Röhrßen, Thomas AU - Kircelli, Fatih AU - Arendt, Svenja AU - Tschulena, Ulrich PY - 2024/8/6 TI - The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals JO - JMIR Med Educ SP - e46220 VL - 10 KW - peritoneal dialysis KW - virtual reality KW - patient education KW - patient training KW - chronic kidney disease KW - nursing KW - qualitative assessment N2 - Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay?safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay?safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay?safe MyTraining VR ranged from 2 to 5 for each professional. The stay?safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents? perspective, the technology improved patients? learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient?s needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients? acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay?safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. UR - https://mededu.jmir.org/2024/1/e46220 UR - http://dx.doi.org/10.2196/46220 UR - http://www.ncbi.nlm.nih.gov/pubmed/39106093 ID - info:doi/10.2196/46220 ER - TY - JOUR AU - Mikkonen, Kasperi AU - Helminen, Eeva-Eerika AU - Saarni, I. Samuli AU - Saarni, E. Suoma PY - 2024/7/29 TI - Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review JO - J Med Internet Res SP - e54473 VL - 26 KW - mental health KW - psychotherapy KW - digital learning KW - Kirkpatrick model KW - e-learning KW - online health KW - psychotherapy training KW - learning outcome KW - learning outcomes KW - systematic review KW - training methods KW - mental disorders KW - mental disorder KW - accessibility KW - evidence-based KW - scalability KW - cost-effectiveness KW - internet KW - education N2 - Background: Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. Objective: This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. Results: The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. Conclusions: e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings. UR - https://www.jmir.org/2024/1/e54473 UR - http://dx.doi.org/10.2196/54473 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073862 ID - info:doi/10.2196/54473 ER - TY - JOUR AU - Zhui, Li AU - Yhap, Nina AU - Liping, Liu AU - Zhengjie, Wang AU - Zhonghao, Xiong AU - Xiaoshu, Yuan AU - Hong, Cui AU - Xuexiu, Liu AU - Wei, Ren PY - 2024/7/25 TI - Impact of Large Language Models on Medical Education and Teaching Adaptations JO - JMIR Med Inform SP - e55933 VL - 12 KW - large language models KW - medical education KW - opportunities KW - challenges KW - critical thinking KW - educator UR - https://medinform.jmir.org/2024/1/e55933 UR - http://dx.doi.org/10.2196/55933 ID - info:doi/10.2196/55933 ER - TY - JOUR AU - Burke, B. Harry AU - Hoang, Albert AU - Lopreiato, O. Joseph AU - King, Heidi AU - Hemmer, Paul AU - Montgomery, Michael AU - Gagarin, Viktoria PY - 2024/7/25 TI - Assessing the Ability of a Large Language Model to Score Free-Text Medical Student Clinical Notes: Quantitative Study JO - JMIR Med Educ SP - e56342 VL - 10 KW - medical education KW - generative artificial intelligence KW - natural language processing KW - ChatGPT KW - generative pretrained transformer KW - standardized patients KW - clinical notes KW - free-text notes KW - history and physical examination KW - large language model KW - LLM KW - medical student KW - medical students KW - clinical information KW - artificial intelligence KW - AI KW - patients KW - patient KW - medicine N2 - Background: Teaching medical students the skills required to acquire, interpret, apply, and communicate clinical information is an integral part of medical education. A crucial aspect of this process involves providing students with feedback regarding the quality of their free-text clinical notes. Objective: The goal of this study was to assess the ability of ChatGPT 3.5, a large language model, to score medical students? free-text history and physical notes. Methods: This is a single-institution, retrospective study. Standardized patients learned a prespecified clinical case and, acting as the patient, interacted with medical students. Each student wrote a free-text history and physical note of their interaction. The students? notes were scored independently by the standardized patients and ChatGPT using a prespecified scoring rubric that consisted of 85 case elements. The measure of accuracy was percent correct. Results: The study population consisted of 168 first-year medical students. There was a total of 14,280 scores. The ChatGPT incorrect scoring rate was 1.0%, and the standardized patient incorrect scoring rate was 7.2%. The ChatGPT error rate was 86%, lower than the standardized patient error rate. The ChatGPT mean incorrect scoring rate of 12 (SD 11) was significantly lower than the standardized patient mean incorrect scoring rate of 85 (SD 74; P=.002). Conclusions: ChatGPT demonstrated a significantly lower error rate compared to standardized patients. This is the first study to assess the ability of a generative pretrained transformer (GPT) program to score medical students? standardized patient-based free-text clinical notes. It is expected that, in the near future, large language models will provide real-time feedback to practicing physicians regarding their free-text notes. GPT artificial intelligence programs represent an important advance in medical education and medical practice. UR - https://mededu.jmir.org/2024/1/e56342 UR - http://dx.doi.org/10.2196/56342 ID - info:doi/10.2196/56342 ER - TY - JOUR AU - Noroozi, Mohammad AU - St John, Ace AU - Masino, Caterina AU - Laplante, Simon AU - Hunter, Jaryd AU - Brudno, Michael AU - Madani, Amin AU - Kersten-Oertel, Marta PY - 2024/7/25 TI - Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game JO - JMIR Form Res SP - e52878 VL - 8 KW - gamification KW - serious games KW - surgery KW - education KW - laparoscopic cholecystectomy KW - artificial intelligence KW - AI KW - laparoscope KW - gallbladder KW - cholecystectomy KW - mobile game KW - gamify KW - educational game KW - interactive KW - decision-making KW - mobile phone N2 - Background:  Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. Objective:  To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. Methods:  LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Results:  Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. Conclusions:  LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees. UR - https://formative.jmir.org/2024/1/e52878 UR - http://dx.doi.org/10.2196/52878 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52878 ER - TY - JOUR AU - Park, Subin AU - Shin, Ju Hui AU - Kwak, Hyoeun AU - Lee, Joo Hyun PY - 2024/7/24 TI - Effects of Immersive Technology?Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach JO - J Med Internet Res SP - e57566 VL - 26 KW - nursing education KW - nursing students KW - immersive technology KW - systematic review KW - meta-analysis KW - virtual reality KW - augmented reality KW - extended reality KW - simulation-based learning KW - medical education N2 - Background: The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs. Objective: This systematic review aimed to identify the contents of immersive technology?based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. Methods: A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature. Results: A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology?based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%). Conclusions: These findings support the effectiveness of immersive technology?based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology?based nursing education on NWKM level 4. UR - https://www.jmir.org/2024/1/e57566 UR - http://dx.doi.org/10.2196/57566 UR - http://www.ncbi.nlm.nih.gov/pubmed/38978483 ID - info:doi/10.2196/57566 ER - TY - JOUR AU - Kamel Boulos, N. Maged AU - Dellavalle, Robert PY - 2024/7/24 TI - NVIDIA?s ?Chat with RTX? Custom Large Language Model and Personalized AI Chatbot Augments the Value of Electronic Dermatology Reference Material JO - JMIR Dermatol SP - e58396 VL - 7 KW - AI chatbots KW - artificial intelligence KW - AI KW - generative AI KW - large language models KW - dermatology KW - education KW - self-study KW - NVIDIA RTX KW - retrieval-augmented generation KW - RAG UR - https://derma.jmir.org/2024/1/e58396 UR - http://dx.doi.org/10.2196/58396 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58396 ER - TY - JOUR AU - Li, Linger AU - Li, Pengfei AU - Wang, Kun AU - Zhang, Liang AU - Ji, Hongwei AU - Zhao, Hongqin PY - 2024/7/23 TI - Benchmarking State-of-the-Art Large Language Models for Migraine Patient Education: Performance Comparison of Responses to Common Queries JO - J Med Internet Res SP - e55927 VL - 26 KW - migraine KW - large language models KW - patient education KW - ChatGPT KW - Google Bard KW - language model KW - education KW - headache KW - accuracy KW - OpenAI KW - AI KW - artificial intelligence KW - AI-assisted KW - holistic KW - migraine management KW - management UR - https://www.jmir.org/2024/1/e55927 UR - http://dx.doi.org/10.2196/55927 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55927 ER - TY - JOUR AU - Jafari, Mahtab PY - 2024/7/22 TI - Can an Online Course, Life101: Mental and Physical Self-Care, Improve the Well-Being of College Students? JO - JMIR Med Educ SP - e50111 VL - 10 KW - self-care course KW - stress management KW - student mental health KW - multimodal online course KW - mental health interventions UR - https://mededu.jmir.org/2024/1/e50111 UR - http://dx.doi.org/10.2196/50111 ID - info:doi/10.2196/50111 ER - TY - JOUR AU - Fukui, Sho AU - Shimizu, Taro AU - Nishizaki, Yuji AU - Shikino, Kiyoshi AU - Yamamoto, Yu AU - Kobayashi, Hiroyuki AU - Tokuda, Yasuharu PY - 2024/7/19 TI - The Utility of Wearable Cameras in Developing Examination Questions and Answers on Physical Examinations: Preliminary Study JO - JMIR Med Educ SP - e53193 VL - 10 KW - medical education KW - medical technology KW - wearable device KW - wearable camera KW - medical examination KW - exam KW - examination KW - exams KW - examinations KW - physical KW - resident physicians KW - wearable KW - wearables KW - camera KW - cameras KW - video KW - videos KW - innovation KW - innovations KW - innovative KW - recording KW - recordings KW - survey KW - surveys UR - https://mededu.jmir.org/2024/1/e53193 UR - http://dx.doi.org/10.2196/53193 ID - info:doi/10.2196/53193 ER - TY - JOUR AU - Gil-Hernández, Eva AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Bohomol, Elena AU - Serpa, C. Piedad AU - Ribeiro Neves, Vanessa AU - Maluenda Martínez, Maria AU - Martin-Delgado, Jimmy AU - Pérez-Esteve, Clara AU - Fernández, César AU - Mira, Joaquín José PY - 2024/7/18 TI - Development and Implementation of a Safety Incident Report System for Health Care Discipline Students During Clinical Internships: Observational Study JO - JMIR Med Educ SP - e56879 VL - 10 KW - reporting systems KW - education KW - medical KW - nursing KW - undergraduate KW - patient safety N2 - Background: Patient safety is a fundamental aspect of health care practice across global health systems. Safe practices, which include incident reporting systems, have proven valuable in preventing the recurrence of safety incidents. However, the accessibility of this tool for health care discipline students is not consistent, limiting their acquisition of competencies. In addition, there is no tools to familiarize students with analyzing safety incidents. Gamification has emerged as an effective strategy in health care education. Objective: This study aims to develop an incident reporting system tailored to the specific needs of health care discipline students, named Safety Incident Report System for Students. Secondary objectives included studying the performance of different groups of students in the use of the platform and training them on the correct procedures for reporting. Methods: This was an observational study carried out in 3 phases. Phase 1 consisted of the development of the web-based platform and the incident registration form. For this purpose, systems already developed and in use in Spain were taken as a basis. During phase 2, a total of 223 students in medicine and nursing with clinical internships from universities in Argentina, Brazil, Colombia, Ecuador, and Spain received an introductory seminar and were given access to the platform. Phase 3 ran in parallel and involved evaluation and feedback of the reports received as well as the opportunity to submit the students? opinion on the process. Descriptive statistics were obtained to gain information about the incidents, and mean comparisons by groups were performed to analyze the scores obtained. Results: The final form was divided into 9 sections and consisted of 48 questions that allowed for introducing data about the incident, its causes, and proposals for an improvement plan. The platform included a personal dashboard displaying submitted reports, average scores, progression, and score rankings. A total of 105 students participated, submitting 147 reports. Incidents were mainly reported in the hospital setting, with complications of care (87/346, 25.1%) and effects of medication or medical products (82/346, 23.7%) being predominant. The most repeated causes were related confusion, oversight, or distractions (49/147, 33.3%) and absence of process verification (44/147, 29.9%). Statistically significant differences were observed between the mean final scores received by country (P<.001) and sex (P=.006) but not by studies (P=.47). Overall, participants rated the experience of using the Safety Incident Report System for Students positively. Conclusions: This study presents an initial adaptation of reporting systems to suit the needs of students, introducing a guided and inspiring framework that has garnered positive acceptance among students. Through this endeavor, a pathway toward a safety culture within the faculty is established. A long-term follow-up would be desirable to check the real benefits of using the tool during education. Trial Registration: Trial Registration: ClinicalTrials.gov NCT05350345; https://clinicaltrials.gov/study/NCT05350345 UR - https://mededu.jmir.org/2024/1/e56879 UR - http://dx.doi.org/10.2196/56879 UR - http://www.ncbi.nlm.nih.gov/pubmed/39024005 ID - info:doi/10.2196/56879 ER - TY - JOUR AU - Tolentino, Raymond AU - Baradaran, Ashkan AU - Gore, Genevieve AU - Pluye, Pierre AU - Abbasgholizadeh-Rahimi, Samira PY - 2024/7/18 TI - Curriculum Frameworks and Educational Programs in AI for Medical Students, Residents, and Practicing Physicians: Scoping Review JO - JMIR Med Educ SP - e54793 VL - 10 KW - artificial intelligence KW - machine learning KW - curriculum KW - framework KW - medical education KW - review N2 - Background: The successful integration of artificial intelligence (AI) into clinical practice is contingent upon physicians? comprehension of AI principles and its applications. Therefore, it is essential for medical education curricula to incorporate AI topics and concepts, providing future physicians with the foundational knowledge and skills needed. However, there is a knowledge gap in the current understanding and availability of structured AI curriculum frameworks tailored for medical education, which serve as vital guides for instructing and facilitating the learning process. Objective: The overall aim of this study is to synthesize knowledge from the literature on curriculum frameworks and current educational programs that focus on the teaching and learning of AI for medical students, residents, and practicing physicians. Methods: We followed a validated framework and the Joanna Briggs Institute methodological guidance for scoping reviews. An information specialist performed a comprehensive search from 2000 to May 2023 in the following bibliographic databases: MEDLINE (Ovid), Embase (Ovid), CENTRAL (Cochrane Library), CINAHL (EBSCOhost), and Scopus as well as the gray literature. Papers were limited to English and French languages. This review included papers that describe curriculum frameworks for teaching and learning AI in medicine, irrespective of country. All types of papers and study designs were included, except conference abstracts and protocols. Two reviewers independently screened the titles and abstracts, read the full texts, and extracted data using a validated data extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. We adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting the results. Results: Of the 5104 papers screened, 21 papers relevant to our eligibility criteria were identified. In total, 90% (19/21) of the papers altogether described 30 current or previously offered educational programs, and 10% (2/21) of the papers described elements of a curriculum framework. One framework describes a general approach to integrating AI curricula throughout the medical learning continuum and another describes a core curriculum for AI in ophthalmology. No papers described a theory, pedagogy, or framework that guided the educational programs. Conclusions: This review synthesizes recent advancements in AI curriculum frameworks and educational programs within the domain of medical education. To build on this foundation, future researchers are encouraged to engage in a multidisciplinary approach to curriculum redesign. In addition, it is encouraged to initiate dialogues on the integration of AI into medical curriculum planning and to investigate the development, deployment, and appraisal of these innovative educational programs. International Registered Report Identifier (IRRID): RR2-10.11124/JBIES-22-00374 UR - https://mededu.jmir.org/2024/1/e54793 UR - http://dx.doi.org/10.2196/54793 UR - http://www.ncbi.nlm.nih.gov/pubmed/39023999 ID - info:doi/10.2196/54793 ER - TY - JOUR AU - Tan, Wen Jun AU - Tan, Gabriel AU - Lian, Xia AU - Chong, Siang Darren Kai AU - Rajalingam, Preman AU - Dalan, Rinkoo AU - Mogali, Reddy Sreenivasulu PY - 2024/7/17 TI - Impact of Facilitation on Cognitive Flow in a Novel Diabetes Management Rehearsal Game for Health Professions Education: Mixed Methods, Open-Label, Superiority Randomized Controlled Trial JO - JMIR Serious Games SP - e54703 VL - 12 KW - serious game KW - randomized control trial KW - facilitation KW - diabetes KW - diabetes management KW - flow KW - education N2 - Background: Though the prevalence of diabetes is set to increase, most serious game solutions typically target patient self-management and education. Few games target health care professions education, and even fewer consider the factors that may increase their efficacies. The impact of facilitation, a prominent feature of health professions education, is examined in the context of a rehearsal-based diabetes management serious game. Objective: In this mixed methods, open-label, superiority randomized controlled trial, we compare student performance, attitudes, and perceptions of a rehearsal-based diabetes management game for health care professionals. Methods: Student participants were randomized into 2 groups to play a diabetes management game. The control group played the game alone, and the intervention group played the same game alongside a facilitator tasked to moderate overall challenge levels and address queries. Both groups were administered the Flow Short Scale, a 13-item measure rated on a 7-point Likert scale ranging from 1 (?not at all?) to 7 (?very much?) immediately after the game. Students were then invited to voluntary focus group discussions to elicit their attitudes and perceptions of the game. Findings were subject to between-group comparisons and inductive thematic analysis respectively. Results: A total of 48 (26 control, 22 intervention) clinical-year undergraduates from the Lee Kong Chian School of Medicine in Singapore participated in this study, with 18 continuing to the focus group discussions. Flow Short Scale results indicated the superiority of the intervention group for overall flow (t46=?2.17, P=.04) and the absorption subdomain (t46=?2.6, P=.01). Qualitative results indicated students viewed facilitation as helpful and appropriate, and were able to identify improvable elements of the game?s theoretical foundations and overall design. Conclusions: While serious games are efficacious means of rehearsing previously learned knowledge, facilitation allows for their efficiency to be greatly increased. Such increases are likely crucial in the coming years with the increased digitization of health care professions education and the prevalence of diabetes. Trial Registration: ClinicalTrials.gov NCT05637749; https://www.clinicaltrials.gov/study/NCT05637749 UR - https://games.jmir.org/2024/1/e54703 UR - http://dx.doi.org/10.2196/54703 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900700 ID - info:doi/10.2196/54703 ER - TY - JOUR AU - Chan, Kitty AU - Kor, Kin Patrick Pui AU - Liu, Wa Justina Yat AU - Cheung, Kin AU - Lai, Timothy AU - Kwan, Cho Rick Yiu PY - 2024/7/10 TI - The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study JO - Asian Pac Isl Nurs J SP - e58818 VL - 8 KW - education KW - educational KW - hospital KW - hospitals KW - nontechnical skills KW - nurse KW - nurses KW - nursing education KW - nursing KW - satisfaction KW - self-confidence KW - simulation KW - simulations KW - virtual reality KW - VR KW - immersive N2 - Background: Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology. Objective: This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students? NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students? experience in using VR-Hosp. Methods: A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews. Results: In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS. Conclusions: The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice. UR - https://apinj.jmir.org/2024/1/e58818 UR - http://dx.doi.org/10.2196/58818 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58818 ER - TY - JOUR AU - Steindorff, Jenny-Victoria AU - Redlich, Lisa-Marie AU - Paulicke, Denny AU - Jahn, Patrick PY - 2024/7/8 TI - Use and Design of Virtual Reality?Supported Learning Scenarios in the Vocational Qualification of Nursing Professionals: Scoping Review JO - JMIR Serious Games SP - e53356 VL - 12 KW - scoping review KW - generalist nursing education KW - digital teaching formats KW - virtual reality application KW - co-creation N2 - Background: Numerous reviews advocate using virtual reality (VR) in educational contexts. This medium allows learners to test experiences in realistic environments. Virtually supported scenarios offer a safe and motivating way to explore, practice, and consolidate nursing skills in rare and critical nursing tasks. This is also cited as one of the reasons why VR can significantly increase the knowledge acquisition of nursing students. Nevertheless, studies are limited in their significance owing to the chosen design. Despite great interest, this results in a low level of confidence in VR as a curricular teaching method for nursing education. Therefore, defining concrete design and didactic-methodological parameters that support teachers in the use and implementation of VR is more relevant. Objective: This scoping review aims to provide an overview of significant design aspects for VR scenario conception and its transfer to generalist nursing education to generate value for the development of teaching scenarios and their sustainable implementation in teaching. Methods: A comprehensive literature search was performed using the MEDLINE (via PubMed) and CINAHL databases, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist was applied. The search was conducted from May to July 2022, using a specific search principle corresponding to the focus and the growing study corpus. A previously defined ?population, concept, and context? scheme was employed as the basis for the double-blind review of all relevant international German and English publications released up to May 1, 2022. Results: In accordance with the predefined selection procedure, 22 publications were identified. The identified aspects aided in the development of design, didactic, and research recommendations. The intuitive operation of realistically designed VR scenarios, which are standardized, reliable, and modifiable, as well as clear instructions and specific multimodal feedback functions were described positively. The same applied to the linear structure of the sequences with graduated demands and high image quality for increased immersion with low sensory overload. Changes in perspectives, multiuser options, dialogs, and recording functions can contribute to an interactive care practice. On the research side, it is advisable to define VR terminologies. In addition to considering larger samples, varying settings, and financial issues, it is recommended to conduct long-term studies on knowledge acquisition or improved patient outcomes. Conclusions: VR scenarios offer high potential in the context of nursing education if teachers and learners develop them co-creatively according to design features and implement them by means of a well-conceived concept. VR enables trainees to develop practical skills continuously in a standardized way. In addition, its deployment supports the sensitization of trainees to digital nursing technologies and the expansion of their digital skills in a practical setting. Furthermore, it allows sustainability issues to be addressed. UR - https://games.jmir.org/2024/1/e53356 UR - http://dx.doi.org/10.2196/53356 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53356 ER - TY - JOUR AU - He, Zonglin AU - Zhou, Botao AU - Feng, Haixiao AU - Bai, Jian AU - Wang, Yuechun PY - 2024/6/25 TI - Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis JO - JMIR Med Educ SP - e52224 VL - 10 KW - flipped classroom KW - flipped classroom teaching KW - physiology KW - scientific knowledge map KW - hot topics KW - frontier progress KW - evolution trend KW - classroom-based KW - bibliometric visual analysis KW - bibliometric KW - visual analysis KW - medical education KW - teaching method KW - bibliometric analysis KW - visualization tool KW - academic KW - academic community KW - inverted classroom N2 - Background: Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students? and teachers? responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively. Objective: This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature. Methods: A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends. Results: A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013?2014), extensive practice stage (2015?2019), and modification and growth stage (2020?2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others. Conclusions: This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents. UR - https://mededu.jmir.org/2024/1/e52224 UR - http://dx.doi.org/10.2196/52224 ID - info:doi/10.2196/52224 ER - TY - JOUR AU - Aqib, Ayma AU - Fareez, Faiha AU - Assadpour, Elnaz AU - Babar, Tubba AU - Kokavec, Andrew AU - Wang, Edward AU - Lo, Thomas AU - Lam, Jean-Paul AU - Smith, Christopher PY - 2024/6/20 TI - Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education JO - JMIR Med Educ SP - e47438 VL - 10 KW - medical education KW - objective structured clinical examination KW - OSCE KW - e-OSCE KW - Medical Council of Canada KW - MCC KW - virtual health KW - exam KW - examination KW - utility KW - usability KW - online learning KW - e-learning KW - medical student KW - medical students KW - clinical practice KW - clinical skills KW - clinical skill KW - OSCE tool UR - https://mededu.jmir.org/2024/1/e47438 UR - http://dx.doi.org/10.2196/47438 ID - info:doi/10.2196/47438 ER - TY - JOUR AU - Jones, Jennifer AU - Johnston, Sewan Jamie AU - Ndiaye, Yabsa Ngouille AU - Tokar, Anna AU - Singla, Saumya AU - Skinner, Ann Nadine AU - Strehlow, Matthew AU - Utunen, Heini PY - 2024/6/19 TI - Health Care Workers? Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis JO - JMIR Med Educ SP - e51915 VL - 10 KW - massive open online course KW - MOOC KW - online learning KW - online courses KW - online course KW - health care education KW - medical education KW - education KW - training KW - professional development KW - continuing education KW - COVID-19 training KW - infectious disease outbreak response KW - emergency KW - public health KW - crisis KW - crises KW - outbreak KW - pandemic KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - humanitarian emergency response KW - health care workers KW - nurse KW - nurses KW - practitioner KW - practitioners KW - clinician KW - clinicians KW - health care worker KW - medic KW - low-income KW - lower-middle income KW - LIC KW - LMIC KW - developing country KW - developing countries KW - developing nation KW - developing nations KW - case study KW - survey KW - surveys KW - descriptive analysis KW - descriptive analyses KW - motivation KW - motivations KW - lower-middle?income country KW - low-income country N2 - Background: Massive open online courses (MOOCs) are increasingly used to educate health care workers during public health emergencies. In early 2020, the World Health Organization (WHO) developed a series of MOOCs for COVID-19, introducing the disease and strategies to control its outbreak, with 6 courses specifically targeting health care workers as learners. In 2020, Stanford University also launched a MOOC designed to deliver accurate and timely education on COVID-19, equipping health care workers across the globe to provide health care safely and effectively to patients with the novel infectious disease. Although the use of MOOCs for just-in-time training has expanded during the pandemic, evidence is limited regarding the factors motivating health care workers to enroll in and complete courses, particularly in low-income countries (LICs) and lower-middle?income countries (LMICs). Objective: This study seeks to gain insights on the characteristics and motivations of learners turning to MOOCs for just-in-time training, to provide evidence that can better inform MOOC design to meet the needs of health care workers. We examine data from learners in 1 Stanford University and 6 WHO COVID-19 courses to identify (1) the characteristics of health care workers completing the courses and (2) the factors motivating them to enroll. Methods: We analyze (1) course registration data of the 49,098 health care workers who completed the 7 focal courses and (2) survey responses from 6272 course completers. The survey asked respondents to rank their motivations for enrollment and share feedback about their learning experience. We use descriptive statistics to compare responses by health care profession and by World Bank country income classification. Results: Health care workers completed the focal courses from all regions of the world, with nearly one-third (14,159/49,098, 28.84%) practicing in LICs and LMICs. Survey data revealed a diverse range of professional roles among the learners, including physicians (2171/6272, 34.61%); nurses (1599/6272, 25.49%); and other health care professionals such as allied health professionals, community health workers, paramedics, and pharmacists (2502/6272, 39.89%). Across all health care professions, the primary motivation to enroll was for personal learning to improve clinical practice. Continuing education credit was also an important motivator, particularly for nonphysicians and learners in LICs and LMICs. Course cost (3423/6272, 54.58%) and certification (4238/6272, 67.57%) were also important to a majority of learners. Conclusions: Our results demonstrate that a diverse range of health care professionals accessed MOOCs for just-in-time training during a public health emergency. Although all health care workers were motivated to improve their clinical practice, different factors were influential across professions and locations. These factors should be considered in MOOC design to meet the needs of health care workers, particularly those in lower-resource settings where alternative avenues for training may be limited. UR - https://mededu.jmir.org/2024/1/e51915 UR - http://dx.doi.org/10.2196/51915 ID - info:doi/10.2196/51915 ER - TY - JOUR AU - Syed, Ahmed Toufeeq AU - Thompson, L. Erika AU - Latif, Zainab AU - Johnson, Jay AU - Javier, Damaris AU - Stinson, Katie AU - Saleh, Gabrielle AU - Vishwanatha, K. Jamboor PY - 2024/6/17 TI - Diverse Mentoring Connections Across Institutional Boundaries in the Biomedical Sciences: Innovative Graph Database Analysis JO - J Med Internet Res SP - e47560 VL - 26 KW - online platform KW - mentorship KW - diversity KW - network analysis KW - graph database KW - online communities N2 - Background: With an overarching goal of increasing diversity and inclusion in biomedical sciences, the National Research Mentoring Network (NRMN) developed a web-based national mentoring platform (MyNRMN) that seeks to connect mentors and mentees to support the persistence of underrepresented minorities in the biomedical sciences. As of May 15, 2024, the MyNRMN platform, which provides mentoring, networking, and professional development tools, has facilitated more than 12,100 unique mentoring connections between faculty, students, and researchers in the biomedical domain. Objective: This study aimed to examine the large-scale mentoring connections facilitated by our web-based platform between students (mentees) and faculty (mentors) across institutional and geographic boundaries. Using an innovative graph database, we analyzed diverse mentoring connections between mentors and mentees across demographic characteristics in the biomedical sciences. Methods: Through the MyNRMN platform, we observed profile data and analyzed mentoring connections made between students and faculty across institutional boundaries by race, ethnicity, gender, institution type, and educational attainment between July 1, 2016, and May 31, 2021. Results: In total, there were 15,024 connections with 2222 mentees and 1652 mentors across 1625 institutions contributing data. Female mentees participated in the highest number of connections (3996/6108, 65%), whereas female mentors participated in 58% (5206/8916) of the connections. Black mentees made up 38% (2297/6108) of the connections, whereas White mentors participated in 56% (5036/8916) of the connections. Mentees were predominately from institutions classified as Research 1 (R1; doctoral universities?very high research activity) and historically Black colleges and universities (556/2222, 25% and 307/2222, 14%, respectively), whereas 31% (504/1652) of mentors were from R1 institutions. Conclusions: To date, the utility of mentoring connections across institutions throughout the United States and how mentors and mentees are connected is unknown. This study examined these connections and the diversity of these connections using an extensive web-based mentoring network. UR - https://www.jmir.org/2024/1/e47560 UR - http://dx.doi.org/10.2196/47560 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885013 ID - info:doi/10.2196/47560 ER - TY - JOUR AU - Zhang, Fang AU - Liu, Xiaoliu AU - Wu, Wenyan AU - Zhu, Shiben PY - 2024/6/13 TI - Evolution of Chatbots in Nursing Education: Narrative Review JO - JMIR Med Educ SP - e54987 VL - 10 KW - nursing education KW - chatbots KW - artificial intelligence KW - narrative review KW - ChatGPT N2 - Background: The integration of chatbots in nursing education is a rapidly evolving area with potential transformative impacts. This narrative review aims to synthesize and analyze the existing literature on chatbots in nursing education. Objective: This study aims to comprehensively examine the temporal trends, international distribution, study designs, and implications of chatbots in nursing education. Methods: A comprehensive search was conducted across 3 databases (PubMed, Web of Science, and Embase) following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Results: A total of 40 articles met the eligibility criteria, with a notable increase of publications in 2023 (n=28, 70%). Temporal analysis revealed a notable surge in publications from 2021 to 2023, emphasizing the growing scholarly interest. Geographically, Taiwan province made substantial contributions (n=8, 20%), followed by the United States (n=6, 15%) and South Korea (n=4, 10%). Study designs varied, with reviews (n=8, 20%) and editorials (n=7, 18%) being predominant, showcasing the richness of research in this domain. Conclusions: Integrating chatbots into nursing education presents a promising yet relatively unexplored avenue. This review highlights the urgent need for original research, emphasizing the importance of ethical considerations. UR - https://mededu.jmir.org/2024/1/e54987 UR - http://dx.doi.org/10.2196/54987 ID - info:doi/10.2196/54987 ER - TY - JOUR AU - Srinivasan, Muthuvenkatachalam AU - Venugopal, Ambili AU - Venkatesan, Latha AU - Kumar, Rajesh PY - 2024/6/13 TI - Navigating the Pedagogical Landscape: Exploring the Implications of AI and Chatbots in Nursing Education JO - JMIR Nursing SP - e52105 VL - 7 KW - AI KW - artificial intelligence KW - ChatGPT KW - chatbots KW - nursing education KW - education KW - chatbot KW - nursing KW - ethical KW - ethics KW - ethical consideration KW - accessible KW - learning KW - efficiency KW - student KW - student engagement KW - student learning UR - https://nursing.jmir.org/2024/1/e52105 UR - http://dx.doi.org/10.2196/52105 UR - http://www.ncbi.nlm.nih.gov/pubmed/38870516 ID - info:doi/10.2196/52105 ER - TY - JOUR AU - Moldt, Julia-Astrid AU - Festl-Wietek, Teresa AU - Fuhl, Wolfgang AU - Zabel, Susanne AU - Claassen, Manfred AU - Wagner, Samuel AU - Nieselt, Kay AU - Herrmann-Werner, Anne PY - 2024/6/12 TI - Assessing AI Awareness and Identifying Essential Competencies: Insights From Key Stakeholders in Integrating AI Into Medical Education JO - JMIR Med Educ SP - e58355 VL - 10 KW - AI in medicine KW - artificial intelligence KW - medical education KW - medical students KW - qualitative approach KW - qualitative analysis KW - needs assessment N2 - Background: The increasing importance of artificial intelligence (AI) in health care has generated a growing need for health care professionals to possess a comprehensive understanding of AI technologies, requiring an adaptation in medical education. Objective: This paper explores stakeholder perceptions and expectations regarding AI in medicine and examines their potential impact on the medical curriculum. This study project aims to assess the AI experiences and awareness of different stakeholders and identify essential AI-related topics in medical education to define necessary competencies for students. Methods: The empirical data were collected as part of the TüKITZMed project between August 2022 and March 2023, using a semistructured qualitative interview. These interviews were administered to a diverse group of stakeholders to explore their experiences and perspectives of AI in medicine. A qualitative content analysis of the collected data was conducted using MAXQDA software. Results: Semistructured interviews were conducted with 38 participants (6 lecturers, 9 clinicians, 10 students, 6 AI experts, and 7 institutional stakeholders). The qualitative content analysis revealed 6 primary categories with a total of 24 subcategories to answer the research questions. The evaluation of the stakeholders? statements revealed several commonalities and differences regarding their understanding of AI. Crucial identified AI themes based on the main categories were as follows: possible curriculum contents, skills, and competencies; programming skills; curriculum scope; and curriculum structure. Conclusions: The analysis emphasizes integrating AI into medical curricula to ensure students? proficiency in clinical applications. Standardized AI comprehension is crucial for defining and teaching relevant content. Considering diverse perspectives in implementation is essential to comprehensively define AI in the medical context, addressing gaps and facilitating effective solutions for future AI use in medical studies. The results provide insights into potential curriculum content and structure, including aspects of AI in medicine. UR - https://mededu.jmir.org/2024/1/e58355 UR - http://dx.doi.org/10.2196/58355 ID - info:doi/10.2196/58355 ER - TY - JOUR AU - van Dijk, R. Merle AU - van der Marel, Anne-Fleur AU - van Rheenen-Flach, E. Leonie AU - Ganzevoort, Wessel AU - Moll, Etelka AU - Scheele, Fedde AU - Velzel, Joost PY - 2024/6/6 TI - YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study JO - JMIR Form Res SP - e50087 VL - 8 KW - YouTube KW - ECV KW - external cephalic version KW - breech KW - education KW - video KW - cesarean KW - health education KW - childbirth KW - patient information KW - cross-sectional study KW - cesarean delivery KW - implementation KW - usefulness KW - medical information KW - pregnancy KW - pregnant women KW - engagement N2 - Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. UR - https://formative.jmir.org/2024/1/e50087 UR - http://dx.doi.org/10.2196/50087 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843520 ID - info:doi/10.2196/50087 ER - TY - JOUR AU - Nxumalo, Thembelenkosini Celenkosini AU - Pillay, Pavitra AU - Mchunu, Gladness Gugu PY - 2024/6/3 TI - The Durban University of Technology Faculty of Health Sciences Decentralized Clinical Training Project: Protocol for an Implementation Study in KwaZulu-Natal, South Africa JO - JMIR Res Protoc SP - e52243 VL - 13 KW - decentralized clinical training programs KW - curriculum KW - clinical education KW - health science education KW - university of technology KW - pedagogy KW - transformative education KW - teaching KW - higher education KW - South Africa N2 - Background: The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. Objective: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. Methods: Participatory action research comprising various designs?namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design?will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programs?namely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescue?will be part of the project?s pilot phase. Findings from the project?s pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the university?s strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. Results: The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. Conclusions: This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. International Registered Report Identifier (IRRID): PRR1-10.2196/52243 UR - https://www.researchprotocols.org/2024/1/e52243 UR - http://dx.doi.org/10.2196/52243 UR - http://www.ncbi.nlm.nih.gov/pubmed/38829695 ID - info:doi/10.2196/52243 ER - TY - JOUR AU - Kataoka, Koshi AU - Nishizaki, Yuji AU - Shimizu, Taro AU - Yamamoto, Yu AU - Shikino, Kiyoshi AU - Nojima, Masanori AU - Nagasaki, Kazuya AU - Fukui, Sho AU - Nishiguchi, Sho AU - Katayama, Kohta AU - Kurihara, Masaru AU - Ueda, Rieko AU - Kobayashi, Hiroyuki AU - Tokuda, Yasuharu PY - 2024/5/30 TI - Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study JO - JMIR Med Educ SP - e52207 VL - 10 KW - clinical knowledge support system KW - GM-ITE KW - postgraduate clinical resident KW - in-training examination performance KW - exam KW - exams KW - examination KW - examinations KW - resident KW - residents KW - cross-sectional KW - national KW - nationwide KW - postgraduate KW - decision support KW - point-of-care KW - UpToDate KW - DynaMed KW - knowledge support KW - medical education KW - performance KW - information behavior KW - information behaviour KW - information seeking KW - teaching KW - pedagogy KW - pedagogical KW - log KW - logs KW - usage KW - evidence-based medicine KW - EBM KW - educational KW - decision support system KW - clinical decision support KW - Japan KW - General Medicine In-Training Examination N2 - Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents? General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year?1 and ?2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents? GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents? clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes. UR - https://mededu.jmir.org/2024/1/e52207 UR - http://dx.doi.org/10.2196/52207 ID - info:doi/10.2196/52207 ER - TY - JOUR AU - Sritharan, Mithusha AU - Siraj, Samyah AU - Brunton, Ginny AU - Dubrowski, Adam PY - 2024/5/27 TI - Exploring the Distribution of 3D-Printed Simulator Designs Using Open-Source Databases to Facilitate Simulation-Based Learning Through a University and Nonprofit Collaboration: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53167 VL - 13 KW - simulation KW - three-dimensional printing KW - health professions education KW - database KW - simulator KW - simulator design KW - health care provider training KW - simulation-based education KW - simulation technology KW - open-source KW - databases KW - simulation-based learning KW - e-Learning KW - scoping review KW - technology KW - 3D printed simulators KW - design KW - 3D printing KW - 3D KW - health care training KW - university-based KW - research centers KW - gaps N2 - Background: Advancements in technology have enhanced education, training, and application in health care. However, limitations are present surrounding the accessibility and use of simulation technology (eg, simulators) for health profession education. Improving the accessibility of technology developed in university-based research centers by nonprofit organizations (NPOs; eg, hospitals) has the potential to benefit the health of populations worldwide. One example of such technology is 3D-printed simulators. Objective: This scoping review aims to identify how the use of open-source databases for the distribution of simulator designs used for 3D printing can promote credible solutions for health care training while minimizing the risks of commercialization of designs for profit. Methods: This scoping review will follow the Arksey and O?Malley methodological framework and the Joanna Briggs Institute guidance for scoping reviews. Ovid MEDLINE, CINAHL, Web of Science, and PsycINFO will be searched with an applied time frame of 2012 to 2022. Additionally, gray literature will be searched along with reference list searching. Papers that explore the use of open-source databases in academic settings and the health care sector for the distribution of simulator designs will be included. A 2-step screening process will be administered to titles and abstracts, then full texts, to establish paper eligibility. Screening and data extraction of the papers will be completed by 2 reviewers (MS and SS) for quality assurance. The scoping review will report information on the facilitation of distributing 3D-printed simulator designs through open-source databases. Results: The results of this review will identify gaps in forming partnerships with NPOs and university-based research centers to share simulator designs. The scoping review will be initiated in December 2024. Conclusions: The information collected will be relevant and useful for stakeholders such as health care providers, researchers, and NPOs for the purpose of overcoming the gaps in research regarding the use and distribution of simulation technology. The scoping review has not been conducted yet. Therefore, there are currently no findings to report on. International Registered Report Identifier (IRRID): PRR1-10.2196/53167 UR - https://www.researchprotocols.org/2024/1/e53167 UR - http://dx.doi.org/10.2196/53167 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801764 ID - info:doi/10.2196/53167 ER - TY - JOUR AU - Arango-Ibanez, Pablo Juan AU - Posso-Nuñez, Alejandro Jose AU - Díaz-Solórzano, Pablo Juan AU - Cruz-Suárez, Gustavo PY - 2024/5/24 TI - Evidence-Based Learning Strategies in Medicine Using AI JO - JMIR Med Educ SP - e54507 VL - 10 KW - artificial intelligence KW - large language models KW - ChatGPT KW - active recall KW - memory cues KW - LLMs KW - evidence-based KW - learning strategy KW - medicine KW - AI KW - medical education KW - knowledge KW - relevance UR - https://mededu.jmir.org/2024/1/e54507 UR - http://dx.doi.org/10.2196/54507 ID - info:doi/10.2196/54507 ER - TY - JOUR AU - Yoo, Suyoung AU - Heo, Sejin AU - Song, Soojin AU - Park, Aeyoung AU - Cho, Hyunchung AU - Kim, Yuna AU - Cha, Chul Won AU - Kim, Kyeongsug AU - Son, Hi Meong PY - 2024/5/23 TI - Adoption of Augmented Reality in Educational Programs for Nurses in Intensive Care Units of Tertiary Academic Hospitals: Mixed Methods Study JO - JMIR Serious Games SP - e54188 VL - 12 KW - augmented reality KW - AR KW - clinical skills education KW - nurse education KW - technology-based education KW - education KW - nurse KW - nursing KW - allied health KW - technology-enhanced learning KW - interview KW - training KW - usability KW - acceptability KW - educational KW - teaching KW - ICU KW - intensive care unit KW - self-guided KW - self-directed KW - hands-on KW - adoption KW - TAM KW - Technology Acceptance Model KW - skill KW - acquisition N2 - Background: In the wake of challenges brought by the COVID-19 pandemic to conventional medical education, the demand for innovative teaching methods has surged. Nurse training, with its focus on hands-on practice and self-directed learning, encountered significant hurdles with conventional approaches. Augmented reality (AR) offers a potential solution to addressing this issue. Objective: The aim of this study was to develop, introduce, and evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning. Methods: An AR-based educational program for nursing was developed anchored by the Kern six-step framework. First, we identified challenges in conventional teaching methods through interviews and literature reviews. Interviews highlighted the need for hands-on practice and on-site self-directed learning with feedback from a remote site. The training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system. Intensive care nurses were enrolled to evaluate AR education. We then assessed usability and acceptability of the AR training using the System Usability Scale and Technology Acceptance Model with intensive care nurses who agreed to test the new platform. Additionally, selected participants provided deeper insights through semistructured interviews. Results: This study highlights feasibility and key considerations for implementing an AR-based educational program for intensive care unit nurses, focusing on training objectives of the platform. Implemented over 2 months using Microsoft Dynamics 365 Guides and HoloLens 2, 28 participants were trained. Feedback gathered through interviews with the trainers and trainees indicated a positive reception. In particular, the trainees mentioned finding AR particularly useful for hands-on learning, appreciating its realism and the ability for repetitive practice. However, some challenges such as difficulty in adapting to the new technology were expressed. Overall, AR exhibits potential as a supplementary tool in nurse education. Conclusions: To our knowledge, this is the first study to substitute conventional methods with AR in this specific area of critical care nursing. These results indicate the multiple principal factors to take into consideration when adopting AR education in hospitals. AR is effective in promoting self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition. Trial Registration: ClinicalTrials.gov NCT05629663; https://clinicaltrials.gov/study/NCT05629663. UR - https://games.jmir.org/2024/1/e54188 UR - http://dx.doi.org/10.2196/54188 UR - http://www.ncbi.nlm.nih.gov/pubmed/38780998 ID - info:doi/10.2196/54188 ER - TY - JOUR AU - Xue, Elisabetta AU - Bracken-Clarke, Dara AU - Iannantuono, Maria Giovanni AU - Choo-Wosoba, Hyoyoung AU - Gulley, L. James AU - Floudas, S. Charalampos PY - 2024/5/17 TI - Utility of Large Language Models for Health Care Professionals and Patients in Navigating Hematopoietic Stem Cell Transplantation: Comparison of the Performance of ChatGPT-3.5, ChatGPT-4, and Bard JO - J Med Internet Res SP - e54758 VL - 26 KW - hematopoietic stem cell transplant KW - large language models KW - chatbot KW - chatbots KW - stem cell KW - large language model KW - artificial intelligence KW - AI KW - medical information KW - hematopoietic KW - HSCT KW - ChatGPT N2 - Background: Artificial intelligence is increasingly being applied to many workflows. Large language models (LLMs) are publicly accessible platforms trained to understand, interact with, and produce human-readable text; their ability to deliver relevant and reliable information is also of particular interest for the health care providers and the patients. Hematopoietic stem cell transplantation (HSCT) is a complex medical field requiring extensive knowledge, background, and training to practice successfully and can be challenging for the nonspecialist audience to comprehend. Objective: We aimed to test the applicability of 3 prominent LLMs, namely ChatGPT-3.5 (OpenAI), ChatGPT-4 (OpenAI), and Bard (Google AI), in guiding nonspecialist health care professionals and advising patients seeking information regarding HSCT. Methods: We submitted 72 open-ended HSCT?related questions of variable difficulty to the LLMs and rated their responses based on consistency?defined as replicability of the response?response veracity, language comprehensibility, specificity to the topic, and the presence of hallucinations. We then rechallenged the 2 best performing chatbots by resubmitting the most difficult questions and prompting to respond as if communicating with either a health care professional or a patient and to provide verifiable sources of information. Responses were then rerated with the additional criterion of language appropriateness, defined as language adaptation for the intended audience. Results: ChatGPT-4 outperformed both ChatGPT-3.5 and Bard in terms of response consistency (66/72, 92%; 54/72, 75%; and 63/69, 91%, respectively; P=.007), response veracity (58/66, 88%; 40/54, 74%; and 16/63, 25%, respectively; P<.001), and specificity to the topic (60/66, 91%; 43/54, 80%; and 27/63, 43%, respectively; P<.001). Both ChatGPT-4 and ChatGPT-3.5 outperformed Bard in terms of language comprehensibility (64/66, 97%; 53/54, 98%; and 52/63, 83%, respectively; P=.002). All displayed episodes of hallucinations. ChatGPT-3.5 and ChatGPT-4 were then rechallenged with a prompt to adapt their language to the audience and to provide source of information, and responses were rated. ChatGPT-3.5 showed better ability to adapt its language to nonmedical audience than ChatGPT-4 (17/21, 81% and 10/22, 46%, respectively; P=.03); however, both failed to consistently provide correct and up-to-date information resources, reporting either out-of-date materials, incorrect URLs, or unfocused references, making their output not verifiable by the reader. Conclusions: In conclusion, despite LLMs? potential capability in confronting challenging medical topics such as HSCT, the presence of mistakes and lack of clear references make them not yet appropriate for routine, unsupervised clinical use, or patient counseling. Implementation of LLMs? ability to access and to reference current and updated websites and research papers, as well as development of LLMs trained in specialized domain knowledge data sets, may offer potential solutions for their future clinical application. UR - https://www.jmir.org/2024/1/e54758 UR - http://dx.doi.org/10.2196/54758 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758582 ID - info:doi/10.2196/54758 ER - TY - JOUR AU - Tourrette, Cédric AU - Tostain, Jean-Baptiste AU - Kozub, Eva AU - Badreddine, Maha AU - James, Julia AU - Noraz, Aurore AU - De Choudens, Charlotte AU - Moulis, Lionel AU - Duflos, Claire AU - Carbonnel, Francois PY - 2024/5/14 TI - An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study JO - JMIR Form Res SP - e56138 VL - 8 KW - planetary health KW - One Health KW - medical education KW - environmental health KW - education KW - e-learning KW - general practitioner KW - pilot study KW - climate change KW - training KW - environmental KW - e-learning module KW - behavior change KW - ecosystem KW - questionnaire KW - behavior KW - self-assessment KW - e-learning intervention KW - environment N2 - Background: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ?65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. Objective: The objective of this study was to assess the impact of the e-learning module on participants? knowledge and behavior change. Methods: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. Results: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants? pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). Conclusions: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice. UR - https://formative.jmir.org/2024/1/e56138 UR - http://dx.doi.org/10.2196/56138 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743463 ID - info:doi/10.2196/56138 ER - TY - JOUR AU - Friche, Pauline AU - Moulis, Lionel AU - Du Thanh, Aurélie AU - Dereure, Olivier AU - Duflos, Claire AU - Carbonnel, Francois PY - 2024/5/13 TI - Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study JO - JMIR Form Res SP - e56005 VL - 8 KW - dermoscopy KW - dermatoscope KW - dermatoscopes KW - dermatological KW - skin KW - training KW - GP KW - family practitioner KW - family practitioners KW - family physician KW - family physicians KW - general practice KW - family medicine KW - primary health care KW - internship and residency KW - education KW - e-learning KW - eLearning KW - dermatology KW - resident KW - residency KW - intern KW - interns KW - internship KW - internships N2 - Background: Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60% to 90%, but its use is limited due to lack of training. The characteristics of ?ideal? dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy. Objective: This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training. Methods: We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-Nîmes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question. Results: In total, 134 residents were included, and 66.4% (n=89) and 47% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1% (n=82) of participants for module 1 and 87.3% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6%) with the training course, and 96.3% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident?s initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001). Conclusions: The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors. UR - https://formative.jmir.org/2024/1/e56005 UR - http://dx.doi.org/10.2196/56005 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739910 ID - info:doi/10.2196/56005 ER - TY - JOUR AU - Tostain, Jean-Baptiste AU - Mathieu, Marina AU - Oude Engberink, Agnès AU - Clary, Bernard AU - Amouyal, Michel AU - Lognos, Béatrice AU - Demoly, Pascal AU - Annesi-Maesano, Isabella AU - Ninot, Grégory AU - Molinari, Nicolas AU - Richard, Arnaud AU - Badreddine, Maha AU - Duflos, Claire AU - Carbonnel, Francois PY - 2024/5/9 TI - The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study JO - JMIR Form Res SP - e56130 VL - 8 KW - environmental health KW - medical education KW - One Health KW - environment KW - environmental KW - eLearning KW - e-learning KW - remote KW - learning KW - online learning KW - primary care KW - satisfaction KW - awareness KW - behavioral KW - behavior change KW - questionnaire KW - survey KW - course KW - educational KW - teaching KW - GP KW - general practice KW - general practitioner N2 - Background: Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. Objective: This study assessed the impact of the e-learning component of the PCEH course on participants? satisfaction, knowledge, and behavior changes toward EH. Methods: This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants? satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients? health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar ?2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. Results: A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant?s health and by 26% for patients? health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). Conclusions: The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs. UR - https://formative.jmir.org/2024/1/e56130 UR - http://dx.doi.org/10.2196/56130 UR - http://www.ncbi.nlm.nih.gov/pubmed/38722679 ID - info:doi/10.2196/56130 ER - TY - JOUR AU - Shetty, Shishir AU - Bhat, Supriya AU - Al Bayatti, Saad AU - Al Kawas, Sausan AU - Talaat, Wael AU - El-Kishawi, Mohamed AU - Al Rawi, Natheer AU - Narasimhan, Sangeetha AU - Al-Daghestani, Hiba AU - Madi, Medhini AU - Shetty, Raghavendra PY - 2024/5/8 TI - The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review JO - JMIR Med Educ SP - e52953 VL - 10 KW - virtual reality KW - simulators KW - radiology education KW - medical imaging KW - radiology KW - education KW - systematic review KW - literature review KW - imaging KW - meta analysis KW - student KW - students KW - VR KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. Objective: This systematic literature review aims to explore the scope of VR use in radiology education. Methods: A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)?defined study selection process. Results: The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored ?good? in the overall quality and the remaining 5 (71%) scored ?fair.? VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students? skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. Conclusions: The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education. UR - https://mededu.jmir.org/2024/1/e52953 UR - http://dx.doi.org/10.2196/52953 ID - info:doi/10.2196/52953 ER - TY - JOUR AU - Skryd, Anthony AU - Lawrence, Katharine PY - 2024/5/8 TI - ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study JO - JMIR Form Res SP - e51346 VL - 8 KW - ChatGPT KW - medical education KW - large language models KW - LLMs KW - clinical decision-making N2 - Background: Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments. Objective: The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts. Methods: A brief, single-site exploratory evaluation of the publicly available ChatGPT-3.5 (OpenAI) was conducted by implementing the tool into the daily attending rounds of a general internal medicine inpatient service at a large urban academic medical center. ChatGPT was integrated into rounds via both structured and organic use, using the web-based ?chatbot? style interface to interact with the LLM through conversational free-text and discrete queries. A qualitative approach using phenomenological inquiry was used to identify key insights related to the use of ChatGPT through analysis of ChatGPT conversation logs and associated shorthand notes from the clinical sessions. Results: Identified use cases for ChatGPT integration included addressing medical knowledge gaps through discrete medical knowledge inquiries, building differential diagnoses and engaging dual-process thinking, challenging medical axioms, using cognitive aids to support acute care decision-making, and improving complex care management by facilitating conversations with subspecialties. Potential additional uses included engaging in difficult conversations with patients, exploring ethical challenges and general medical ethics teaching, personal continuing medical education resources, developing ward-based teaching tools, supporting and automating clinical documentation, and supporting productivity and task management. LLM biases, misinformation, ethics, and health equity were identified as areas of concern and potential limitations to clinical and training use. A code of conduct on ethical and appropriate use was also developed to guide team usage on the wards. Conclusions: Overall, ChatGPT offers a novel tool to enhance ward-based learning through rapid information querying, second-order content exploration, and engaged team discussion regarding generated responses. More research is needed to fully understand contexts for educational use, particularly regarding the risks and limitations of the tool in clinical settings and its impacts on trainee development. UR - https://formative.jmir.org/2024/1/e51346 UR - http://dx.doi.org/10.2196/51346 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717811 ID - info:doi/10.2196/51346 ER - TY - JOUR AU - Yun, Hyun Young AU - Shin, Hoon Dong AU - Choi, Jin Hyung PY - 2024/5/7 TI - Perspectives of Medical Students and Developers Regarding Virtual Reality, Augmented Reality, Mixed Reality, and 3D Printing Technologies: Survey Study JO - JMIR XR Spatial Comput SP - e54230 VL - 1 KW - medical student KW - developer KW - virtual reality KW - augmented reality KW - mixed reality KW - 3D printing KW - perspective KW - survey N2 - Background: Emerging technologies, such as virtual reality (VR), augmented reality (AR), mixed reality (MR), and 3D printing (3DP), have transformative potential in education and health care. However, complete integration has not yet been achieved, and routine use is limited. There may exist gaps in the perspectives of these technologies between users and developers, and improvement may be necessary in developing such technologies. Objective: The purpose of this study was to investigate the gaps in perspectives between medical students and developers in medical education regarding satisfaction and anticipated future use of VR, AR, MR, and 3DP technologies, as well as developers? perspectives on their advantages and current challenges. Methods: This retrospective survey study was conducted during a 4-hour elective course over a period of 4 weeks. In this course, computed tomography scans of congenital heart disease patients, medical image processing software, head-mounted displays, and a virtual table were used. Student pre- and postsurveys and the developer survey included demographic and other characteristics, satisfaction, and anticipated future use of VR, AR, MR, and 3DP technologies. The advantages and current challenges of these technologies were only assessed in the developer survey. Results: The study enrolled 41 participants, including 15 first-year medical students and 26 software and content developers. Students were more satisfied than developers across AR, VR, and 3DP in terms of overall satisfaction (VR and AR: P<.001; 3DP: P=.002), esthetics (VR: all P<.001; AR: vividness, P=.006 and design, P<.001; 3DP: vividness, P=.001 and design, P=.002), and continuous use intention (VR: repetition, P=.04 and continuous use, P=.02). Particularly in VR, satisfaction with reality was higher among students than among developers (real world, P=.006). Developers anticipated future use of MR for educating medical students and residents, individual and collaborative surgical planning, and performing surgery on patients. In contrast, students anticipated future use of VR primarily for student education, 3DP for resident education and individual surgical planning, and AR for collaborative surgical planning and performing surgery on patients. Developers perceived the inherent capabilities of VR, AR, and MR technologies as strengths, with hardware performance identified as a drawback. For 3DP, the possibility of customized product manufacturing was seen as an advantage, while cost was seen as a disadvantage. Conclusions: This study elucidated the different perspectives between medical students and developers regarding 3D technologies, highlighting the discrepancy in potential applications and challenges within the medical field. These findings will guide the integration of 3D technologies in education and health care to fulfill the needs and goals of both medical students and developers. UR - https://xr.jmir.org/2024/1/e54230 UR - http://dx.doi.org/10.2196/54230 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54230 ER - TY - JOUR AU - De Martinis, Massimo AU - Ginaldi, Lia PY - 2024/5/1 TI - Digital Skills to Improve Levels of Care and Renew Health Care Professions JO - JMIR Med Educ SP - e58743 VL - 10 KW - digital competence KW - telehealth KW - nursing KW - health care workforce KW - health care professionals KW - informatics KW - education KW - curriculum KW - interdisciplinary education KW - health care education UR - https://mededu.jmir.org/2024/1/e58743 UR - http://dx.doi.org/10.2196/58743 ID - info:doi/10.2196/58743 ER - TY - JOUR AU - Grosjean, Julien AU - Dufour, Frank AU - Benis, Arriel AU - Januel, Jean-Marie AU - Staccini, Pascal AU - Darmoni, Jacques Stéfan PY - 2024/4/30 TI - Digital Health Education for the Future: The SaNuRN (Santé Numérique Rouen-Nice) Consortium?s Journey JO - JMIR Med Educ SP - e53997 VL - 10 KW - digital health KW - medical informatics KW - education KW - health education KW - curriculum KW - students KW - teaching materials KW - hybrid learning KW - program development KW - capacity building KW - access to information KW - e-learning KW - open access KW - open data KW - skills framework KW - competency-based learning KW - telemedicine training KW - medical simulation KW - objective structured clinical examination KW - OSCE KW - script concordance test KW - SCT KW - virtual patient UR - https://mededu.jmir.org/2024/1/e53997 UR - http://dx.doi.org/10.2196/53997 ID - info:doi/10.2196/53997 ER - TY - JOUR AU - Dallora, Luiza Ana AU - Andersson, Kazimiera Ewa AU - Gregory Palm, Bruna AU - Bohman, Doris AU - Björling, Gunilla AU - Marcinowicz, Ludmi?a AU - Stjernberg, Louise AU - Anderberg, Peter PY - 2024/4/29 TI - Nursing Students? Attitudes Toward Technology: Multicenter Cross-Sectional Study JO - JMIR Med Educ SP - e50297 VL - 10 KW - nursing education KW - technophilia KW - eHealth KW - technology anxiety KW - technology enthusiasm KW - mobile phone N2 - Background: The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students? attitudes toward technology could be investigated to assess their needs regarding this proficiency. Objective: This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes. Methods: Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences. Results: In total, 646 students answered the questionnaire?342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students? technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ?Swedish=?0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ?all=0.265; ?Swedish=0.190; ?Polish=0.352) and with the perceived skill in using computer devices (P<.001; ?all=0.360; ?Swedish=0.341; ?Polish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ?Swedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ?all=?0.196; ?Swedish=?0.262; ?Polish=?0.133) and with the perceived skill in using computer devices (P<.001; ?all=?0.209; ?Swedish=?0.347; ?Polish=?0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ?Swedish=?0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively). Conclusions: This study highlights nursing students? techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care?s increasing reliance on technology, integrating health technology?related topics into education is crucial for future professionals to address health care challenges effectively. International Registered Report Identifier (IRRID): RR2-10.2196/14643 UR - https://mededu.jmir.org/2024/1/e50297 UR - http://dx.doi.org/10.2196/50297 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683660 ID - info:doi/10.2196/50297 ER - TY - JOUR AU - Lam, T. Lawrence AU - Lam, P. Mary K. PY - 2024/4/23 TI - A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial JO - JMIR Ment Health SP - e51791 VL - 11 KW - mHealth KW - web-based intervention KW - mental health literacy KW - psychoeducation KW - randomized controlled trial KW - workplace KW - performance KW - worker KW - intervention KW - digital health KW - mental wellness KW - promote KW - well-being KW - mobile health KW - technology N2 - Background: Workplace mental health is an important global health concern. Objectives: This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app. Methods: The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures. Results: Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score. Conclusions: The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000464167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377176 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3748-y UR - https://mental.jmir.org/2024/1/e51791 UR - http://dx.doi.org/10.2196/51791 ID - info:doi/10.2196/51791 ER - TY - JOUR AU - Cardoso Pinto, M. Alexandra AU - Soussi, Daniella AU - Qasim, Subaan AU - Dunin-Borkowska, Aleksandra AU - Rupasinghe, Thiara AU - Ubhi, Nicholas AU - Ranasinghe, Lasith PY - 2024/4/23 TI - The Use of Animations Depicting Cardiac Electrical Activity to Improve Confidence in Understanding of Cardiac Pathology and Electrocardiography Traces Among Final-Year Medical Students: Nonrandomized Controlled Trial JO - JMIR Med Educ SP - e46507 VL - 10 KW - medical education KW - cardiology KW - technology KW - clinical skills KW - cardiac KW - cardiac electrical activity KW - ECG KW - mixed methods study KW - students KW - education KW - medical professionals KW - development KW - web-based tutorial KW - teaching KW - cardiovascular KW - learning KW - electrocardiography N2 - Background: Electrocardiography (ECG) interpretation is a fundamental skill for medical students and practicing medical professionals. Recognizing ECG pathologies promptly allows for quick intervention, especially in acute settings where urgent care is needed. However, many medical students find ECG interpretation and understanding of the underlying pathology challenging, with teaching methods varying greatly. Objective: This study involved the development of novel animations demonstrating the passage of electrical activity for well-described cardiac pathologies and showcased them alongside the corresponding live ECG traces during a web-based tutorial for final-year medical students. We aimed to assess whether the animations improved medical students? confidence in visualizing cardiac electrical activity and ECG interpretation, compared to standard ECG teaching methods. Methods: Final-year medical students at Imperial College London attended a web-based tutorial demonstrating the 7 animations depicting cardiac electrical activity and the corresponding ECG trace. Another tutorial without the animations was held to act as a control. Students completed a questionnaire assessing their confidence in interpreting ECGs and visualizing cardiovascular electrical transmission before and after the tutorial. Intervention-arm participants were also invited to a web-based focus group to explore their experiences of past ECG teaching and the tutorial, particularly on aspects they found helpful and what could be further improved in the tutorial and animations. Wilcoxon signed-rank tests and Mann-Whitney U tests were used to assess the statistical significance of any changes in confidence. Focus group transcripts were analyzed using inductive thematic analysis. Results: Overall, 19 students attended the intervention arm, with 15 (79%) completing both the pre- and posttutorial questionnaires and 15 (79%) participating in focus groups, whereas 14 students attended the control arm, with 13 (93%) completing both questionnaires. Median confidence in interpreting ECGs in the intervention arm increased after the tutorial (2, IQR 1.5-3.0 vs 3, IQR 3-4.5; P<.001). Improvement was seen in both confidence in reviewing or diagnosing cardiac rhythms and the visualization of cardiac electrical activity. However, there was no significant difference between the intervention and control arms, for all pathologies (all P>.05). The main themes from the thematic analysis were that ECGs are a complex topic and past ECG teaching has focused on memorizing traces; the visualizations enabled deeper understanding of cardiac pathology; and ECG learning requires repetition, and clinical links remain essential. Conclusions: This study highlights the value of providing concise explanations of the meaning and pathophysiology behind ECG traces, both visually and verbally. ECG teaching that incorporates relevant pathophysiology, alongside vignettes with discussions regarding investigations and management options, is likely more helpful to students than practices based solely on pattern recognition. Although the animations supported student learning, the key element was the tutor?s explanations. These animations may be more helpful as a supplement to teaching, for instance, as open-access videos. UR - https://mededu.jmir.org/2024/1/e46507 UR - http://dx.doi.org/10.2196/46507 ID - info:doi/10.2196/46507 ER - TY - JOUR AU - Laidsaar-Powell, Rebekah AU - Giunta, Sarah AU - Butow, Phyllis AU - Keast, Rachael AU - Koczwara, Bogda AU - Kay, Judy AU - Jefford, Michael AU - Turner, Sandra AU - Saunders, Christobel AU - Schofield, Penelope AU - Boyle, Frances AU - Yates, Patsy AU - White, Kate AU - Miller, Annie AU - Butt, Zoe AU - Bonnaudet, Melanie AU - Juraskova, Ilona PY - 2024/4/17 TI - Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers JO - JMIR Med Educ SP - e50118 VL - 10 KW - family carers KW - patient education KW - health professional education KW - web-based intervention KW - mobile phone N2 - Background: Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill?equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. Objective: To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO?pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. Methods: The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including ?think-aloud? interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). Results: The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small ?snackable? sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. Conclusions: The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care. UR - https://mededu.jmir.org/2024/1/e50118 UR - http://dx.doi.org/10.2196/50118 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630531 ID - info:doi/10.2196/50118 ER - TY - JOUR AU - Min, Jennifer Hyojin AU - Andler, Caroline AU - Barber, Banca Rebecca Ortiz La AU - Chang, P. Todd AU - Abelairas-Gomez, Cristian AU - Knowlin, T. Laquanda AU - Liu, R. Deborah AU - Fija?ko, Nino PY - 2024/4/16 TI - Virtual Reality for Basic Life Support Training in High School Students: Thematic Analysis of Focus Group Interviews JO - JMIR XR Spatial Comput SP - e53212 VL - 1 KW - virtual reality KW - mixed reality KW - technology KW - basic life support KW - cardiovascular pulmonary resuscitation KW - near-peer mentoring KW - education KW - high school students N2 - Background: High-quality and engaging cardiopulmonary resuscitation (CPR) training of both health care professionals and members of the public is necessary to provide timely and effective CPR to maximize survival and minimize injuries. Virtual reality (VR) is a novel method to enhance CPR engagement and training. However, a near-peer mentoring framework has not been applied in such training to date. Objective: The purpose of this pilot qualitative study was to understand the acceptability and feasibility of using VR technology to introduce basic life support (BLS) to high school students reinforced by near-peer coaching. Methods: Dyads of high school students underwent BLS training in CPR using a VR experience reinforced by the near-peer mentoring model. Focus group interviews were performed following the intervention. The interview sessions were recorded, transcribed verbatim, and subjected to thematic analysis. VR software data were analyzed after five cycles of chest compressions between the two participants. Results: The overwhelming responses from the three dyads of high school students indicated positive acceptance of learning CPR using VR. Analysis of emerging themes revealed three main categories of barriers and facilitators: (1) motivation to learn CPR, (2) CPR learning modality, and (3) coaching CPR content. These themes supported the theoretical framework of an ?intention-focused? paradigm leading to acquiring the skills needed to perform CPR and ultimately increasing the chances of a bystander performing CPR. Conclusions: This study highlights the potential for training a unique population to increase bystander effects using novel VR technology coupled with a near-peer mentoring method. Further research is warranted to measure the outcome of the knowledge attained and the intention to perform CPR by high school students who participate in CPR education using VR and a near-peer mentoring method. UR - https://xr.jmir.org/2024/1/e53212 UR - http://dx.doi.org/10.2196/53212 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53212 ER - TY - JOUR AU - Dsouza, Maria Jeanne PY - 2024/4/15 TI - A Student?s Viewpoint on ChatGPT Use and Automation Bias in Medical Education JO - JMIR Med Educ SP - e57696 VL - 10 KW - AI KW - artificial intelligence KW - ChatGPT KW - medical education UR - https://mededu.jmir.org/2024/1/e57696 UR - http://dx.doi.org/10.2196/57696 ID - info:doi/10.2196/57696 ER - TY - JOUR AU - Kröplin, Juliane AU - Maier, Leonie AU - Lenz, Jan-Hendrik AU - Romeike, Bernd PY - 2024/4/15 TI - Knowledge Transfer and Networking Upon Implementation of a Transdisciplinary Digital Health Curriculum in a Unique Digital Health Training Culture: Prospective Analysis JO - JMIR Med Educ SP - e51389 VL - 10 KW - big data KW - digital didactics KW - digital health applications KW - digital leadership KW - digital literacy KW - generative artificial intelligence KW - mobile working KW - robotics KW - telemedicine KW - wearables N2 - Background: Digital health has been taught at medical faculties for a few years. However, in general, the teaching of digital competencies in medical education and training is still underrepresented. Objective: This study aims to analyze the objective acquisition of digital competencies through the implementation of a transdisciplinary digital health curriculum as a compulsory elective subject at a German university. The main subject areas of digital leadership and management, digital learning and didactics, digital communication, robotics, and generative artificial intelligence were developed and taught in a transdisciplinary manner over a period of 1 semester. Methods: The participants evaluated the relevant content of the curriculum regarding the competencies already taught in advance during the study, using a Likert scale. The participants? increase in digital competencies were examined with a pre-post test consisting of 12 questions. Statistical analysis was performed using an unpaired 2-tailed Student t test. A P value of <.05 was considered statistically significant. Furthermore, an analysis of the acceptance of the transdisciplinary approach as well as the application of an alternative examination method (term paper instead of a test with closed and open questions) was carried out. Results: In the first year after the introduction of the compulsory elective subject, students of human medicine (n=15), dentistry (n=3), and medical biotechnology (n=2) participated in the curriculum. In total, 13 participants were women (7 men), and 61.1% (n=11) of the participants in human medicine and dentistry were in the preclinical study stage (clinical: n=7, 38.9%). All the aforementioned learning objectives were largely absent in all study sections (preclinical: mean 4.2; clinical: mean 4.4; P=.02). The pre-post test comparison revealed a significant increase of 106% in knowledge (P<.001) among the participants. Conclusions: The transdisciplinary teaching of a digital health curriculum, including digital teaching methods, considers perspectives and skills from different disciplines. Our new curriculum facilitates an objective increase in knowledge regarding the complex challenges of the digital transformation of our health care system. Of the 16 student term papers arising from the course, robotics and artificial intelligence attracted the most interest, accounting for 9 of the submissions. UR - https://mededu.jmir.org/2024/1/e51389 UR - http://dx.doi.org/10.2196/51389 ID - info:doi/10.2196/51389 ER - TY - JOUR AU - Thiesmeier, Robert AU - Orsini, Nicola PY - 2024/4/15 TI - Rolling the DICE (Design, Interpret, Compute, Estimate): Interactive Learning of Biostatistics With Simulations JO - JMIR Med Educ SP - e52679 VL - 10 KW - learning statistics KW - Monte Carlo simulation KW - simulation-based learning KW - survival analysis KW - Weibull UR - https://mededu.jmir.org/2024/1/e52679 UR - http://dx.doi.org/10.2196/52679 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619866 ID - info:doi/10.2196/52679 ER - TY - JOUR AU - Fija?ko, Nino AU - Masterson Creber, Ruth AU - Metli?ar, ?pela AU - Strnad, Matej AU - Greif, Robert AU - ?tiglic, Gregor AU - Skok, Pavel PY - 2024/4/5 TI - Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List?Controlled Trial JO - JMIR Serious Games SP - e56037 VL - 12 KW - serious smartphone game KW - adult basic life support KW - teaching KW - game KW - games KW - gaming KW - education KW - nurse KW - nursing KW - nurses KW - educational KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - smartphone KW - smartphones KW - RCT KW - randomized controlled trial KW - controlled trial KW - technology-enhanced learning KW - TEL KW - life support KW - knowledge retention KW - theoretical knowledge KW - practice KW - practical KW - resuscitation N2 - Background: Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education. Objective: The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students? theoretical knowledge of and practical skills in adult BLS. Methods: This study used a randomized wait list?controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants? theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist. Results: In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants? theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator. Conclusions: Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training. Trial Registration: ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675 UR - https://games.jmir.org/2024/1/e56037 UR - http://dx.doi.org/10.2196/56037 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578690 ID - info:doi/10.2196/56037 ER - TY - JOUR AU - Chamouard, Valérie AU - Freyssenge, Julie AU - Clairaz-Mahiou, Béatrice AU - Ferrera Bibas, Felicia AU - Fraticelli, Laurie PY - 2024/4/4 TI - Evaluation of an e-Learning Program for Community Pharmacists for Dispensing Emicizumab (Hemlibra) in France: Nationwide Cross-Sectional Study JO - JMIR Form Res SP - e54656 VL - 8 KW - hemophilia KW - care pathway KW - emicizumab KW - Kirkpatrick model KW - pharmacy KW - survey KW - Hemlibra KW - France KW - e-learning program KW - pharmacists KW - pharmacist KW - hemophilia A KW - hospital KW - HEMOPHAR KW - methodology KW - community KW - engagement KW - pharmaceutical KW - rare disease KW - digital health KW - intervention N2 - Background: Since June 2021, patients with hemophilia A with antifactor VIII inhibitors and those with severe hemophilia A without antifactor VIII inhibitors treated with Hemlibra have had to choose between a community or hospital pharmacy. The French reference center for hemophilia developed the HEMOPHAR e-learning program for community pharmacists for dispensing emicizumab.  Objective: This study aims to evaluate the efficiency and safety of this new care pathway by assessing the HEMOPHAR e-learning program.  Methods: The methodology is based on Kirkpatrick?s model for evaluating the immediate reaction of trained community pharmacists (level 1), their level of acquired knowledge (level 2), and their professional practice after 3 months of dispensation (level 3).  Results: The HEMOPHAR e-learning program reached a large audience, with 67% (337/502) of the eligible community pharmacists following it. The immediate reaction was overall satisfying. High rates of engagement were reported with 63.5% (214/337) to 73.3% (247/337) of completed training modules, along with high rates of success with quizzes of 61.5% (174/337) to 95.7% (244/337). We observed that 83.9% (193/230) of the community pharmacists needed less than 2 attempts to pass the quiz of the module related to professional practice, while the other quizzes required more attempts. Advice on compliance and drug interactions were most frequently provided to patients by the community pharmacists.  Conclusions: This study suggests ways to improve the training of community pharmacists and to optimize coordination with treatment centers. This study also reports on the feasibility of switching to a community pharmacy in a secure pharmaceutical circuit, including in the context of a rare bleeding disease.  Trial Registration: ClinicalTrials.gov NCT05449197; https://clinicaltrials.gov/study/NCT05449197 International Registered Report Identifier (IRRID): RR2-10.2196/43091 UR - https://formative.jmir.org/2024/1/e54656 UR - http://dx.doi.org/10.2196/54656 UR - http://www.ncbi.nlm.nih.gov/pubmed/38574351 ID - info:doi/10.2196/54656 ER - TY - JOUR AU - Koester, MacKenzie AU - Motz, Rosemary AU - Porto, Ariel AU - Reyes Nieves, Nikita AU - Ashley, Karen PY - 2024/4/1 TI - Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study JO - JMIR Med Educ SP - e48135 VL - 10 KW - continuing medical education KW - telementoring KW - substance use disorder treatment KW - substance use disorder KW - SUD KW - primary care KW - Extension for Community Healthcare Outcomes KW - Project ECHO N2 - Background: Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio?s growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care. Objective: The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants? change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health. Methods: We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants? self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants? knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries. Results: The results of the content analysis indicated that 3 learning objective themes?team-based care, harm reduction, and social determinants of health?resulted in the highest frequencies and dose, appearing in 100% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03). Conclusions: These findings indicate that the ECHO program?s content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care. UR - https://mededu.jmir.org/2024/1/e48135 UR - http://dx.doi.org/10.2196/48135 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557477 ID - info:doi/10.2196/48135 ER - TY - JOUR AU - Noda, Masao AU - Ueno, Takayoshi AU - Koshu, Ryota AU - Takaso, Yuji AU - Shimada, Dias Mari AU - Saito, Chizu AU - Sugimoto, Hisashi AU - Fushiki, Hiroaki AU - Ito, Makoto AU - Nomura, Akihiro AU - Yoshizaki, Tomokazu PY - 2024/3/28 TI - Performance of GPT-4V in Answering the Japanese Otolaryngology Board Certification Examination Questions: Evaluation Study JO - JMIR Med Educ SP - e57054 VL - 10 KW - artificial intelligence KW - GPT-4v KW - large language model KW - otolaryngology KW - GPT KW - ChatGPT KW - LLM KW - LLMs KW - language model KW - language models KW - head KW - respiratory KW - ENT: ear KW - nose KW - throat KW - neck KW - NLP KW - natural language processing KW - image KW - images KW - exam KW - exams KW - examination KW - examinations KW - answer KW - answers KW - answering KW - response KW - responses N2 - Background: Artificial intelligence models can learn from medical literature and clinical cases and generate answers that rival human experts. However, challenges remain in the analysis of complex data containing images and diagrams. Objective: This study aims to assess the answering capabilities and accuracy of ChatGPT-4 Vision (GPT-4V) for a set of 100 questions, including image-based questions, from the 2023 otolaryngology board certification examination. Methods: Answers to 100 questions from the 2023 otolaryngology board certification examination, including image-based questions, were generated using GPT-4V. The accuracy rate was evaluated using different prompts, and the presence of images, clinical area of the questions, and variations in the answer content were examined. Results: The accuracy rate for text-only input was, on average, 24.7% but improved to 47.3% with the addition of English translation and prompts (P<.001). The average nonresponse rate for text-only input was 46.3%; this decreased to 2.7% with the addition of English translation and prompts (P<.001). The accuracy rate was lower for image-based questions than for text-only questions across all types of input, with a relatively high nonresponse rate. General questions and questions from the fields of head and neck allergies and nasal allergies had relatively high accuracy rates, which increased with the addition of translation and prompts. In terms of content, questions related to anatomy had the highest accuracy rate. For all content types, the addition of translation and prompts increased the accuracy rate. As for the performance based on image-based questions, the average of correct answer rate with text-only input was 30.4%, and that with text-plus-image input was 41.3% (P=.02). Conclusions: Examination of artificial intelligence?s answering capabilities for the otolaryngology board certification examination improves our understanding of its potential and limitations in this field. Although the improvement was noted with the addition of translation and prompts, the accuracy rate for image-based questions was lower than that for text-based questions, suggesting room for improvement in GPT-4V at this stage. Furthermore, text-plus-image input answers a higher rate in image-based questions. Our findings imply the usefulness and potential of GPT-4V in medicine; however, future consideration of safe use methods is needed. UR - https://mededu.jmir.org/2024/1/e57054 UR - http://dx.doi.org/10.2196/57054 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546736 ID - info:doi/10.2196/57054 ER - TY - JOUR AU - Rettinger, Lena AU - Putz, Peter AU - Aichinger, Lea AU - Javorszky, Maria Susanne AU - Widhalm, Klaus AU - Ertelt-Bach, Veronika AU - Huber, Andreas AU - Sargis, Sevan AU - Maul, Lukas AU - Radinger, Oliver AU - Werner, Franz AU - Kuhn, Sebastian PY - 2024/3/21 TI - Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students? Perceived Knowledge, Skills, Attitudes, and Experience JO - JMIR Med Educ SP - e51112 VL - 10 KW - telehealth KW - health care education KW - student perspectives KW - curriculum KW - interdisciplinary education N2 - Background: The COVID-19 pandemic has highlighted the growing relevance of telehealth in health care. Assessing health care and nursing students? telehealth competencies is crucial for its successful integration into education and practice. Objective: We aimed to assess students? perceived telehealth knowledge, skills, attitudes, and experiences. In addition, we aimed to examine students? preferences for telehealth content and teaching methods within their curricula. Methods: We conducted a cross-sectional web-based study in May 2022. A project-specific questionnaire, developed and refined through iterative feedback and face-validity testing, addressed topics such as demographics, personal perceptions, and professional experience with telehealth and solicited input on potential telehealth course content. Statistical analyses were conducted on surveys with at least a 50% completion rate, including descriptive statistics of categorical variables, graphical representation of results, and Kruskal Wallis tests for central tendencies in subgroup analyses. Results: A total of 261 students from 7 bachelor?s and 4 master?s health care and nursing programs participated in the study. Most students expressed interest in telehealth (180/261, 69% very or rather interested) and recognized its importance in their education (215/261, 82.4% very or rather important). However, most participants reported limited knowledge of telehealth applications concerning their profession (only 7/261, 2.7% stated profound knowledge) and limited active telehealth experience with various telehealth applications (between 18/261, 6.9% and 63/261, 24.1%). Statistically significant differences were found between study programs regarding telehealth interest (P=.005), knowledge (P<.001), perceived importance in education (P<.001), and perceived relevance after the pandemic (P=.004). Practical training with devices, software, and apps and telehealth case examples with various patient groups were perceived as most important for integration in future curricula. Most students preferred both interdisciplinary and program-specific courses. Conclusions: This study emphasizes the need to integrate telehealth into health care education curricula, as students state positive telehealth attitudes but seem to be not adequately prepared for its implementation. To optimally prepare future health professionals for the increasing role of telehealth in practice, the results of this study can be considered when designing telehealth curricula. UR - https://mededu.jmir.org/2024/1/e51112 UR - http://dx.doi.org/10.2196/51112 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512310 ID - info:doi/10.2196/51112 ER - TY - JOUR AU - Gnant, Michael AU - Abdullah, Lim Khatijah AU - Boyle, Frances AU - Huang, Chiun-Sheng AU - Bickford, Katie AU - Neunie, Sola AU - Noble, Alexander AU - Nunn, Anne AU - Sproat, Caroline AU - Harbeck, Nadia AU - Barrios, Carlos PY - 2024/3/21 TI - Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis JO - JMIR Form Res SP - e50931 VL - 8 KW - continuing medical education KW - early breast cancer KW - performance KW - risk stratification KW - shared decision-making N2 - Background: Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. Objective: This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. Methods: We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Results: Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ?20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Conclusions: Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities. UR - https://formative.jmir.org/2024/1/e50931 UR - http://dx.doi.org/10.2196/50931 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512328 ID - info:doi/10.2196/50931 ER - TY - JOUR AU - Magalhães Araujo, Sabrina AU - Cruz-Correia, Ricardo PY - 2024/3/20 TI - Incorporating ChatGPT in Medical Informatics Education: Mixed Methods Study on Student Perceptions and Experiential Integration Proposals JO - JMIR Med Educ SP - e51151 VL - 10 KW - education KW - medical informatics KW - artificial intelligence KW - AI KW - generative language model KW - ChatGPT N2 - Background: The integration of artificial intelligence (AI) technologies, such as ChatGPT, in the educational landscape has the potential to enhance the learning experience of medical informatics students and prepare them for using AI in professional settings. The incorporation of AI in classes aims to develop critical thinking by encouraging students to interact with ChatGPT and critically analyze the responses generated by the chatbot. This approach also helps students develop important skills in the field of biomedical and health informatics to enhance their interaction with AI tools. Objective: The aim of the study is to explore the perceptions of students regarding the use of ChatGPT as a learning tool in their educational context and provide professors with examples of prompts for incorporating ChatGPT into their teaching and learning activities, thereby enhancing the educational experience for students in medical informatics courses. Methods: This study used a mixed methods approach to gain insights from students regarding the use of ChatGPT in education. To accomplish this, a structured questionnaire was applied to evaluate students? familiarity with ChatGPT, gauge their perceptions of its use, and understand their attitudes toward its use in academic and learning tasks. Learning outcomes of 2 courses were analyzed to propose ChatGPT?s incorporation in master?s programs in medicine and medical informatics. Results: The majority of students expressed satisfaction with the use of ChatGPT in education, finding it beneficial for various purposes, including generating academic content, brainstorming ideas, and rewriting text. While some participants raised concerns about potential biases and the need for informed use, the overall perception was positive. Additionally, the study proposed integrating ChatGPT into 2 specific courses in the master?s programs in medicine and medical informatics. The incorporation of ChatGPT was envisioned to enhance student learning experiences and assist in project planning, programming code generation, examination preparation, workflow exploration, and technical interview preparation, thus advancing medical informatics education. In medical teaching, it will be used as an assistant for simplifying the explanation of concepts and solving complex problems, as well as for generating clinical narratives and patient simulators. Conclusions: The study?s valuable insights into medical faculty students? perspectives and integration proposals for ChatGPT serve as an informative guide for professors aiming to enhance medical informatics education. The research delves into the potential of ChatGPT, emphasizes the necessity of collaboration in academic environments, identifies subject areas with discernible benefits, and underscores its transformative role in fostering innovative and engaging learning experiences. The envisaged proposals hold promise in empowering future health care professionals to work in the rapidly evolving era of digital health care. UR - https://mededu.jmir.org/2024/1/e51151 UR - http://dx.doi.org/10.2196/51151 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506920 ID - info:doi/10.2196/51151 ER - TY - JOUR AU - Alsahali, Saud AU - Almutairi, Salman AU - Almutairi, Salem AU - Almofadhi, Saleh AU - Anaam, Mohammed AU - Alshammari, Mohammed AU - Abdulsalim, Suhaj AU - Almogbel, Yasser PY - 2024/3/15 TI - Pharmacy Students? Attitudes Toward Distance Learning After the COVID-19 Pandemic: Cross-Sectional Study From Saudi Arabia JO - JMIR Form Res SP - e54500 VL - 8 KW - distance learning KW - e-learning KW - pharmacy education KW - team based learning KW - educational experience. N2 - Background: Electronic learning refers to the use of assistive tools in offline and distance learning environments. It allows students to access learning tools and materials anytime and anywhere. However, distance learning courses depend on several factors that affect the quality of learning, which consequently affect students? preferences in the settings and tools used to deliver educational materials. Objective: This study aimed to evaluate students? preferences for continuing distance learning after the pandemic and to assess the distance educational environment after the pandemic. It also aimed to identify the factors affecting distance learning and evaluate students? preferences regarding modes of communication with instructors. Methods: A web-based survey was used to conduct this cross-sectional study. The target participants of this study were students in the doctor of pharmacy program at Unaizah College of Pharmacy, Qassim, Saudi Arabia. All students enrolled from December 2022 to January 2023 received an invitation with a link to the web-based survey. Results: The survey was completed by 141 students (58 female students and 83 male students). The research results showed that most students (102/141, 72.3%) did not wish to continue distance education for laboratory courses, and 60.3% (85/141) did not wish to continue taking distance team-based learning after the pandemic. Additionally, 83.7% (118/141) of the students indicated that distance courses were simple. More than half of the participants (79/141, 56%) stated that having a camera on during class negatively impacted their learning, and only 29.1% (41/141) of the students stated that nonvisual communication with their fellow students impacted their learning. A large proportion of students (83/141, 58.9%) reported impairment of social engagement on campus, 44% (62/141) in-person interactions during classes, and 73.7% (104/141) were relieved that their classes were not disrupted. Conclusions: Similar to all types of education, distance learning is characterized by advantages and disadvantages, as reported by students. Students felt that the course material was intelligible, and the distance course was uncomplicated. Moreover, they expressed relief that their studies were not disrupted. However, they also reported the loss of face-to-face contact during courses as the most significant drawback of distance learning versus face-to-face learning, followed by a lack of social connection on campus. UR - https://formative.jmir.org/2024/1/e54500 UR - http://dx.doi.org/10.2196/54500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488833 ID - info:doi/10.2196/54500 ER - TY - JOUR AU - Bresolin, Paula AU - Steindal, A. Simen AU - Bingen, Maria Hanne AU - Zlamal, Jaroslav AU - Gue Martini, Jussara AU - Petersen, Kaupang Eline AU - Nes, Gonçalves Andréa Aparecida PY - 2024/3/8 TI - Technology-Supported Guidance Models to Stimulate Nursing Students? Self-Efficacy in Clinical Practice: Scoping Review JO - JMIR Nursing SP - e54443 VL - 7 KW - clinical practice KW - guidance model KW - nursing education KW - review KW - self-efficacy KW - technology KW - mobile phone KW - nurse KW - nurses KW - nursing KW - education KW - allied health KW - synthesis KW - review methods KW - review methodology KW - search KW - searches KW - searching KW - scoping KW - MEDLINE KW - CINAHL KW - technology enhanced KW - Technology Enhanced Learning KW - digital health KW - guidance KW - model KW - models KW - practical KW - student KW - students N2 - Background: In nursing education, bridging the gap between theoretical knowledge and practical skills is crucial for developing competence in clinical practice. Nursing students encounter challenges in acquiring these essential skills, making self-efficacy a critical component in their professional development. Self-efficacy pertains to individual?s belief in their ability to perform tasks and overcome challenges, with significant implications for clinical skills acquisition and academic success. Previous research has underscored the strong link between nursing students? self-efficacy and their clinical competence. Technology has emerged as a promising tool to enhance self-efficacy by enabling personalized learning experiences and in-depth discussions. However, there is a need for a comprehensive literature review to assess the existing body of knowledge and identify research gaps. Objective: The aim of this study is to systematically map and identify gaps in published studies on the use of technology-supported guidance models to stimulate nursing students? self-efficacy in clinical practice. Methods: This scoping review followed the framework of Arksey and O?Malley and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). A systematic, comprehensive literature search was conducted in ERIC, CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science for studies published between January 2011 and April 2023. The reference lists of the included papers were manually searched to identify additional studies. Pairs of authors screened the papers, assessed eligibility, and extracted the data. The data were thematically organized. Results: A total of 8 studies were included and four thematic groups were identified: (1) technological solutions for learning support, (2) learning focus in clinical practice, (3) teaching strategies and theoretical approaches for self-efficacy, and (4) assessment of self-efficacy and complementary outcomes. Conclusions: Various technological solutions were adopted in the guidance models to stimulate the self-efficacy of nursing students in clinical practice, leading to positive findings. A total of 7 out of 8 studies presented results that were not statistically significant, highlighting the need for further refinement of the applied interventions. Nurse educators play a pivotal role in applying learning strategies and theoretical approaches to enhance nursing students? self-efficacy, but the contributions of nurse preceptors and peers should not be overlooked. Future studies should consider involving users in the intervention process and using validated instruments tailored to the studies? intervention objectives, ensuring relevance and enabling comparisons across studies. UR - https://nursing.jmir.org/2024/1/e54443 UR - http://dx.doi.org/10.2196/54443 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457802 ID - info:doi/10.2196/54443 ER - TY - JOUR AU - Lee, Minjung AU - An, Youn So AU - Ihm, Jungjoon PY - 2024/3/8 TI - Dental Students? Satisfaction With Web-Based Learning During the Initial Phase of the COVID-19 Pandemic: Mixed Methods Study JO - J Med Internet Res SP - e50278 VL - 26 KW - web-based learning KW - student satisfaction KW - transactional distance theory KW - health profession education KW - COVID-19 N2 - Background: The COVID-19 pandemic has precipitated an accelerated shift in education, moving from traditional learning to web-based learning. This transition introduced a notable transactional distance (TD) between the instructors and learners. Although disease control and staff and students? safety are the top priorities during a pandemic, the successful delivery of education is equally crucial. However, the ramifications of this swift transition are particularly critical in the context of dental education. Dental education is inherently practice oriented, necessitating hands-on training and manual skills development, which poses unique challenges to distance learning approaches. Objective: This study aims to examine dental students? web-based learning satisfaction and experience of TD, investigate the predictors of web-based learning satisfaction, and explore the perceptions of students about the advantages and disadvantages of web-based learning. Methods: This study explored the factors associated with web-based learning satisfaction using TD theory during the transition to web-based education. Psychological factors that could influence satisfaction were adapted from the health belief model. We conducted a cross-sectional web-based survey of 345 dental students from 2 institutions in South Korea who were enrolled in the spring semester of 2020. Data were collected between July 8 and September 14, 2020. Qualitative analysis was used to examine responses to open-ended questions concerning perceptions of web-based learning. Results: A multivariate hierarchical linear regression model was used to analyze the effects of student characteristics, TD, and psychological factors (ie, perceived risk of infection and efficacy belief of web-based learning) on web-based learning satisfaction. The average score for web-based learning satisfaction was 3.62 (SD 0.84), just above the midpoint of the possible range (1-5). Self-regulated learning (?=0.08; P=.046), learner-instructor interaction (?=0.08; P=.03), and learner-content interaction (?=0.64; P<.001) were associated with higher levels of satisfaction. Moreover, a significant association was revealed between high efficacy beliefs in web-based learning (?=0.20; P<.001) and satisfaction. Although the learning structure (synchronous vs asynchronous) did not exhibit a significant association with satisfaction, the qualitative analysis results revealed that each structure possesses distinct strengths and weaknesses. The students in synchronous learning (79/345, 22.9%) recognized heightened autonomy in the ?learning environment? (19/79, 24%); however, technical issues (28/79, 35%) and reduced concentration (15/79, 19%) were identified as downsides. Conversely, the students in asynchronous settings (266/345, 77.1%) emphasized unlimited access to learning content (74/266, 27.8%) and the flexibility of ?learning in preferred time? (69/266, 25.9%). Nevertheless, challenges, such as self-management difficulties (66/266, 24.8%) and limited interactions (55/266, 20.7%), were evident. Conclusions: The findings suggest that efforts to minimize TD, facilitating self-regulated learning and interaction among students and instructors, are critical for achieving web-based learning satisfaction. Moreover, establishing a common understanding among students regarding the necessity and efficacy of web-based learning during epidemics could enhance their satisfaction. UR - https://www.jmir.org/2024/1/e50278 UR - http://dx.doi.org/10.2196/50278 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457808 ID - info:doi/10.2196/50278 ER - TY - JOUR AU - Burch, Vanessa AU - McGuire, Jessica AU - Buch, Eric AU - Sathekge, Mike AU - M'bouaffou, Francis AU - Senkubuge, Flavia AU - Fagan, Johannes PY - 2024/3/6 TI - Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation JO - JMIR Form Res SP - e40868 VL - 8 KW - web-based certification examinations KW - web-based structured oral examinations KW - medical education KW - specialist and subspecialist examinations KW - structured oral examinations KW - Colleges of Medicine of South Africa N2 - Background: The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. Objective: This formative evaluation explored candidates? acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates? overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. Methods: This mixed methods, single-arm evaluation anonymously gathered candidates? perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Results: Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; ?21=667; P<.001; 2021: N=7988; ?21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). Conclusions: Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method. UR - https://formative.jmir.org/2024/1/e40868 UR - http://dx.doi.org/10.2196/40868 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064633 ID - info:doi/10.2196/40868 ER - TY - JOUR AU - Al-Sbei, Rasha AU - Ataya, Jawdat AU - Jamous, Issam AU - Dashash, Mayssoon PY - 2024/3/5 TI - The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study JO - JMIR Form Res SP - e51141 VL - 8 KW - restorative dentistry KW - online learning KW - dental education KW - dental graduates KW - Syria KW - education KW - dental KW - dentistry KW - dental practice KW - effectiveness KW - educational program KW - survey N2 - Background: Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. Objective: This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. Methods: This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants? knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. Results: The results showed a significant improvement in the participants? knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ?2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. Conclusions: The findings indicated a notable enhancement in the participants? understanding of restorative dentistry. The participants? high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field. UR - https://formative.jmir.org/2024/1/e51141 UR - http://dx.doi.org/10.2196/51141 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441921 ID - info:doi/10.2196/51141 ER - TY - JOUR AU - Grosjean, Julien AU - Benis, Arriel AU - Dufour, Jean-Charles AU - Lejeune, Émeline AU - Disson, Flavien AU - Dahamna, Badisse AU - Cieslik, Hélène AU - Léguillon, Romain AU - Faure, Matthieu AU - Dufour, Frank AU - Staccini, Pascal AU - Darmoni, Jacques Stéfan PY - 2024/3/4 TI - Sharing Digital Health Educational Resources in a One-Stop Shop Portal: Tutorial on the Catalog and Index of Digital Health Teaching Resources (CIDHR) Semantic Search Engine JO - JMIR Med Educ SP - e48393 VL - 10 KW - digital health KW - medical informatics KW - medical education KW - search engine KW - knowledge management KW - semantic web KW - language KW - teaching KW - vocabulary KW - controlled KW - students KW - educational personnel KW - French KW - curriculum N2 - Background: Access to reliable and accurate digital health web-based resources is crucial. However, the lack of dedicated search engines for non-English languages, such as French, is a significant obstacle in this field. Thus, we developed and implemented a multilingual, multiterminology semantic search engine called Catalog and Index of Digital Health Teaching Resources (CIDHR). CIDHR is freely accessible to everyone, with a focus on French-speaking resources. CIDHR has been initiated to provide validated, high-quality content tailored to the specific needs of each user profile, be it students or professionals. Objective: This study?s primary aim in developing and implementing the CIDHR is to improve knowledge sharing and spreading in digital health and health informatics and expand the health-related educational community, primarily French speaking but also in other languages. We intend to support the continuous development of initial (ie, bachelor level), advanced (ie, master and doctoral levels), and continuing training (ie, professionals and postgraduate levels) in digital health for health and social work fields. The main objective is to describe the development and implementation of CIDHR. The hypothesis guiding this research is that controlled vocabularies dedicated to medical informatics and digital health, such as the Medical Informatics Multilingual Ontology (MIMO) and the concepts structuring the French National Referential on Digital Health (FNRDH), to index digital health teaching and learning resources, are effectively increasing the availability and accessibility of these resources to medical students and other health care professionals. Methods: First, resource identification is processed by medical librarians from websites and scientific sources preselected and validated by domain experts and surveyed every week. Then, based on MIMO and FNRDH, the educational resources are indexed for each related knowledge domain. The same resources are also tagged with relevant academic and professional experience levels. Afterward, the indexed resources are shared with the digital health teaching and learning community. The last step consists of assessing CIDHR by obtaining informal feedback from users. Results: Resource identification and evaluation processes were executed by a dedicated team of medical librarians, aiming to collect and curate an extensive collection of digital health teaching and learning resources. The resources that successfully passed the evaluation process were promptly included in CIDHR. These resources were diligently indexed (with MIMO and FNRDH) and tagged for the study field and degree level. By October 2023, a total of 371 indexed resources were available on a dedicated portal. Conclusions: CIDHR is a multilingual digital health education semantic search engine and platform that aims to increase the accessibility of educational resources to the broader health care?related community. It focuses on making resources ?findable,? ?accessible,? ?interoperable,? and ?reusable? by using a one-stop shop portal approach. CIDHR has and will have an essential role in increasing digital health literacy. UR - https://mededu.jmir.org/2024/1/e48393 UR - http://dx.doi.org/10.2196/48393 UR - http://www.ncbi.nlm.nih.gov/pubmed/38437007 ID - info:doi/10.2196/48393 ER - TY - JOUR AU - Shikino, Kiyoshi AU - Nishizaki, Yuji AU - Fukui, Sho AU - Yokokawa, Daiki AU - Yamamoto, Yu AU - Kobayashi, Hiroyuki AU - Shimizu, Taro AU - Tokuda, Yasuharu PY - 2024/2/29 TI - Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study JO - JMIR Med Educ SP - e54401 VL - 10 KW - discrimination index KW - General Medicine In-Training Examination KW - clinical simulation video KW - postgraduate medical education KW - video KW - videos KW - training KW - examination KW - examinations KW - medical education KW - resident KW - residents KW - postgraduate KW - postgraduates KW - simulation KW - simulations KW - diagnosis KW - diagnoses KW - diagnose KW - general medicine KW - general practice KW - general practitioner KW - skill KW - skills N2 - Background: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents? clinical knowledge. A clinical simulation video (CSV) may assess learners? interpersonal abilities. Objective: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians? diagnostic skills by having them watch a CSV and to explore resident physicians? perceptions of the CSV?s realism, educational value, and impact on their motivation to learn. Methods: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ?0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject?s qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants? views on the realism and educational value of the CSV and its impact on their motivation to learn. Results: Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. Conclusions: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees? clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners? motivation, suggesting a multifaceted role for simulation in medical education. UR - https://mededu.jmir.org/2024/1/e54401 UR - http://dx.doi.org/10.2196/54401 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421691 ID - info:doi/10.2196/54401 ER - TY - JOUR AU - Brondfield, Sam AU - Schwede, Matthew AU - Johnson, P. Tyler AU - Arora, Shagun PY - 2024/2/23 TI - Web-Based Scaffolds: The Feasibility of a Constructivist Approach to Oncology Fellow Learning JO - JMIR Cancer SP - e52501 VL - 10 KW - constructivist learning KW - scaffolded learning KW - graduate medical education KW - fellowship training KW - oncology KW - feasibility KW - medical education KW - pilot study KW - study KW - online learning KW - online tool KW - online tools KW - remote learning KW - e-learning KW - training KW - cancer UR - https://cancer.jmir.org/2024/1/e52501 UR - http://dx.doi.org/10.2196/52501 UR - http://www.ncbi.nlm.nih.gov/pubmed/38393780 ID - info:doi/10.2196/52501 ER - TY - JOUR AU - Farhat, Faiza AU - Chaudhry, Moalla Beenish AU - Nadeem, Mohammad AU - Sohail, Saquib Shahab AU - Madsen, Øivind Dag PY - 2024/2/21 TI - Evaluating Large Language Models for the National Premedical Exam in India: Comparative Analysis of GPT-3.5, GPT-4, and Bard JO - JMIR Med Educ SP - e51523 VL - 10 KW - accuracy KW - AI model KW - artificial intelligence KW - Bard KW - ChatGPT KW - educational task KW - GPT-4 KW - Generative Pre-trained Transformers KW - large language models KW - medical education, medical exam KW - natural language processing KW - performance KW - premedical exams KW - suitability N2 - Background: Large language models (LLMs) have revolutionized natural language processing with their ability to generate human-like text through extensive training on large data sets. These models, including Generative Pre-trained Transformers (GPT)-3.5 (OpenAI), GPT-4 (OpenAI), and Bard (Google LLC), find applications beyond natural language processing, attracting interest from academia and industry. Students are actively leveraging LLMs to enhance learning experiences and prepare for high-stakes exams, such as the National Eligibility cum Entrance Test (NEET) in India. Objective: This comparative analysis aims to evaluate the performance of GPT-3.5, GPT-4, and Bard in answering NEET-2023 questions. Methods: In this paper, we evaluated the performance of the 3 mainstream LLMs, namely GPT-3.5, GPT-4, and Google Bard, in answering questions related to the NEET-2023 exam. The questions of the NEET were provided to these artificial intelligence models, and the responses were recorded and compared against the correct answers from the official answer key. Consensus was used to evaluate the performance of all 3 models. Results: It was evident that GPT-4 passed the entrance test with flying colors (300/700, 42.9%), showcasing exceptional performance. On the other hand, GPT-3.5 managed to meet the qualifying criteria, but with a substantially lower score (145/700, 20.7%). However, Bard (115/700, 16.4%) failed to meet the qualifying criteria and did not pass the test. GPT-4 demonstrated consistent superiority over Bard and GPT-3.5 in all 3 subjects. Specifically, GPT-4 achieved accuracy rates of 73% (29/40) in physics, 44% (16/36) in chemistry, and 51% (50/99) in biology. Conversely, GPT-3.5 attained an accuracy rate of 45% (18/40) in physics, 33% (13/26) in chemistry, and 34% (34/99) in biology. The accuracy consensus metric showed that the matching responses between GPT-4 and Bard, as well as GPT-4 and GPT-3.5, had higher incidences of being correct, at 0.56 and 0.57, respectively, compared to the matching responses between Bard and GPT-3.5, which stood at 0.42. When all 3 models were considered together, their matching responses reached the highest accuracy consensus of 0.59. Conclusions: The study?s findings provide valuable insights into the performance of GPT-3.5, GPT-4, and Bard in answering NEET-2023 questions. GPT-4 emerged as the most accurate model, highlighting its potential for educational applications. Cross-checking responses across models may result in confusion as the compared models (as duos or a trio) tend to agree on only a little over half of the correct responses. Using GPT-4 as one of the compared models will result in higher accuracy consensus. The results underscore the suitability of LLMs for high-stakes exams and their positive impact on education. Additionally, the study establishes a benchmark for evaluating and enhancing LLMs? performance in educational tasks, promoting responsible and informed use of these models in diverse learning environments. UR - https://mededu.jmir.org/2024/1/e51523 UR - http://dx.doi.org/10.2196/51523 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381486 ID - info:doi/10.2196/51523 ER - TY - JOUR AU - Johnson, G. Susanne AU - Espehaug, Birgitte AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2024/2/21 TI - Occupational Therapy Students? Evidence-Based Practice Skills as Reported in a Mobile App: Cross-Sectional Study JO - JMIR Med Educ SP - e48507 VL - 10 KW - active learning strategies KW - application KW - cross-sectional study KW - development KW - education KW - higher education KW - interactive KW - mobile application KW - mobile app KW - occupational therapy students KW - occupational therapy KW - students KW - usability KW - use N2 - Background: Evidence-based practice (EBP) is an important aspect of the health care education curriculum. EBP involves following the 5 EBP steps: ask, assess, appraise, apply, and audit. These 5 steps reflect the suggested core competencies covered in teaching and learning programs to support future health care professionals applying EBP. When implementing EBP teaching, assessing outcomes by documenting the student?s performance and skills is relevant. This can be done using mobile devices. Objective: The aim of this study was to assess occupational therapy students? EBP skills as reported in a mobile app. Methods: We applied a cross-sectional design. Descriptive statistics were used to present frequencies, percentages, means, and ranges of data regarding EBP skills found in the EBPsteps app. Associations between students? ability to formulate the Population, Intervention, Comparison, and Outcome/Population, Interest, and Context (PICO/PICo) elements and identifying relevant research evidence were analyzed with the chi-square test. Results: Of 4 cohorts with 150 students, 119 (79.3%) students used the app and produced 240 critically appraised topics (CATs) in the app. The EBP steps ?ask,? ?assess,? and ?appraise? were often correctly performed. The clinical question was formulated correctly in 53.3% (128/240) of the CATs, and students identified research evidence in 81.2% (195/240) of the CATs. Critical appraisal checklists were used in 81.2% (195/240) of the CATs, and most of these checklists were assessed as relevant for the type of research evidence identified (165/195, 84.6%). The least frequently correctly reported steps were ?apply? and ?audit.? In 39.6% (95/240) of the CATs, it was reported that research evidence was applied. Only 61% (58/95) of these CATs described how the research was applied to clinical practice. Evaluation of practice changes was reported in 38.8% (93/240) of the CATs. However, details about practice changes were lacking in all these CATs. A positive association was found between correctly reporting the "population" and "interventions/interest" elements of the PICO/PICo and identifying research evidence (P<.001). Conclusions: We assessed the students? EBP skills based on how they documented following the EBP steps in the EBPsteps app, and our results showed variations in how well the students mastered the steps. ?Apply? and ?audit? were the most difficult EBP steps for the students to perform, and this finding has implications and gives directions for further development of the app and educational instruction in EBP. The EBPsteps app is a new and relevant app for students to learn and practice EBP, and it can be used to assess students? EBP skills objectively. UR - https://mededu.jmir.org/2024/1/e48507 UR - http://dx.doi.org/10.2196/48507 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381475 ID - info:doi/10.2196/48507 ER - TY - JOUR AU - Acharya, Amish AU - Black, Claire Ruth AU - Smithies, Alisdair AU - Darzi, Ara PY - 2024/2/21 TI - Evaluating the Impact of the National Health Service Digital Academy on Participants? Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study JO - JMIR Med Educ SP - e46740 VL - 10 KW - digital leadership KW - professional identity KW - dissertation of practice N2 - Background: The key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership. Objective: This study aims to examine the impact of the NHSDA program on participants? perceptions of themselves as digital health leaders. Methods: We recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals? perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework. Results: Of the 41 participants, 42% (17/41) were in clinical roles, 34% (14/41) were in program delivery or management roles, 20% (8/41) were in data science roles, and 5% (2/41) were in ?other? roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants? values and direction within the wider digital health community. According to the questionnaire, after graduation, 59% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46% (11/24) reporting that the course was a strong determinant of this change. Conclusions: A digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development. UR - https://mededu.jmir.org/2024/1/e46740 UR - http://dx.doi.org/10.2196/46740 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381477 ID - info:doi/10.2196/46740 ER - TY - JOUR AU - Abid, Areeba AU - Murugan, Avinash AU - Banerjee, Imon AU - Purkayastha, Saptarshi AU - Trivedi, Hari AU - Gichoya, Judy PY - 2024/2/20 TI - AI Education for Fourth-Year Medical Students: Two-Year Experience of a Web-Based, Self-Guided Curriculum and Mixed Methods Study JO - JMIR Med Educ SP - e46500 VL - 10 KW - medical education KW - machine learning KW - artificial intelligence KW - elective curriculum KW - medical student KW - student KW - students KW - elective KW - electives KW - curricula KW - curriculum KW - lesson plan KW - lesson plans KW - educators KW - educator KW - teacher KW - teachers KW - teaching KW - computer programming KW - programming KW - coding KW - programmer KW - programmers KW - self guided KW - self directed N2 - Background: Artificial intelligence (AI) and machine learning (ML) are poised to have a substantial impact in the health care space. While a plethora of web-based resources exist to teach programming skills and ML model development, there are few introductory curricula specifically tailored to medical students without a background in data science or programming. Programs that do exist are often restricted to a specific specialty. Objective: We hypothesized that a 1-month elective for fourth-year medical students, composed of high-quality existing web-based resources and a project-based structure, would empower students to learn about the impact of AI and ML in their chosen specialty and begin contributing to innovation in their field of interest. This study aims to evaluate the success of this elective in improving self-reported confidence scores in AI and ML. The authors also share our curriculum with other educators who may be interested in its adoption. Methods: This elective was offered in 2 tracks: technical (for students who were already competent programmers) and nontechnical (with no technical prerequisites, focusing on building a conceptual understanding of AI and ML). Students established a conceptual foundation of knowledge using curated web-based resources and relevant research papers, and were then tasked with completing 3 projects in their chosen specialty: a data set analysis, a literature review, and an AI project proposal. The project-based nature of the elective was designed to be self-guided and flexible to each student?s interest area and career goals. Students? success was measured by self-reported confidence in AI and ML skills in pre and postsurveys. Qualitative feedback on students? experiences was also collected. Results: This web-based, self-directed elective was offered on a pass-or-fail basis each month to fourth-year students at Emory University School of Medicine beginning in May 2021. As of June 2022, a total of 19 students had successfully completed the elective, representing a wide range of chosen specialties: diagnostic radiology (n=3), general surgery (n=1), internal medicine (n=5), neurology (n=2), obstetrics and gynecology (n=1), ophthalmology (n=1), orthopedic surgery (n=1), otolaryngology (n=2), pathology (n=2), and pediatrics (n=1). Students? self-reported confidence scores for AI and ML rose by 66% after this 1-month elective. In qualitative surveys, students overwhelmingly reported enthusiasm and satisfaction with the course and commented that the self-direction and flexibility and the project-based design of the course were essential. Conclusions: Course participants were successful in diving deep into applications of AI in their widely-ranging specialties, produced substantial project deliverables, and generally reported satisfaction with their elective experience. The authors are hopeful that a brief, 1-month investment in AI and ML education during medical school will empower this next generation of physicians to pave the way for AI and ML innovation in health care. UR - https://mededu.jmir.org/2024/1/e46500 UR - http://dx.doi.org/10.2196/46500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38376896 ID - info:doi/10.2196/46500 ER - TY - JOUR AU - Bevens, William AU - Davenport, Rebekah AU - Neate, Sandra AU - Yu, Maggie AU - Jelinek, Pia AU - Jelinek, Alexander George AU - Reece, Jeanette PY - 2024/2/9 TI - Web-Based Health Information Seeking by People Living With Multiple Sclerosis: Qualitative Investigation of the Multiple Sclerosis Online Course JO - J Med Internet Res SP - e53372 VL - 26 KW - information-seeking behavior KW - self-management KW - lifestyle KW - digital health N2 - Background: Digital technologies have afforded people living with multiple sclerosis (MS) access to telehealth consultations, diagnostic tools, and monitoring. Although health care professionals remain the most trusted source of information, the internet has emerged as a valuable resource for providing MS-related information, particularly during the COVID-19 pandemic. Notably, people living with MS are increasingly seeking educational content for a range of topics related to the self-management of MS; however, web-based information seeking remains largely underevaluated. To address this gap and ensure that web-based health-related information is accessible and engaging, this study used qualitative methods to analyze the reflections from participants of web-based educational programs for people living with MS. Objective: This study aimed to explore the motivations, behaviors, and expectations of web-based health information seeking for people living with MS. Methods: We conducted semistructured interviews for 38 people living with MS 1 month after they completed the novel MS Online Course, which provided information on modifiable lifestyle-related risk factors for people living with MS. Of the 38 participants, 22 (58%) completed the intervention course and 16 (42%) completed the standard care course. Inductive thematic analysis was used within a qualitative paradigm, and 2 authors coded each interview separately and arrived at themes with consensus. Results: We identified 2 themes: motivation to learn and MS information on the web. The diagnosis of MS was described as a pivotal moment for precipitating web-based information seeking. People living with MS sought lifestyle-related information to facilitate self-management and increase control of their MS. Although social media sites and MS websites were considered useful for providing both support and information, discretion was needed to critically appraise information. Recognizable institutions were frequently accessed because of their trustworthiness. Conclusions: This study provided novel insights into the motivations of people living with MS for seeking web-based health information. Furthermore, their preferences for the content and format of the web-based information accessed and their experiences and reactions to this information were explored. These findings may guide educators, researchers, and clinicians involved in MS care to optimize the engagement and processing of web-based health information seeking by people living with MS. UR - https://www.jmir.org/2024/1/e53372 UR - http://dx.doi.org/10.2196/53372 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335016 ID - info:doi/10.2196/53372 ER - TY - JOUR AU - Weidener, Lukas AU - Fischer, Michael PY - 2024/2/9 TI - Proposing a Principle-Based Approach for Teaching AI Ethics in Medical Education JO - JMIR Med Educ SP - e55368 VL - 10 KW - artificial intelligence KW - AI KW - ethics KW - artificial intelligence ethics KW - AI ethics KW - medical education KW - medicine KW - medical artificial intelligence ethics KW - medical AI ethics KW - medical ethics KW - public health ethics UR - https://mededu.jmir.org/2024/1/e55368 UR - http://dx.doi.org/10.2196/55368 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285931 ID - info:doi/10.2196/55368 ER - TY - JOUR AU - Yu, Peng AU - Fang, Changchang AU - Liu, Xiaolin AU - Fu, Wanying AU - Ling, Jitao AU - Yan, Zhiwei AU - Jiang, Yuan AU - Cao, Zhengyu AU - Wu, Maoxiong AU - Chen, Zhiteng AU - Zhu, Wengen AU - Zhang, Yuling AU - Abudukeremu, Ayiguli AU - Wang, Yue AU - Liu, Xiao AU - Wang, Jingfeng PY - 2024/2/9 TI - Performance of ChatGPT on the Chinese Postgraduate Examination for Clinical Medicine: Survey Study JO - JMIR Med Educ SP - e48514 VL - 10 KW - ChatGPT KW - Chinese Postgraduate Examination for Clinical Medicine KW - medical student KW - performance KW - artificial intelligence KW - medical care KW - qualitative feedback KW - medical education KW - clinical decision-making N2 - Background: ChatGPT, an artificial intelligence (AI) based on large-scale language models, has sparked interest in the field of health care. Nonetheless, the capabilities of AI in text comprehension and generation are constrained by the quality and volume of available training data for a specific language, and the performance of AI across different languages requires further investigation. While AI harbors substantial potential in medicine, it is imperative to tackle challenges such as the formulation of clinical care standards; facilitating cultural transitions in medical education and practice; and managing ethical issues including data privacy, consent, and bias. Objective: The study aimed to evaluate ChatGPT?s performance in processing Chinese Postgraduate Examination for Clinical Medicine questions, assess its clinical reasoning ability, investigate potential limitations with the Chinese language, and explore its potential as a valuable tool for medical professionals in the Chinese context. Methods: A data set of Chinese Postgraduate Examination for Clinical Medicine questions was used to assess the effectiveness of ChatGPT?s (version 3.5) medical knowledge in the Chinese language, which has a data set of 165 medical questions that were divided into three categories: (1) common questions (n=90) assessing basic medical knowledge, (2) case analysis questions (n=45) focusing on clinical decision-making through patient case evaluations, and (3) multichoice questions (n=30) requiring the selection of multiple correct answers. First of all, we assessed whether ChatGPT could meet the stringent cutoff score defined by the government agency, which requires a performance within the top 20% of candidates. Additionally, in our evaluation of ChatGPT?s performance on both original and encoded medical questions, 3 primary indicators were used: accuracy, concordance (which validates the answer), and the frequency of insights. Results: Our evaluation revealed that ChatGPT scored 153.5 out of 300 for original questions in Chinese, which signifies the minimum score set to ensure that at least 20% more candidates pass than the enrollment quota. However, ChatGPT had low accuracy in answering open-ended medical questions, with only 31.5% total accuracy. The accuracy for common questions, multichoice questions, and case analysis questions was 42%, 37%, and 17%, respectively. ChatGPT achieved a 90% concordance across all questions. Among correct responses, the concordance was 100%, significantly exceeding that of incorrect responses (n=57, 50%; P<.001). ChatGPT provided innovative insights for 80% (n=132) of all questions, with an average of 2.95 insights per accurate response. Conclusions: Although ChatGPT surpassed the passing threshold for the Chinese Postgraduate Examination for Clinical Medicine, its performance in answering open-ended medical questions was suboptimal. Nonetheless, ChatGPT exhibited high internal concordance and the ability to generate multiple insights in the Chinese language. Future research should investigate the language-based discrepancies in ChatGPT?s performance within the health care context. UR - https://mededu.jmir.org/2024/1/e48514 UR - http://dx.doi.org/10.2196/48514 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335017 ID - info:doi/10.2196/48514 ER - TY - JOUR AU - Meyer, Annika AU - Riese, Janik AU - Streichert, Thomas PY - 2024/2/8 TI - Comparison of the Performance of GPT-3.5 and GPT-4 With That of Medical Students on the Written German Medical Licensing Examination: Observational Study JO - JMIR Med Educ SP - e50965 VL - 10 KW - ChatGPT KW - artificial intelligence KW - large language model KW - medical exams KW - medical examinations KW - medical education KW - LLM KW - public trust KW - trust KW - medical accuracy KW - licensing exam KW - licensing examination KW - improvement KW - patient care KW - general population KW - licensure examination N2 - Background: The potential of artificial intelligence (AI)?based large language models, such as ChatGPT, has gained significant attention in the medical field. This enthusiasm is driven not only by recent breakthroughs and improved accessibility, but also by the prospect of democratizing medical knowledge and promoting equitable health care. However, the performance of ChatGPT is substantially influenced by the input language, and given the growing public trust in this AI tool compared to that in traditional sources of information, investigating its medical accuracy across different languages is of particular importance. Objective: This study aimed to compare the performance of GPT-3.5 and GPT-4 with that of medical students on the written German medical licensing examination. Methods: To assess GPT-3.5?s and GPT-4's medical proficiency, we used 937 original multiple-choice questions from 3 written German medical licensing examinations in October 2021, April 2022, and October 2022. Results: GPT-4 achieved an average score of 85% and ranked in the 92.8th, 99.5th, and 92.6th percentiles among medical students who took the same examinations in October 2021, April 2022, and October 2022, respectively. This represents a substantial improvement of 27% compared to GPT-3.5, which only passed 1 out of the 3 examinations. While GPT-3.5 performed well in psychiatry questions, GPT-4 exhibited strengths in internal medicine and surgery but showed weakness in academic research. Conclusions: The study results highlight ChatGPT?s remarkable improvement from moderate (GPT-3.5) to high competency (GPT-4) in answering medical licensing examination questions in German. While GPT-4?s predecessor (GPT-3.5) was imprecise and inconsistent, it demonstrates considerable potential to improve medical education and patient care, provided that medically trained users critically evaluate its results. As the replacement of search engines by AI tools seems possible in the future, further studies with nonprofessional questions are needed to assess the safety and accuracy of ChatGPT for the general population. UR - https://mededu.jmir.org/2024/1/e50965 UR - http://dx.doi.org/10.2196/50965 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329802 ID - info:doi/10.2196/50965 ER - TY - JOUR AU - Martínez-Gaitero, Carlos AU - Dennerlein, Maximilian Sebastian AU - Dobrowolska, Beata AU - Fessl, Angela AU - Moreno-Martínez, Daniel AU - Herbstreit, Stephanie AU - Peffer, Gilbert AU - Cabrera, Esther AU - PY - 2024/2/8 TI - Connecting Actors With the Introduction of Mobile Technology in Health Care Practice Placements (4D Project): Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e53284 VL - 13 KW - practice-based learning KW - practice placement KW - technology enhanced learning KW - mobile learning KW - co-design KW - cocreation KW - higher education KW - health professionals KW - health students. N2 - Background: The learning process in clinical placements for health care students is a multifaceted endeavor that engages numerous actors and stakeholders, including students, clinical tutors, link teachers, and academic assessors. Successfully navigating this complex process requires the implementation of tasks and mentorships that are synchronized with educational and clinical processes, seamlessly embedded within their respective contexts. Given the escalating number of students and the rising demand for health care services from the general population, it becomes imperative to develop additional tools that support the learning process. These tools aim to simplify day-to-day clinical practice, allowing a concentrated focus on value-based activities. This paper introduces a project funded by the European Commission that involves 5 European countries. The project?s objective is to comprehensively outline the entire process of development and ultimately implement mobile technology in practice placements. The project tackles the existing gap by constructing tailored mobile apps designed for students, teachers, tutors, and supervisors within each participating organization. This approach leverages practice-based learning, mobile technology, and technology adoption to enhance the overall educational experience. Objective: This study aims to introduce mobile technology in clinical practice placements with the goal of facilitating and enhancing practice-based learning. The objective is to improve the overall effectiveness of the process for all stakeholders involved. Methods: The ?4D in the Digitalization of Learning in Practice Placement? (4D Project) will use a mixed methods research design, encompassing 3 distinct study phases: phase 1 (preliminary research), which incorporates focus groups and a scoping review, to define the problem, identify necessities, and analyze contextual factors; phase 2 (collaborative app development), which involves researchers and prospective users working together to cocreate and co-design tailored apps; and phase 3, which involves feasibility testing of these mobile apps within practice settings. Results: The study?s potential impact will primarily focus on improving communication and interaction processes, fostering connections among stakeholders in practice placements, and enhancing the assessment of training needs. The literature review and focus groups will play a crucial role in identifying barriers, facilitators, and factors supporting the integration of mobile technology in clinical education. The cocreation process of mobile learning apps will reveal the core values and needs of various stakeholders, including students, teachers, and health care professionals. This process also involves adapting and using mobile apps to meet the specific requirements of practice placements. A pilot study aimed at validating the app will test and assess mobile technology in practice placements. The study will determine results related to usability and design, learning outcomes, student engagement, communication among stakeholders, user behavior, potential issues, and compliance with regulations. Conclusions: Health care education, encompassing disciplines such as medicine, nursing, midwifery, and others, confronts evolving challenges in clinical training. Essential to addressing these challenges is bridging the gap between health care institutions and academic settings. The introduction of a new digital tool holds promise for empowering health students and mentors in effectively navigating the intricacies of the learning process. International Registered Report Identifier (IRRID): DERR1-10.2196/53284 UR - https://www.researchprotocols.org/2024/1/e53284 UR - http://dx.doi.org/10.2196/53284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329786 ID - info:doi/10.2196/53284 ER - TY - JOUR AU - Denny, Alanna AU - Curtin, Brian AU - Taylor-Robinson, Simon AU - Chirambo, Baxter Griphin AU - Cilliers, Liezel AU - Wu, Joseph Tsung-Shu AU - O'Meara, Ciara AU - Booth, Richard AU - O'Donoghue, John PY - 2024/2/6 TI - Evaluating the Appropriateness of Podcasts to Improve the Knowledge and Awareness of Selected Health Topics Among Undergraduate General Nursing Students: Protocol for an International Feasibility Study JO - JMIR Res Protoc SP - e50735 VL - 13 KW - podcasting KW - podcast KW - nursing student KW - gestational diabetes KW - mental health KW - health KW - knowledge N2 - Background: Podcasts have proven to be a successful alternative source of educational material for students. Given the ability to listen to podcasts 24/7 and while on the go, this technology has the potential to provide informative and educational material to a large number of people at any given time. Podcasts are usually freely available on commonly used mobile devices, such as smartphones, laptops, and tablets. Objective: This paper describes the impact of health-related podcasts as an intervention tool to support the knowledge and awareness of nursing students on a given topic. Methods: Pre- and postpodcast questionnaires will gather data regarding the participants? knowledge and awareness of two topics?gestational diabetes and mental health. This intervention will be tested on general nursing undergraduate students. The total number of students (N=2395) from the participating universities are broken down as follows: (1) University College Cork (n=850) and the University of Galway (n=450) in Ireland, (2) Mzuzu University in Malawi (n=719), and (3) University of Fort Hare in South Africa (n=376). Results: The study received ethical approval from the University College Cork Ethics Committee (2022-027A1). The approval obtained from University College Cork sufficed as ethics coverage for the University of Galway in Ireland. Ethics approval was also received from the Mzuzu University Research Ethics Committee (ID MZUNIREC/DOR/23/28) and the Inter-Faculty Research Ethics Committee of the University of Fort Hare (ID CIL002-21). Data collection is currently underway and will continue until the end of February 2024. The quantitative and qualitative data are expected to be analyzed in March 2024. Conclusions: Results from this study will allow for an investigation into the impact of podcasts in different settings: a high-income country (Ireland), an upper-middle?income country (South Africa), and a low-to-middle?income country (Malawi). The data gathered from this feasibility study will provide more clarity on the potential utility of podcasts as an intervention tool. We will gather data regarding listener demographics (eg, country of residence, age, gender, and year of study). International Registered Report Identifier (IRRID): DERR1-10.2196/50735 UR - https://www.researchprotocols.org/2024/1/e50735 UR - http://dx.doi.org/10.2196/50735 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319702 ID - info:doi/10.2196/50735 ER - TY - JOUR AU - Silva, Silveira Cristiana AU - Vasconcellos, Cidia AU - Souza, Barreto Murilo AU - Fernandes, Dumet Juliana AU - Rego, Almeida Vitoria Regina Pedreira de PY - 2024/2/1 TI - Comparison of Blended Learning With Traditional Dermatology Learning for Medical Students: Prospective Evaluation Study JO - JMIR Form Res SP - e49616 VL - 8 KW - dermatology KW - distance education KW - distance learning KW - e-learning KW - medical education KW - undergraduate medical education N2 - Background: Novel internet-based applications and associated technologies have influenced all aspects of society, ranging from commerce and business to entertainment and health care, and education is no exception. In this context, this study was designed to evaluate the impact of a dermatology e-learning program on the academic performance of medical students in dermatology. Objective: The aim of this study is to develop a dermatology blended-learning course for undergraduate medical students, evaluate the knowledge gained by students exposed to this course, and compare the results to those of traditional teaching methods. Methods: In this prospective study, we evaluated the performance of fourth-semester medical students at the Federal University of Bahia, Brazil. Students who had been in their second year of the medical course in 2019 were considered the control group, while students in their second year in 2020 were considered the blended or hybrid group. The first group attended traditional classes, using printed material (books and handouts), while the second group used our web-based course and e-book as a supplement in a hybrid web-plus-traditional fashion. Neither participants nor evaluators were blinded. The students in both groups were subjected to the same pre- and postcourse face-to-face, multiple-choice, paper-based evaluations, and we compared their performances. The content of the classes was the same for both groups. All didactic activities were developed by a team of certified dermatologists and professors from the university. Results: A total of 129 students were selected and divided into 2 groups: the control group (n=57) and the hybrid group (n=72). The precourse tests did not indicate any difference between the control group (mean score 2.74, SD 1.25) and the hybrid group (mean score 3.2, SD 1.22 SD; P>.05). The hybrid group had better final-term grades (mean 8.18, SD 1.26) than the traditional group (mean 7.11, SD 1.04). This difference was statistically significant (P<.05). Conclusions: This study explores pedagogical possibilities in the field of dermatology teaching for medical school students. The results suggest that the performance of undergraduate students who attended the course with additional e-learning material was superior when compared to the performance of those who participated in the traditional course alone. UR - https://formative.jmir.org/2024/1/e49616 UR - http://dx.doi.org/10.2196/49616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300698 ID - info:doi/10.2196/49616 ER - TY - JOUR AU - Khodabakhshian, Nairy AU - Gaeul Lee, Kyla AU - Marawi, Tulip AU - Sorkhou, Maryam AU - Vyravanathan, Sobiga AU - Harnett, Nicole PY - 2024/2/1 TI - Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53901 VL - 13 KW - communication KW - medical education KW - patient-facing KW - scoping review KW - technology KW - virtual reality N2 - Background: Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education. Objective: The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education. Methods: A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non?communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. Results: As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods. Conclusions: The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care?specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry. International Registered Report Identifier (IRRID): DERR1-10.2196/53901 UR - https://www.researchprotocols.org/2024/1/e53901 UR - http://dx.doi.org/10.2196/53901 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300671 ID - info:doi/10.2196/53901 ER - TY - JOUR AU - Kavadella, Argyro AU - Dias da Silva, Antonio Marco AU - Kaklamanos, G. Eleftherios AU - Stamatopoulos, Vasileios AU - Giannakopoulos, Kostis PY - 2024/1/31 TI - Evaluation of ChatGPT?s Real-Life Implementation in Undergraduate Dental Education: Mixed Methods Study JO - JMIR Med Educ SP - e51344 VL - 10 KW - ChatGPT KW - large language models KW - LLM KW - natural language processing KW - artificial Intelligence KW - dental education KW - higher education KW - learning assignments KW - dental students KW - AI pedagogy KW - dentistry KW - university N2 - Background: The recent artificial intelligence tool ChatGPT seems to offer a range of benefits in academic education while also raising concerns. Relevant literature encompasses issues of plagiarism and academic dishonesty, as well as pedagogy and educational affordances; yet, no real-life implementation of ChatGPT in the educational process has been reported to our knowledge so far. Objective: This mixed methods study aimed to evaluate the implementation of ChatGPT in the educational process, both quantitatively and qualitatively. Methods: In March 2023, a total of 77 second-year dental students of the European University Cyprus were divided into 2 groups and asked to compose a learning assignment on ?Radiation Biology and Radiation Protection in the Dental Office,? working collaboratively in small subgroups, as part of the educational semester program of the Dentomaxillofacial Radiology module. Careful planning ensured a seamless integration of ChatGPT, addressing potential challenges. One group searched the internet for scientific resources to perform the task and the other group used ChatGPT for this purpose. Both groups developed a PowerPoint (Microsoft Corp) presentation based on their research and presented it in class. The ChatGPT group students additionally registered all interactions with the language model during the prompting process and evaluated the final outcome; they also answered an open-ended evaluation questionnaire, including questions on their learning experience. Finally, all students undertook a knowledge examination on the topic, and the grades between the 2 groups were compared statistically, whereas the free-text comments of the questionnaires were thematically analyzed. Results: Out of the 77 students, 39 were assigned to the ChatGPT group and 38 to the literature research group. Seventy students undertook the multiple choice question knowledge examination, and examination grades ranged from 5 to 10 on the 0-10 grading scale. The Mann-Whitney U test showed that students of the ChatGPT group performed significantly better (P=.045) than students of the literature research group. The evaluation questionnaires revealed the benefits (human-like interface, immediate response, and wide knowledge base), the limitations (need for rephrasing the prompts to get a relevant answer, general content, false citations, and incapability to provide images or videos), and the prospects (in education, clinical practice, continuing education, and research) of ChatGPT. Conclusions: Students using ChatGPT for their learning assignments performed significantly better in the knowledge examination than their fellow students who used the literature research methodology. Students adapted quickly to the technological environment of the language model, recognized its opportunities and limitations, and used it creatively and efficiently. Implications for practice: the study underscores the adaptability of students to technological innovations including ChatGPT and its potential to enhance educational outcomes. Educators should consider integrating ChatGPT into curriculum design; awareness programs are warranted to educate both students and educators about the limitations of ChatGPT, encouraging critical engagement and responsible use. UR - https://mededu.jmir.org/2024/1/e51344 UR - http://dx.doi.org/10.2196/51344 UR - http://www.ncbi.nlm.nih.gov/pubmed/38111256 ID - info:doi/10.2196/51344 ER - TY - JOUR AU - Ang, Darryl Wei How AU - Lim, Grace Zhi Qi AU - Lau, Tiang Siew AU - Dong, Jie AU - Lau, Ying PY - 2024/1/31 TI - Unpacking the Experiences of Health Care Professionals About the Web-Based Building Resilience At Work Program During the COVID-19 Pandemic: Framework Analysis JO - JMIR Med Educ SP - e49551 VL - 10 KW - resilience KW - intent to stay KW - employability KW - health care professionals KW - process evaluation KW - framework analysis KW - framework KW - stress KW - mental health disorder KW - prevention KW - training KW - qualitative study KW - web-based tool KW - tool KW - sustainability N2 - Background: The COVID-19 pandemic has resulted in a greater workload in the health care system. Therefore, health care professionals (HCPs) continue to experience high levels of stress, resulting in mental health disorders. From a preventive perspective, building resilience has been associated with reduced stress and mental health disorders and promotes HCPs? intent to stay. Despite the benefits of resilience training, few studies provided an in-depth understanding of the contextual factors, implementation, and mechanisms of impact that influences the sustainability of resilience programs. Therefore, examining target users? experiences of the resilience program is important. This will provide meaningful information to refine and improve future resilience programs. Objective: This qualitative study aims to explore HCPs? experiences of participating in the web-based Building Resilience At Work (BRAW) program. In particular, this study aims to explore the contextual and implementational factors that would influence participants? interaction and outcome from the program. Methods: A descriptive qualitative approach using individual semistructured Zoom interviews was conducted with participants of the web-based resilience program. A framework analysis was conducted, and it is guided by the process evaluation framework. Results: A total of 33 HCPs participated in this qualitative study. Three themes depicting participants? experiences, interactions, and impacts from the BRAW program were elucidated from the framework analysis: learning from web-based tools, interacting with the BRAW program, and promoting participants? workforce readiness. Conclusions: Findings show that a web-based asynchronous and self-paced resilience program is an acceptable and feasible approach for HCPs. The program also led to encouraging findings on participants? resilience, intent to stay, and employability. However, continued refinements in the components of the web-based resilience program should be carried out to ensure the sustainability of this intervention. Trial Registration: ClinicalTrials.gov NCT05130879; https://clinicaltrials.gov/ct2/show/NCT05130879 UR - https://mededu.jmir.org/2024/1/e49551 UR - http://dx.doi.org/10.2196/49551 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294866 ID - info:doi/10.2196/49551 ER - TY - JOUR AU - Guinez-Molinos, Sergio AU - Espinoza, Sonia AU - Andrade, Jose AU - Medina, Alejandro PY - 2024/1/29 TI - Design and Development of Learning Management System Huemul for Teaching Fast Healthcare Interoperability Resource: Algorithm Development and Validation Study JO - JMIR Med Educ SP - e45413 VL - 10 KW - interoperability KW - health information system KW - Health Level Seven International KW - HL7 KW - Fast Healthcare Interoperability Resource KW - FHIR KW - certification KW - training KW - interoperable KW - e-learning KW - application programming interface KW - API N2 - Background: Interoperability between health information systems is a fundamental requirement to guarantee the continuity of health care for the population. The Fast Healthcare Interoperability Resource (FHIR) is the standard that enables the design and development of interoperable systems with broad adoption worldwide. However, FHIR training curriculums need an easily administered web-based self-learning platform with modules to create scenarios and questions that the learner answers. This paper proposes a system for teaching FHIR that automatically evaluates the answers, providing the learner with continuous feedback and progress. Objective: We are designing and developing a learning management system for creating, applying, deploying, and automatically assessing FHIR web-based courses. Methods: The system requirements for teaching FHIR were collected through interviews with experts involved in academic and professional FHIR activities (universities and health institutions). The interviews were semistructured, recording and documenting each meeting. In addition, we used an ad hoc instrument to register and analyze all the needs to elicit the requirements. Finally, the information obtained was triangulated with the available evidence. This analysis was carried out with Atlas-ti software. For design purposes, the requirements were divided into functional and nonfunctional. The functional requirements were (1) a test and question manager, (2) an application programming interface (API) to orchestrate components, (3) a test evaluator that automatically evaluates the responses, and (4) a client application for students. Security and usability are essential nonfunctional requirements to design functional and secure interfaces. The software development methodology was based on the traditional spiral model. The end users of the proposed system are (1) the system administrator for all technical aspects of the server, (2) the teacher designing the courses, and (3) the students interested in learning FHIR. Results: The main result described in this work is Huemul, a learning management system for training on FHIR, which includes the following components: (1) Huemul Admin: a web application to create users, tests, and questions and define scores; (2) Huemul API: module for communication between different software components (FHIR server, client, and engine); (3) Huemul Engine: component for answers evaluation to identify differences and validate the content; and (4) Huemul Client: the web application for users to show the test and questions. Huemul was successfully implemented with 416 students associated with the 10 active courses on the platform. In addition, the teachers have created 60 tests and 695 questions. Overall, the 416 students who completed their courses rated Huemul highly. Conclusions: Huemul is the first platform that allows the creation of courses, tests, and questions that enable the automatic evaluation and feedback of FHIR operations. Huemul has been implemented in multiple FHIR teaching scenarios for health care professionals. Professionals trained on FHIR with Huemul are leading successful national and international initiatives. UR - https://mededu.jmir.org/2024/1/e45413 UR - http://dx.doi.org/10.2196/45413 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285492 ID - info:doi/10.2196/45413 ER - TY - JOUR AU - Cranston, D. Kaela AU - Grieve, J. Natalie AU - Dineen, E. Tineke AU - Jung, E. Mary PY - 2024/1/26 TI - Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study JO - JMIR Form Res SP - e50942 VL - 8 KW - program evaluation KW - prediabetic state KW - e-learning education KW - e-learning KW - platform KW - usability KW - diabetes KW - prevention KW - knowledge translation KW - end user KW - type 2 diabetes KW - framework N2 - Background: e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners. Objective: This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training. Methods: An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study. Results: Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved. Conclusions: Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training. UR - https://formative.jmir.org/2024/1/e50942 UR - http://dx.doi.org/10.2196/50942 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277214 ID - info:doi/10.2196/50942 ER - TY - JOUR AU - Soller, Brian AU - Myers, Orrin AU - Sood, Akshay PY - 2024/1/24 TI - Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study JO - JMIR Form Res SP - e52414 VL - 8 KW - community of practice KW - knowledge transfer KW - pneumoconiosis KW - telementoring KW - rural health care KW - transfer KW - information KW - rural KW - virtual community KW - lung diseases KW - lung disease KW - rural professionals KW - rural professional KW - multidisciplinary management KW - multidisciplinary KW - miners KW - miner KW - health equity N2 - Background: Given the re-emergence of coal workers? pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners? Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners? Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown. Objective: We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach. Methods: This is a cross-sectional study of 70 professionals participating in the Miners? Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants? patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent?s self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources. Results: Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons). Conclusions: Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners. UR - https://formative.jmir.org/2024/1/e52414 UR - http://dx.doi.org/10.2196/52414 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265861 ID - info:doi/10.2196/52414 ER - TY - JOUR AU - Liu, Xiaocong AU - Wu, Jiageng AU - Shao, An AU - Shen, Wenyue AU - Ye, Panpan AU - Wang, Yao AU - Ye, Juan AU - Jin, Kai AU - Yang, Jie PY - 2024/1/22 TI - Uncovering Language Disparity of ChatGPT on Retinal Vascular Disease Classification: Cross-Sectional Study JO - J Med Internet Res SP - e51926 VL - 26 KW - large language models KW - ChatGPT KW - clinical decision support KW - retinal vascular disease KW - artificial intelligence N2 - Background: Benefiting from rich knowledge and the exceptional ability to understand text, large language models like ChatGPT have shown great potential in English clinical environments. However, the performance of ChatGPT in non-English clinical settings, as well as its reasoning, have not been explored in depth. Objective: This study aimed to evaluate ChatGPT?s diagnostic performance and inference abilities for retinal vascular diseases in a non-English clinical environment. Methods: In this cross-sectional study, we collected 1226 fundus fluorescein angiography reports and corresponding diagnoses written in Chinese and tested ChatGPT with 4 prompting strategies (direct diagnosis or diagnosis with a step-by-step reasoning process and in Chinese or English). Results: Compared with ChatGPT using Chinese prompts for direct diagnosis that achieved an F1-score of 70.47%, ChatGPT using English prompts for direct diagnosis achieved the best diagnostic performance (80.05%), which was inferior to ophthalmologists (89.35%) but close to ophthalmologist interns (82.69%). As for its inference abilities, although ChatGPT can derive a reasoning process with a low error rate (0.4 per report) for both Chinese and English prompts, ophthalmologists identified that the latter brought more reasoning steps with less incompleteness (44.31%), misinformation (1.96%), and hallucinations (0.59%) (all P<.001). Also, analysis of the robustness of ChatGPT with different language prompts indicated significant differences in the recall (P=.03) and F1-score (P=.04) between Chinese and English prompts. In short, when prompted in English, ChatGPT exhibited enhanced diagnostic and inference capabilities for retinal vascular disease classification based on Chinese fundus fluorescein angiography reports. Conclusions: ChatGPT can serve as a helpful medical assistant to provide diagnosis in non-English clinical environments, but there are still performance gaps, language disparities, and errors compared to professionals, which demonstrate the potential limitations and the need to continually explore more robust large language models in ophthalmology practice. UR - https://www.jmir.org/2024/1/e51926 UR - http://dx.doi.org/10.2196/51926 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252483 ID - info:doi/10.2196/51926 ER - TY - JOUR AU - Agarwal, Kumar Anish AU - Gonzales, Rachel AU - Munden, Cory AU - Albright, DaCarla AU - Tsao, Suzana PY - 2024/1/10 TI - Medical Students? Perceptions on Identifying and Addressing Emotional Responses in Emergency Medicine: Pilot Investigation JO - JMIR Form Res SP - e50827 VL - 8 KW - well-being KW - burnout KW - medical education KW - coping KW - student KW - students KW - university KW - college KW - acute care KW - trauma KW - traumatic KW - emotion KW - emotional KW - stress KW - distress KW - psychological KW - cross-sectional KW - survey KW - surveys KW - critical KW - critically KW - perception KW - perspectives KW - prepared KW - preparedness N2 - Background: Training in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported. Objective: This study aimed to evaluate medical students? perspectives and emotional preparedness for handling acute care and trauma. Methods: We conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources. Results: A total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact. Conclusions: In this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources. UR - https://formative.jmir.org/2024/1/e50827 UR - http://dx.doi.org/10.2196/50827 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198202 ID - info:doi/10.2196/50827 ER - TY - JOUR AU - Weidener, Lukas AU - Fischer, Michael PY - 2024/1/5 TI - Artificial Intelligence in Medicine: Cross-Sectional Study Among Medical Students on Application, Education, and Ethical Aspects JO - JMIR Med Educ SP - e51247 VL - 10 KW - artificial intelligence KW - AI technology KW - medicine KW - medical education KW - medical curriculum KW - medical school KW - AI ethics KW - ethics N2 - Background: The use of artificial intelligence (AI) in medicine not only directly impacts the medical profession but is also increasingly associated with various potential ethical aspects. In addition, the expanding use of AI and AI-based applications such as ChatGPT demands a corresponding shift in medical education to adequately prepare future practitioners for the effective use of these tools and address the associated ethical challenges they present. Objective: This study aims to explore how medical students from Germany, Austria, and Switzerland perceive the use of AI in medicine and the teaching of AI and AI ethics in medical education in accordance with their use of AI-based chat applications, such as ChatGPT. Methods: This cross-sectional study, conducted from June 15 to July 15, 2023, surveyed medical students across Germany, Austria, and Switzerland using a web-based survey. This study aimed to assess students? perceptions of AI in medicine and the integration of AI and AI ethics into medical education. The survey, which included 53 items across 6 sections, was developed and pretested. Data analysis used descriptive statistics (median, mode, IQR, total number, and percentages) and either the chi-square or Mann-Whitney U tests, as appropriate. Results: Surveying 487 medical students across Germany, Austria, and Switzerland revealed limited formal education on AI or AI ethics within medical curricula, although 38.8% (189/487) had prior experience with AI-based chat applications, such as ChatGPT. Despite varied prior exposures, 71.7% (349/487) anticipated a positive impact of AI on medicine. There was widespread consensus (385/487, 74.9%) on the need for AI and AI ethics instruction in medical education, although the current offerings were deemed inadequate. Regarding the AI ethics education content, all proposed topics were rated as highly relevant. Conclusions: This study revealed a pronounced discrepancy between the use of AI-based (chat) applications, such as ChatGPT, among medical students in Germany, Austria, and Switzerland and the teaching of AI in medical education. To adequately prepare future medical professionals, there is an urgent need to integrate the teaching of AI and AI ethics into the medical curricula. UR - https://mededu.jmir.org/2024/1/e51247 UR - http://dx.doi.org/10.2196/51247 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180787 ID - info:doi/10.2196/51247 ER - TY - JOUR AU - Knoedler, Leonard AU - Alfertshofer, Michael AU - Knoedler, Samuel AU - Hoch, C. Cosima AU - Funk, F. Paul AU - Cotofana, Sebastian AU - Maheta, Bhagvat AU - Frank, Konstantin AU - Brébant, Vanessa AU - Prantl, Lukas AU - Lamby, Philipp PY - 2024/1/5 TI - Pure Wisdom or Potemkin Villages? A Comparison of ChatGPT 3.5 and ChatGPT 4 on USMLE Step 3 Style Questions: Quantitative Analysis JO - JMIR Med Educ SP - e51148 VL - 10 KW - ChatGPT KW - United States Medical Licensing Examination KW - artificial intelligence KW - USMLE KW - USMLE Step 1 KW - OpenAI KW - medical education KW - clinical decision-making N2 - Background: The United States Medical Licensing Examination (USMLE) has been critical in medical education since 1992, testing various aspects of a medical student?s knowledge and skills through different steps, based on their training level. Artificial intelligence (AI) tools, including chatbots like ChatGPT, are emerging technologies with potential applications in medicine. However, comprehensive studies analyzing ChatGPT?s performance on USMLE Step 3 in large-scale scenarios and comparing different versions of ChatGPT are limited. Objective: This paper aimed to analyze ChatGPT?s performance on USMLE Step 3 practice test questions to better elucidate the strengths and weaknesses of AI use in medical education and deduce evidence-based strategies to counteract AI cheating. Methods: A total of 2069 USMLE Step 3 practice questions were extracted from the AMBOSS study platform. After including 229 image-based questions, a total of 1840 text-based questions were further categorized and entered into ChatGPT 3.5, while a subset of 229 questions were entered into ChatGPT 4. Responses were recorded, and the accuracy of ChatGPT answers as well as its performance in different test question categories and for different difficulty levels were compared between both versions. Results: Overall, ChatGPT 4 demonstrated a statistically significant superior performance compared to ChatGPT 3.5, achieving an accuracy of 84.7% (194/229) and 56.9% (1047/1840), respectively. A noteworthy correlation was observed between the length of test questions and the performance of ChatGPT 3.5 (?=?0.069; P=.003), which was absent in ChatGPT 4 (P=.87). Additionally, the difficulty of test questions, as categorized by AMBOSS hammer ratings, showed a statistically significant correlation with performance for both ChatGPT versions, with ?=?0.289 for ChatGPT 3.5 and ?=?0.344 for ChatGPT 4. ChatGPT 4 surpassed ChatGPT 3.5 in all levels of test question difficulty, except for the 2 highest difficulty tiers (4 and 5 hammers), where statistical significance was not reached. Conclusions: In this study, ChatGPT 4 demonstrated remarkable proficiency in taking the USMLE Step 3, with an accuracy rate of 84.7% (194/229), outshining ChatGPT 3.5 with an accuracy rate of 56.9% (1047/1840). Although ChatGPT 4 performed exceptionally, it encountered difficulties in questions requiring the application of theoretical concepts, particularly in cardiology and neurology. These insights are pivotal for the development of examination strategies that are resilient to AI and underline the promising role of AI in the realm of medical education and diagnostics. UR - https://mededu.jmir.org/2024/1/e51148 UR - http://dx.doi.org/10.2196/51148 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180782 ID - info:doi/10.2196/51148 ER - TY - JOUR AU - Giannakopoulos, Kostis AU - Kavadella, Argyro AU - Aaqel Salim, Anas AU - Stamatopoulos, Vassilis AU - Kaklamanos, G. Eleftherios PY - 2023/12/28 TI - Evaluation of the Performance of Generative AI Large Language Models ChatGPT, Google Bard, and Microsoft Bing Chat in Supporting Evidence-Based Dentistry: Comparative Mixed Methods Study JO - J Med Internet Res SP - e51580 VL - 25 KW - artificial intelligence KW - AI KW - large language models KW - generative pretrained transformers KW - evidence-based dentistry KW - ChatGPT KW - Google Bard KW - Microsoft Bing KW - clinical practice KW - dental professional KW - dental practice KW - clinical decision-making KW - clinical practice guidelines N2 - Background: The increasing application of generative artificial intelligence large language models (LLMs) in various fields, including dentistry, raises questions about their accuracy. Objective: This study aims to comparatively evaluate the answers provided by 4 LLMs, namely Bard (Google LLC), ChatGPT-3.5 and ChatGPT-4 (OpenAI), and Bing Chat (Microsoft Corp), to clinically relevant questions from the field of dentistry. Methods: The LLMs were queried with 20 open-type, clinical dentistry?related questions from different disciplines, developed by the respective faculty of the School of Dentistry, European University Cyprus. The LLMs? answers were graded 0 (minimum) to 10 (maximum) points against strong, traditionally collected scientific evidence, such as guidelines and consensus statements, using a rubric, as if they were examination questions posed to students, by 2 experienced faculty members. The scores were statistically compared to identify the best-performing model using the Friedman and Wilcoxon tests. Moreover, the evaluators were asked to provide a qualitative evaluation of the comprehensiveness, scientific accuracy, clarity, and relevance of the LLMs? answers. Results: Overall, no statistically significant difference was detected between the scores given by the 2 evaluators; therefore, an average score was computed for every LLM. Although ChatGPT-4 statistically outperformed ChatGPT-3.5 (P=.008), Bing Chat (P=.049), and Bard (P=.045), all models occasionally exhibited inaccuracies, generality, outdated content, and a lack of source references. The evaluators noted instances where the LLMs delivered irrelevant information, vague answers, or information that was not fully accurate. Conclusions: This study demonstrates that although LLMs hold promising potential as an aid in the implementation of evidence-based dentistry, their current limitations can lead to potentially harmful health care decisions if not used judiciously. Therefore, these tools should not replace the dentist?s critical thinking and in-depth understanding of the subject matter. Further research, clinical validation, and model improvements are necessary for these tools to be fully integrated into dental practice. Dental practitioners must be aware of the limitations of LLMs, as their imprudent use could potentially impact patient care. Regulatory measures should be established to oversee the use of these evolving technologies. UR - https://www.jmir.org/2023/1/e51580 UR - http://dx.doi.org/10.2196/51580 UR - http://www.ncbi.nlm.nih.gov/pubmed/38009003 ID - info:doi/10.2196/51580 ER - TY - JOUR AU - Alkhaaldi, I. Saif M. AU - Kassab, H. Carl AU - Dimassi, Zakia AU - Oyoun Alsoud, Leen AU - Al Fahim, Maha AU - Al Hageh, Cynthia AU - Ibrahim, Halah PY - 2023/12/22 TI - Medical Student Experiences and Perceptions of ChatGPT and Artificial Intelligence: Cross-Sectional Study JO - JMIR Med Educ SP - e51302 VL - 9 KW - medical education KW - ChatGPT KW - artificial intelligence KW - large language models KW - LLMs KW - AI KW - medical student KW - medical students KW - cross-sectional study KW - training KW - technology KW - medicine KW - health care professionals KW - risk KW - education N2 - Background: Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology?s capabilities, potential, and risks, there is a gap in studying the perspective of end users. Objective: The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers. Methods: A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies. Results: Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively). Conclusions: The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine. UR - https://mededu.jmir.org/2023/1/e51302 UR - http://dx.doi.org/10.2196/51302 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133911 ID - info:doi/10.2196/51302 ER - TY - JOUR AU - Tangadulrat, Pasin AU - Sono, Supinya AU - Tangtrakulwanich, Boonsin PY - 2023/12/22 TI - Using ChatGPT for Clinical Practice and Medical Education: Cross-Sectional Survey of Medical Students? and Physicians? Perceptions JO - JMIR Med Educ SP - e50658 VL - 9 KW - ChatGPT KW - AI KW - artificial intelligence KW - medical education KW - medical students KW - student KW - students KW - intern KW - interns KW - resident KW - residents KW - knee osteoarthritis KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance N2 - Background: ChatGPT is a well-known large language model?based chatbot. It could be used in the medical field in many aspects. However, some physicians are still unfamiliar with ChatGPT and are concerned about its benefits and risks. Objective: We aim to evaluate the perception of physicians and medical students toward using ChatGPT in the medical field. Methods: A web-based questionnaire was sent to medical students, interns, residents, and attending staff with questions regarding their perception toward using ChatGPT in clinical practice and medical education. Participants were also asked to rate their perception of ChatGPT?s generated response about knee osteoarthritis. Results: Participants included 124 medical students, 46 interns, 37 residents, and 32 attending staff. After reading ChatGPT?s response, 132 of the 239 (55.2%) participants had a positive rating about using ChatGPT for clinical practice. The proportion of positive answers was significantly lower in graduated physicians (48/115, 42%) compared with medical students (84/124, 68%; P<.001). Participants listed a lack of a patient-specific treatment plan, updated evidence, and a language barrier as ChatGPT?s pitfalls. Regarding using ChatGPT for medical education, the proportion of positive responses was also significantly lower in graduate physicians (71/115, 62%) compared to medical students (103/124, 83.1%; P<.001). Participants were concerned that ChatGPT?s response was too superficial, might lack scientific evidence, and might need expert verification. Conclusions: Medical students generally had a positive perception of using ChatGPT for guiding treatment and medical education, whereas graduated doctors were more cautious in this regard. Nonetheless, both medical students and graduated doctors positively perceived using ChatGPT for creating patient educational materials. UR - https://mededu.jmir.org/2023/1/e50658 UR - http://dx.doi.org/10.2196/50658 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133908 ID - info:doi/10.2196/50658 ER - TY - JOUR AU - Luo, Yuanyuan AU - Weng, Huiting AU - Yang, Li AU - Ding, Ziwei AU - Wang, Qin PY - 2023/12/22 TI - College Students? Employability, Cognition, and Demands for ChatGPT in the AI Era Among Chinese Nursing Students: Web-Based Survey JO - JMIR Form Res SP - e50413 VL - 7 KW - college students? employability KW - artificial intelligence quotient KW - ChatGPT KW - nursing students KW - China KW - college student KW - AI KW - artificial intelligence N2 - Background: With the rapid development of artificial intelligence (AI) and the widespread use of ChatGPT, nursing students? artificial intelligence quotient (AIQ), employability, cognition, and demand for ChatGPT are worthy of attention. Objective: We aimed to investigate Chinese nursing students? AIQ and employability status as well as their cognition and demand for the latest AI tool?ChatGPT. This study was conducted to guide future initiatives in nursing intelligence education and to improve the employability of nursing students. Methods: We used a cross-sectional survey to understand nursing college students? AIQ, employability, cognition, and demand for ChatGPT. Using correlation analysis and multiple hierarchical regression analysis, we explored the relevant factors in the employability of nursing college students. Results: In this study, out of 1788 students, 1453 (81.30%) had not used ChatGPT, and 1170 (65.40%) had never heard of ChatGPT before this survey. College students? employability scores were positively correlated with AIQ, self-regulation ability, and their home location and negatively correlated with school level. Additionally, men scored higher on college students? employability compared to women. Furthermore, 76.5% of the variance was explained by the multiple hierarchical regression model for predicting college students? employability scores. Conclusions: Chinese nursing students have limited familiarity and experience with ChatGPT, while their AIQ remains intermediate. Thus, educators should pay more attention to cultivating nursing students? AIQ and self-regulation ability to enhance their employability. Employability, especially for female students, those from rural backgrounds, and students in key colleges, deserves more attention in future educational efforts. UR - https://formative.jmir.org/2023/1/e50413 UR - http://dx.doi.org/10.2196/50413 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133923 ID - info:doi/10.2196/50413 ER - TY - JOUR AU - Jacobs, Marie Sarah AU - Lundy, Nicole Neva AU - Issenberg, Barry Saul AU - Chandran, Latha PY - 2023/12/19 TI - Reimagining Core Entrustable Professional Activities for Undergraduate Medical Education in the Era of Artificial Intelligence JO - JMIR Med Educ SP - e50903 VL - 9 KW - artificial intelligence KW - entrustable professional activities KW - medical education KW - competency-based education KW - educational technology KW - machine learning UR - https://mededu.jmir.org/2023/1/e50903 UR - http://dx.doi.org/10.2196/50903 UR - http://www.ncbi.nlm.nih.gov/pubmed/38052721 ID - info:doi/10.2196/50903 ER - TY - JOUR AU - Sun, Ting AU - Xu, Xuejie AU - Zhu, Ningning AU - Zhang, Jing AU - Ma, Zuchang AU - Xie, Hui PY - 2023/12/15 TI - A Service-Learning Project Based on a Community-Oriented Intelligent Health Promotion System for Postgraduate Nursing Students: Mixed Methods Study JO - JMIR Med Educ SP - e52279 VL - 9 KW - service learning KW - intelligent health promotion system KW - scientific awareness KW - research innovation ability N2 - Background: Service learning (SL) is a pedagogical approach that combines community service with cognitive learning for professionals. Its efficacy in promoting community health has gained broad recognition in nursing education. The application of postgraduate nursing SL programs in community-based intelligent health remains underexplored. Thus, additional investigation is necessary to assess the influence of the SL project based on a community-oriented intelligent health promotion system (SLP-COIHPS) on postgraduate nursing students and health service recipients. Objective: This study aims to assess how SLP-COIHPS influences the scientific awareness and research innovation abilities of postgraduate nursing students. In addition, the study sought to examine the experiences of both participating students and health service recipients. Methods: We conducted a mixed methods investigation by using web-based surveys and conducting interviews. The web-based surveys aimed to explore the differences in scientific awareness and research innovation capabilities between 2 distinct groups: an experimental group of 23 postgraduate nursing students actively participated in SLP-COIHPS, while 23 postgraduate students (matched one-to-one with the experimental group in terms of grade, sex, and research methods) served as control participants. Semistructured interviews were conducted with 65% (15/23) of postgraduate students and 3% (12/405) of community residents who received health services, aiming to assess the project?s impact on them. The community-based intelligent health promotion system installed in intelligent health cabins can be conceptualized as an expert system providing valuable references for student health education. It has the capability to generate comprehensive assessments and personalized health guidance plans. Following training, students were involved in offering health assessments, health education, and related services. Subsequently, after the web-based surveys and semistructured interviews, quantitative data were analyzed using the SPSS (IBM Corp) software package, using 2-tailed t tests and Mann-Whitney U tests; qualitative data underwent analysis using the constructivist grounded theory approach. Results: Postgraduate nursing students participating in this program scored 12.83 (Cohen d>0.8; P<.001) and 10.56 (Cohen d>0.8; P=.004) points higher than postgraduate students in the control group in research awareness and research innovation capability, respectively. On the basis of the qualitative results, postgraduate students reported improvement in this program. Analysis of the interviews revealed a total of 12 subcategories across three primary domains: (1) specialized skills, (2) scientific research ability, and (3) comprehensive qualities. Community residents reported high satisfaction and positive experiences. Analysis of the interviews with community residents identified two primary categories: (1) satisfaction and (2) perceived benefits. Conclusions: SLP-COIHPS had a positive impact on students? development of scientific awareness and research innovation ability. Qualitative study findings also support the further development of practical programs that integrate intelligent health and SL theories in the field of medical education. This includes exploring the potential factors influencing postgraduate nursing students? research capabilities or investigating the long-term effects of the project. UR - https://mededu.jmir.org/2023/1/e52279 UR - http://dx.doi.org/10.2196/52279 UR - http://www.ncbi.nlm.nih.gov/pubmed/38100207 ID - info:doi/10.2196/52279 ER - TY - JOUR AU - Deschênes, Marie-France AU - Fernandez, Nicolas AU - Lechasseur, Kathleen AU - Caty, Marie-Ève AU - Azimzadeh, Dina AU - Mai, Tue-Chieu AU - Lavoie, Patrick PY - 2023/12/13 TI - Transformation and Articulation of Clinical Data to Understand Students? and Health Professionals? Clinical Reasoning: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e50797 VL - 12 KW - clinical reasoning KW - semantic qualifiers KW - discourse KW - linguistics KW - education KW - natural language processing KW - scoping review KW - clinical data KW - educational strategy KW - student KW - health care professional KW - semantic transformation N2 - Background: There are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence. Objective: The aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals? transformation and articulation of clinical data. Methods: This scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions. Results: After removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024. Conclusions: By synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners? developing competencies and educational progress. International Registered Report Identifier (IRRID): DERR1-10.2196/50797 UR - https://www.researchprotocols.org/2023/1/e50797 UR - http://dx.doi.org/10.2196/50797 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090795 ID - info:doi/10.2196/50797 ER - TY - JOUR AU - Maltby, Steven AU - Garcia-Esperon, Carlos AU - Jackson, Kate AU - Butcher, Ken AU - Evans, W. James AU - O'Brien, William AU - Dixon, Courtney AU - Russell, Skye AU - Wilson, Natalie AU - Kluge, G. Murielle AU - Ryan, Annika AU - Paul, L. Christine AU - Spratt, J. Neil AU - Levi, R. Christopher AU - Walker, Rohan Frederick PY - 2023/12/7 TI - TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study JO - JMIR Serious Games SP - e43416 VL - 11 KW - virtual reality KW - technology KW - medical education KW - telehealth KW - stroke management KW - stroke workflow N2 - Background: Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. Objective: We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. Methods: The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. Results: TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site). Conclusions: TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways. UR - https://games.jmir.org/2023/1/e43416 UR - http://dx.doi.org/10.2196/43416 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060297 ID - info:doi/10.2196/43416 ER - TY - JOUR AU - Guo, Huey-Ming Sophie AU - Lin, Jiun-Lu AU - Hsing, Hung-Chun AU - Lee, Chun-Chuan AU - Chuang, Shih-Ming PY - 2023/12/6 TI - The Effect of Mobile eHealth Education to Improve Knowledge, Skills, Self-Care, and Mobile eHealth Literacies Among Patients With Diabetes: Development and Evaluation Study JO - J Med Internet Res SP - e42497 VL - 25 KW - mobile eHealth technology KW - mHealth literacy KW - eHealth literacy KW - diabetes KW - HbA1c KW - self-care behavior N2 - Background: The promotion of mobile health (mHealth) and eHealth technologies as tools for managing chronic diseases, particularly diabetes mellitus, is on the rise. Nevertheless, individuals with diabetes frequently face a literacy gap that hinders their ability to fully leverage the benefits offered by these resources. Enhancing technology literacy to facilitate the adoption of mobile eHealth services poses a significant challenge in numerous countries. Objective: This study aims to develop an educational mobile eHealth literacy (eHL) program for patients with diabetes and to evaluate its effect on patients? outcomes. Methods: This study designed a mobile eHL education program comprising 2 modules specifically tailored for individuals with type 2 diabetes (T2D). These modules focused on guiding participants through the process of effectively navigating reliable health websites and utilizing diabetes-related apps. Using a pre- and posttest experimental design, the study featured an intervention group and a control group. Participants were recruited from 3 outpatient departments in hospitals, and assessments were conducted both before and after the intervention, along with a follow-up measure at the 3-month mark. The evaluation encompassed sociodemographic characteristics, computer and internet proficiency, mobile app usage, mobile eHL, and patient outcomes such as self-care behaviors and glycated hemoglobin (HbA1c) levels. Results: The analysis included a total of 132 eligible participants. Significant differences were observed in the mean scores of knowledge (P<.001) and skills (P<.001) related to computers, the web, and mobile devices at the initiation of the study and after the intervention. During the 3-month follow-up, the findings indicated a significant improvement in mobile eHL (t114=3.391, P=.001) and mHealth literacy (mHL, a subconcept of mobile eHL; t114=3.801, P<.001) within the intervention group, whereas no such improvement was observed in the control group. The chi-square values from the McNemar test underscored that individuals with uncontrolled diabetes (HbA1c?7%) in the intervention group exhibited more improvement compared with the control group. The generalized estimating equations model unveiled a significant difference in the change of general mHL in the intervention group (?=1.91, P=.047) and self-care behavior in the control group from T0 to T2 (?=?8.21, P=.015). Despite being small, the effect sizes for mobile eHL (d=0.49) and HbA1c (d=0.33) in the intervention group were greater than those in the control group (d=0.14 and d=0.16, respectively). Conclusions: The implementation of a mobile eHL education intervention demonstrates a positive influence on the familiarity of patients with T2D regarding health technology, leading to favorable glycemic outcomes. While additional studies are warranted for a more comprehensive understanding, this program emerges as a promising solution for enhancing patients? uptake of digital health technology. UR - https://www.jmir.org/2023/1/e42497 UR - http://dx.doi.org/10.2196/42497 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055321 ID - info:doi/10.2196/42497 ER - TY - JOUR AU - Watari, Takashi AU - Takagi, Soshi AU - Sakaguchi, Kota AU - Nishizaki, Yuji AU - Shimizu, Taro AU - Yamamoto, Yu AU - Tokuda, Yasuharu PY - 2023/12/6 TI - Performance Comparison of ChatGPT-4 and Japanese Medical Residents in the General Medicine In-Training Examination: Comparison Study JO - JMIR Med Educ SP - e52202 VL - 9 KW - ChatGPT KW - artificial intelligence KW - medical education KW - clinical training KW - non-English language KW - ChatGPT-4 KW - Japan KW - Japanese KW - Asia KW - Asian KW - exam KW - examination KW - exams KW - examinations KW - NLP KW - natural language processing KW - LLM KW - language model KW - language models KW - performance KW - response KW - responses KW - answer KW - answers KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - reasoning KW - clinical KW - GM-ITE KW - self-assessment KW - residency programs N2 - Background: The reliability of GPT-4, a state-of-the-art expansive language model specializing in clinical reasoning and medical knowledge, remains largely unverified across non-English languages. Objective: This study aims to compare fundamental clinical competencies between Japanese residents and GPT-4 by using the General Medicine In-Training Examination (GM-ITE). Methods: We used the GPT-4 model provided by OpenAI and the GM-ITE examination questions for the years 2020, 2021, and 2022 to conduct a comparative analysis. This analysis focused on evaluating the performance of individuals who were concluding their second year of residency in comparison to that of GPT-4. Given the current abilities of GPT-4, our study included only single-choice exam questions, excluding those involving audio, video, or image data. The assessment included 4 categories: general theory (professionalism and medical interviewing), symptomatology and clinical reasoning, physical examinations and clinical procedures, and specific diseases. Additionally, we categorized the questions into 7 specialty fields and 3 levels of difficulty, which were determined based on residents? correct response rates. Results: Upon examination of 137 GM-ITE questions in Japanese, GPT-4 scores were significantly higher than the mean scores of residents (residents: 55.8%, GPT-4: 70.1%; P<.001). In terms of specific disciplines, GPT-4 scored 23.5 points higher in the ?specific diseases,? 30.9 points higher in ?obstetrics and gynecology,? and 26.1 points higher in ?internal medicine.? In contrast, GPT-4 scores in ?medical interviewing and professionalism,? ?general practice,? and ?psychiatry? were lower than those of the residents, although this discrepancy was not statistically significant. Upon analyzing scores based on question difficulty, GPT-4 scores were 17.2 points lower for easy problems (P=.007) but were 25.4 and 24.4 points higher for normal and difficult problems, respectively (P<.001). In year-on-year comparisons, GPT-4 scores were 21.7 and 21.5 points higher in the 2020 (P=.01) and 2022 (P=.003) examinations, respectively, but only 3.5 points higher in the 2021 examinations (no significant difference). Conclusions: In the Japanese language, GPT-4 also outperformed the average medical residents in the GM-ITE test, originally designed for them. Specifically, GPT-4 demonstrated a tendency to score higher on difficult questions with low resident correct response rates and those demanding a more comprehensive understanding of diseases. However, GPT-4 scored comparatively lower on questions that residents could readily answer, such as those testing attitudes toward patients and professionalism, as well as those necessitating an understanding of context and communication. These findings highlight the strengths and limitations of artificial intelligence applications in medical education and practice. UR - https://mededu.jmir.org/2023/1/e52202 UR - http://dx.doi.org/10.2196/52202 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055323 ID - info:doi/10.2196/52202 ER - TY - JOUR AU - Buhr, Raphael Christoph AU - Smith, Harry AU - Huppertz, Tilman AU - Bahr-Hamm, Katharina AU - Matthias, Christoph AU - Blaikie, Andrew AU - Kelsey, Tom AU - Kuhn, Sebastian AU - Eckrich, Jonas PY - 2023/12/5 TI - ChatGPT Versus Consultants: Blinded Evaluation on Answering Otorhinolaryngology Case?Based Questions JO - JMIR Med Educ SP - e49183 VL - 9 KW - large language models KW - LLMs KW - LLM KW - artificial intelligence KW - AI KW - ChatGPT KW - otorhinolaryngology KW - ORL KW - digital health KW - chatbots KW - global health KW - low- and middle-income countries KW - telemedicine KW - telehealth KW - language model KW - chatbot N2 - Background: Large language models (LLMs), such as ChatGPT (Open AI), are increasingly used in medicine and supplement standard search engines as information sources. This leads to more ?consultations? of LLMs about personal medical symptoms. Objective: This study aims to evaluate ChatGPT?s performance in answering clinical case?based questions in otorhinolaryngology (ORL) in comparison to ORL consultants? answers. Methods: We used 41 case-based questions from established ORL study books and past German state examinations for doctors. The questions were answered by both ORL consultants and ChatGPT 3. ORL consultants rated all responses, except their own, on medical adequacy, conciseness, coherence, and comprehensibility using a 6-point Likert scale. They also identified (in a blinded setting) if the answer was created by an ORL consultant or ChatGPT. Additionally, the character count was compared. Due to the rapidly evolving pace of technology, a comparison between responses generated by ChatGPT 3 and ChatGPT 4 was included to give an insight into the evolving potential of LLMs. Results: Ratings in all categories were significantly higher for ORL consultants (P<.001). Although inferior to the scores of the ORL consultants, ChatGPT?s scores were relatively higher in semantic categories (conciseness, coherence, and comprehensibility) compared to medical adequacy. ORL consultants identified ChatGPT as the source correctly in 98.4% (121/123) of cases. ChatGPT?s answers had a significantly higher character count compared to ORL consultants (P<.001). Comparison between responses generated by ChatGPT 3 and ChatGPT 4 showed a slight improvement in medical accuracy as well as a better coherence of the answers provided. Contrarily, neither the conciseness (P=.06) nor the comprehensibility (P=.08) improved significantly despite the significant increase in the mean amount of characters by 52.5% (n= (1470-964)/964; P<.001). Conclusions: While ChatGPT provided longer answers to medical problems, medical adequacy and conciseness were significantly lower compared to ORL consultants? answers. LLMs have potential as augmentative tools for medical care, but their ?consultation? for medical problems carries a high risk of misinformation as their high semantic quality may mask contextual deficits. UR - https://mededu.jmir.org/2023/1/e49183 UR - http://dx.doi.org/10.2196/49183 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051578 ID - info:doi/10.2196/49183 ER - TY - JOUR AU - Alkuran, Oqba AU - Al-Mehaisen, Lama AU - Abu Mahfouz, Ismaiel AU - Al-Kuran, Lena AU - Asali, Fida AU - Khamees, Almu?atasim AU - AL-Shatanawi, Tariq AU - Jaber, Hatim PY - 2023/12/5 TI - Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - JMIR Med Educ SP - e42354 VL - 9 KW - COVID-19 KW - distant electronic learning KW - medical KW - medicine KW - school KW - medical school KW - medical education KW - clinical skill KW - teaching hospital KW - questionnaire KW - distance learning KW - distance education KW - web-based education KW - web-based learning KW - medical student N2 - Background: Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions. Objective: This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan. Methods: We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL. Results: A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice. Conclusions: DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction. UR - https://mededu.jmir.org/2023/1/e42354 UR - http://dx.doi.org/10.2196/42354 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051556 ID - info:doi/10.2196/42354 ER - TY - JOUR AU - Ganek, Emily AU - Sazon, P. Romy Antonnette AU - Gray, Lauren AU - Sherry, Daisy PY - 2023/12/1 TI - An Introduction to Faculty Diversity, Equity, and Inclusion for Excellence in Nurse Education: Literature Review JO - Asian Pac Isl Nurs J SP - e49231 VL - 7 KW - nursing education KW - diversity KW - equity KW - inclusion KW - inclusive KW - nursing KW - allied health KW - medical education KW - nurse KW - nurses KW - health care education KW - curriculum KW - DEI KW - teaching KW - educator KW - educators KW - hiring KW - recruiting KW - recruitment KW - teacher KW - teachers N2 - Background: The diversity of the world?s population is increasing, along with the health inequities of underrepresented minority populations. To provide high-quality care to all patients, nurses require an understanding of diversity, equity, and inclusion (DEI) as well as how to implement best practices. Nurse educators are the ones to lead the way for DEI education for students. Objective: This paper aims to describe the findings of a literature review that introduces DEI concepts for excellence in nurse education and their related benefits. Best practices for actions to address DEI in nursing education will be described. Methods: After institutional review board approval, a literature search yielded 61 articles using 15 distinct keywords in 4 global, peer-reviewed literature databases. Melynk and Fineout-Overholt?s (2023) Levels of Evidence guided the process of selecting 26 peer-reviewed articles and resources. Results: Common themes for best practices in DEI were identified. These themes included recruiting underrepresented minority nursing faculty, incorporating DEI into an institution?s mission statement, addressing DEI topics in curricula, providing leadership, having a DEI strategic plan, developing education, developing data-based interventions, instilling policy change, partnering in outreach, targeting impact on hiring committees, recognizing DEI work, and providing mentorship. Conclusions: In summary, this literature review provides several strategies to address DEI for nurse educators. Committing to DEI efforts and improving diversity in the nurse educator workforce are integral steps in improving the quality and inclusivity of nursing education and ultimately improving the health of our communities. UR - https://apinj.jmir.org/2023/1/e49231 UR - http://dx.doi.org/10.2196/49231 UR - http://www.ncbi.nlm.nih.gov/pubmed/38039066 ID - info:doi/10.2196/49231 ER - TY - JOUR AU - Shimizu, Ikuo AU - Kasai, Hajime AU - Shikino, Kiyoshi AU - Araki, Nobuyuki AU - Takahashi, Zaiya AU - Onodera, Misaki AU - Kimura, Yasuhiko AU - Tsukamoto, Tomoko AU - Yamauchi, Kazuyo AU - Asahina, Mayumi AU - Ito, Shoichi AU - Kawakami, Eiryo PY - 2023/11/30 TI - Developing Medical Education Curriculum Reform Strategies to Address the Impact of Generative AI: Qualitative Study JO - JMIR Med Educ SP - e53466 VL - 9 KW - artificial intelligence KW - curriculum reform KW - generative artificial intelligence KW - large language models KW - medical education KW - qualitative analysis KW - strengths-weaknesses-opportunities-threats (SWOT) framework N2 - Background: Generative artificial intelligence (GAI), represented by large language models, have the potential to transform health care and medical education. In particular, GAI?s impact on higher education has the potential to change students? learning experience as well as faculty?s teaching. However, concerns have been raised about ethical consideration and decreased reliability of the existing examinations. Furthermore, in medical education, curriculum reform is required to adapt to the revolutionary changes brought about by the integration of GAI into medical practice and research. Objective: This study analyzes the impact of GAI on medical education curricula and explores strategies for adaptation. Methods: The study was conducted in the context of faculty development at a medical school in Japan. A workshop involving faculty and students was organized, and participants were divided into groups to address two research questions: (1) How does GAI affect undergraduate medical education curricula? and (2) How should medical school curricula be reformed to address the impact of GAI? The strength, weakness, opportunity, and threat (SWOT) framework was used, and cross-SWOT matrix analysis was used to devise strategies. Further, 4 researchers conducted content analysis on the data generated during the workshop discussions. Results: The data were collected from 8 groups comprising 55 participants. Further, 5 themes about the impact of GAI on medical education curricula emerged: improvement of teaching and learning, improved access to information, inhibition of existing learning processes, problems in GAI, and changes in physicians? professionality. Positive impacts included enhanced teaching and learning efficiency and improved access to information, whereas negative impacts included concerns about reduced independent thinking and the adaptability of existing assessment methods. Further, GAI was perceived to change the nature of physicians? expertise. Three themes emerged from the cross-SWOT analysis for curriculum reform: (1) learning about GAI, (2) learning with GAI, and (3) learning aside from GAI. Participants recommended incorporating GAI literacy, ethical considerations, and compliance into the curriculum. Learning with GAI involved improving learning efficiency, supporting information gathering and dissemination, and facilitating patient involvement. Learning aside from GAI emphasized maintaining GAI-free learning processes, fostering higher cognitive domains of learning, and introducing more communication exercises. Conclusions: This study highlights the profound impact of GAI on medical education curricula and provides insights into curriculum reform strategies. Participants recognized the need for GAI literacy, ethical education, and adaptive learning. Further, GAI was recognized as a tool that can enhance efficiency and involve patients in education. The study also suggests that medical education should focus on competencies that GAI hardly replaces, such as clinical experience and communication. Notably, involving both faculty and students in curriculum reform discussions fosters a sense of ownership and ensures broader perspectives are encompassed. UR - https://mededu.jmir.org/2023/1/e53466 UR - http://dx.doi.org/10.2196/53466 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032695 ID - info:doi/10.2196/53466 ER - TY - JOUR AU - Hazelton, Lara AU - da Luz Dias, Raquel AU - Esliger, Mandy AU - Tibbo, Philip AU - Sinha, Nachiketa AU - Njoku, Anthony AU - Satyanarayana, Satyendra AU - Siddhartha, Sanjay AU - Alexiadis-Brown, Peggy AU - Rahman, Faisal AU - Maguire, Hugh AU - Gray, Gerald AU - Bosma, Mark AU - Parker, Deborah AU - Connolly, Owen AU - Raji, Adewale AU - Manning, Alexandra AU - Bagnell, Alexa AU - Israel Opoku Agyapong, Vincent PY - 2023/11/27 TI - Exploring Current Practices, Needs, and Barriers for Expanding Distributed Medical Education and Scholarship in Psychiatry: Protocol for an Environmental Scan Using a Formal Information Search Approach and Explanatory Design JO - JMIR Res Protoc SP - e46835 VL - 12 KW - distributed learning sites KW - medical education KW - psychiatry KW - environmental scan KW - needs assessment KW - strategic plan KW - distributed medical education KW - rural area KW - physician KW - mixed methods approach KW - education program N2 - Background: Distributed medical education (DME) offers manifold benefits, such as increased training capacity, enhanced clinical learning, and enhanced rural physician recruitment. Engaged faculty are pivotal to DME's success, necessitating efforts from the academic department to promote integration into scholarly and research activities. Environmental scanning has been used to gather, analyze, and apply information for strategic planning purposes. It helps organizations identify current practices, assess needs and barriers, and respond to emerging risks and opportunities. There are process models and conceptual frameworks developed for environmental scanning in the business and educational sectors. However, the literature lacks methodological direction on how to go about designing and implementing this strategy to guide research and practice in DME, especially in the psychiatry field. Objective: This paper presents a protocol for an environmental scanning that aims to understand current practices and identify needs and barriers that must be addressed to facilitate the integration of psychiatrists from the Dalhousie University Faculty of Medicine?s distributed education sites in Nova Scotia and New Brunswick into the Department of Psychiatry, contributing for the expansion of DME in both provinces and informing strategic planning and decision-making within the organization. Methods: This protocol adopts an innovative approach combining a formal information search and an explanatory design that includes quantitative and qualitative data. About 120 psychiatrists from 8 administrative health zones of both provinces will be invited to complete an anonymous web-based survey with questions about demographics, participants' experience and interest in undergraduate, postgraduate, and continuing medical education, research and scholarly activities, quality improvement, and knowledge translation. Focus group sessions will be conducted with a purposive sample of psychiatrists to collect qualitative data on their perspectives on the expansion of DME. Results: Results are expected within 6 months of data collection and will inform policy options for expanding Dalhousie University?s psychiatry residency and fellowship programs using the infrastructure and human resources at distributed learning sites, leveraging opportunities regionally, especially in rural areas. Conclusions: This paper proposes a comprehensive environmental scan procedure adapted from existing approaches. It does this by collecting important characteristics that affect psychiatrists' desire to be involved with research and scholarly activities, which is crucial for the DME expansion. Furthermore, its concordance with the literature facilitates interpretation and comparison. The protocol's new method also fills DME information gaps, allowing one to identify insights and patterns that may shape psychiatric education. This environmental scan's results will answer essential questions about how training programs could involve therapists outside the academic core and make the most of training experiences in semiurban and rural areas. This could help other psychiatry and medical units outside tertiary care establish residency and fellowship programs. International Registered Report Identifier (IRRID): DERR1-10.2196/46835 UR - https://www.researchprotocols.org/2023/1/e46835 UR - http://dx.doi.org/10.2196/46835 UR - http://www.ncbi.nlm.nih.gov/pubmed/38010790 ID - info:doi/10.2196/46835 ER - TY - JOUR AU - Davoudi, Kaveh AU - Rakhecha, Tushar AU - Corriero, Chiara Anna AU - Ko, Natalie Kar Chang AU - Ismail, Roseanne AU - King, B. Esther R. AU - Hollén, Linda PY - 2023/11/24 TI - The Impact of UK Medical Students? Demographics and Socioeconomic Factors on Their Self-Reported Familiarity With the Postgraduate Training Pathways and Application Process: Cross-Sectional Study JO - JMIR Med Educ SP - e49013 VL - 9 KW - age KW - career progression KW - clinicians KW - cross-sectional study KW - demographics KW - ethnicity KW - gender KW - leadership KW - medical students demographics KW - medical students KW - online survey KW - research KW - students KW - teaching KW - training N2 - Background: UK medical graduates can apply for specialty training after completing a 2-year internship (foundation training). Postfoundation training application requirements vary depending on specialty but fundamentally require key skills such as teaching, research, and leadership. Objective: This study investigated whether medical student demographics impact their self-reported familiarity with the Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP). Methods: This was a cross-sectional study using a Bristol Online Survey. We invited all UK medical students to answer a range of questions about their demographics. Students were then asked to rank their familiarity with PFTPs and PFAP on a scale of 1 to 5 (1=least familiar and 5=most familiar). The responses were collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata (version 17.1; StataCorp) using chi-square tests. Results: A total of 850 students from 31 UK medical schools took part. There was a significant difference between gender and self-reported familiarity with PFTPs (P<.001) and PFAP (P<.001), with male students expressing higher familiarity. Similarly, there was a difference between ethnicity and self-reported familiarity with PFTPs (P=.02) and PFAP (P<.001), with White students more likely to express higher familiarity than their Black, Asian, or Mixed Ethnic counterparts. Lastly, there was an overall difference between medical background and age and self-reported familiarity with PFTPs and PFAP (all P<.001), with students from medical backgrounds and older students being more likely to express higher familiarity. Conclusions: The impact of gender, ethnicity, age, and medical background on students? self-reported familiarity with PFTPs and PFAP is significant. Further studies are required to evaluate the impact of these factors on tested knowledge of PFTPs and PFAP and whether this impacts the success rate of postfoundation applications. UR - https://mededu.jmir.org/2023/1/e49013 UR - http://dx.doi.org/10.2196/49013 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999951 ID - info:doi/10.2196/49013 ER - TY - JOUR AU - Alzoubi, Hiba AU - Karasneh, Reema AU - Irshaidat, Sara AU - Abuelhaija, Yussuf AU - Abuorouq, Saleh AU - Omeish, Haya AU - Daromar, Shrouq AU - Makhadmeh, Naheda AU - Alqudah, Mohammad AU - Abuawwad, T. Mohammad AU - Taha, J. Mohammad J. AU - Baniamer, Ansam AU - Abu Serhan, Hashem PY - 2023/11/24 TI - Exploring the Use of YouTube as a Pathology Learning Tool and Its Relationship With Pathology Scores Among Medical Students: Cross-Sectional Study JO - JMIR Med Educ SP - e45372 VL - 9 KW - pathology KW - medical students KW - YouTube KW - social media KW - medical education KW - online resources N2 - Background: YouTube is considered one of the most popular sources of information among college students. Objective: This study aimed to explore the use of YouTube as a pathology learning tool and its relationship with pathology scores among medical students at Jordanian public universities. Methods: This cross-sectional, questionnaire-based study included second-year to sixth-year medical students from 6 schools of medicine in Jordan. The questionnaire was distributed among the students using social platforms over a period of 2 months extending from August 2022 to October 2022. The questionnaire included 6 attributes. The first section collected demographic data, and the second section investigated the general use of YouTube and recorded material. The remaining 4 sections targeted the participants who used YouTube to learn pathology including using YouTube for pathology-related content. Results: As of October 2022, 699 students were enrolled in the study. More than 60% (422/699, 60.4%) of the participants were women, and approximately 50% (354/699, 50.6%) were second-year students. The results showed that 96.5% (675/699) of medical students in Jordan were using YouTube in general and 89.1% (623/699) were using it as a source of general information. YouTube use was associated with good and very good scores among the users. In addition, 82.3% (575/699) of medical students in Jordan used YouTube as a learning tool for pathology in particular. These students achieved high scores, with 428 of 699 (61.2%) students scoring above 70%. Most participants (484/699, 69.2%) reported that lectures on YouTube were more interesting than classic teaching and the lectures could enhance the quality of learning (533/699, 76.3%). Studying via YouTube videos was associated with higher odds (odds ratio [OR] 3.86, 95% CI 1.33-11.18) and lower odds (OR 0.27, 95% CI 0.09-0.8) of achieving higher scores in the central nervous system and peripheral nervous system courses, respectively. Watching pathology lectures on YouTube was related to a better chance of attaining higher scores (OR 1.96, 95% CI 1.08-3.57). Surprisingly, spending more time watching pathology videos on YouTube while studying for examinations corresponded with lower performance, with an OR of 0.46 (95% CI 0.26-0.82). Conclusions: YouTube may play a role in enhancing pathology learning, and aiding in understanding, memorization, recalling information, and obtaining higher scores. Many medical students in Jordan have positive attitudes toward using YouTube as a supplementary pathology learning tool. Based on this, it is recommended that pathology instructors should explore the use of YouTube and other emerging educational tools as potential supplementary learning resources. UR - https://mededu.jmir.org/2023/1/e45372/ UR - http://dx.doi.org/10.2196/45372 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45372 ER - TY - JOUR AU - Blomberg, Debra AU - Stephenson, Christopher AU - Atkinson, Teresa AU - Blanshan, Anissa AU - Cabrera, Daniel AU - Ratelle, T. John AU - Mohabbat, B. Arya PY - 2023/11/15 TI - Continuing Medical Education in the Post COVID-19 Pandemic Era JO - JMIR Med Educ SP - e49825 VL - 9 KW - continuing medical education KW - post COVID-19 pandemic KW - content development KW - collaboration KW - audience KW - marketing KW - budgeting KW - accreditation KW - evaluation and outcomes KW - competitive assessment KW - education KW - development KW - assessment KW - continuing education KW - medical education KW - framework UR - https://mededu.jmir.org/2023/1/e49825 UR - http://dx.doi.org/10.2196/49825 UR - http://www.ncbi.nlm.nih.gov/pubmed/37966881 ID - info:doi/10.2196/49825 ER - TY - JOUR AU - Schwarzkopf, Sophie-Caroline AU - Distler, Marius AU - Welsch, Thilo AU - Krause-Jüttler, Grit AU - Weitz, Jürgen AU - Kolbinger, R. Fiona PY - 2023/11/9 TI - Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study JO - JMIR Serious Games SP - e44708 VL - 11 KW - Serious game KW - surgical education KW - clinical reasoning KW - medical education KW - postoperative complications KW - educational games KW - computer-based learning KW - colorectal surgery KW - decision-making KW - pancreatic surgery N2 - Background: The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education. Objective: This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis. Methods: In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants? proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out. Results: A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%). Conclusions: Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care. UR - https://games.jmir.org/2023/1/e44708 UR - http://dx.doi.org/10.2196/44708 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943588 ID - info:doi/10.2196/44708 ER - TY - JOUR AU - Zhang, Yue Xi AU - Arata Found, Anelyse AU - Butler, Sheila PY - 2023/11/8 TI - Effects of Distance-Learning Strategies in Dental Fixed Prosthodontics Amidst the COVID-19 Pandemic: Cross-Sectional Questionnaire Study on Preclinical Dental Students? Perspective JO - JMIR Form Res SP - e45311 VL - 7 KW - dental education KW - dental KW - dentist KW - dentistry KW - technology-based learning KW - online learning KW - pre-clinical training KW - distance learning KW - transmissibility KW - dental school KW - mental health KW - COVID-19 KW - student perception KW - online teaching KW - survey KW - teaching methods KW - training KW - isolation KW - teaching KW - module KW - education N2 - Background: COVID-19?s high transmissibility led to gathering restrictions where dental schools experienced disruptions due to restrictions on attending in-person lectures and limitations placed on applied preclinical and clinical activities. Students not only had to rapidly switch to digital technology-based learning (TB-learning) modules but also experienced high levels of social isolation and anxiety around virus transmission. Objective: This study aims to evaluate the preclinical students? perception of switching TB-learning modules amidst the COVID-19 pandemic, identifying which module parameters were associated with strong student outcomes. Methods: A web-based survey of 39 Likert scale questions was delivered to preclinical dental students (Western University) to evaluate students? perceptions concerning TB-learning, fear amidst the COVID-19 pandemic, and the impact on their preclinical training. A Spearman rank correlation coefficient was determined to estimate the relationship between 2 variables in isolation (P=.01). An ordinal regression analysis was performed on variables of interest to determine how module variables (typically within the instructor?s control) influenced the student outcomes (P=.05). Results: The response rate was 30% (n=39). TB-learning was considered vital (34/39, 87.2%) as the students? education improved (18/39, 46.2%). However, 53.8% (n=21) of students showed increased difficulties in retaining, visualizing, or understanding the materials using TB-learning, and 64.1% (n=25) found it more difficult to concentrate than in in-person classes. In total, 79.5% (n=31) of students showed different levels of agreement about feeling fatigued from TB-learning. Through Spearman ? correlation analysis, the quality of questions in quizzes (?=0.514; P<.001), relevant handouts (?=0.729; P<.001), and high-quality audiovisuals (?=0.585; P<.001) were positively correlated with students responding that the modules were useful to preclinical training. Similarly, good organization (?=0.512; P<.001), high-quality questions in quizzes (?=0.431; P=.01), and relevant handouts (?=0.551; P<.001) were positively correlated with web-based classes as an effective way to learn. In total, 91.6% (n=36) of the students agreed that COVID-19 was a dangerous disease, whereas 53.8% (n=21) showed different levels of agreement that they were afraid to be infected personally, and 69.2% (n=27) feared passing COVID-19 along to family and friends. A total of 82.1% (n=32) of the students showed that COVID-19 impacted their overall learning process and had a negative impact on their practical preclinical training (31/39, 79.5%). Conclusions: The students found a difference between TB-learning and face-to-face learning methods, where the students perceived fatigue toward the web-based method with difficulty concentrating and visualizing the subject. Moreover, there was a consensus that COVID-19 itself affected the students? overall learning process and preclinical training. As dental schools continue implementing TB-learning into their curriculum, this investigation identifies the students? struggles with the paradigm shift. In an effort to improve TB-learning, this work highlights 4 variables (organization, quizzes, quality handouts, and quality audiovisuals) within the control of instructors that can help improve content deliverance, improving the students? experience. UR - https://formative.jmir.org/2023/1/e45311 UR - http://dx.doi.org/10.2196/45311 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938882 ID - info:doi/10.2196/45311 ER - TY - JOUR AU - Kluge, G. Murielle AU - Maltby, Steven AU - Kuhne, Caroline AU - Walker, Nicole AU - Bennett, Neanne AU - Aidman, Eugene AU - Nalivaiko, Eugene AU - Walker, Rohan Frederick PY - 2023/11/6 TI - Evaluation of a Virtual Reality Platform to Train Stress Management Skills for a Defense Workforce: Multisite, Mixed Methods Feasibility Study JO - J Med Internet Res SP - e46368 VL - 25 KW - virtual reality KW - workplace training KW - stress management KW - defense N2 - Background: Psychological stress-related injuries within first-responder organizations have created a need for the implementation of effective stress management training. Most stress management training solutions have limitations associated with scaled adoption within the workforce. For instance, those that are effective in civilian populations often do not align with the human performance culture embedded within first-responder organizations. Programs involving expert-led instructions that are high in quality are often expensive. Objective: This study sought to evaluate a tailored stress management training platform within the existing training schedule of the Australian Defense Force (ADF). The platform, known as Performance Edge (PE), is a novel virtual reality (VR) and biofeedback-enabled stress management skills training platform. Focusing on practical training of well-established skills and strategies, the platform was designed to take advantage of VR technology to generate an immersive and private training environment. This study aimed to assess the feasibility of delivering the VR platform within the existing group-based training context and intended training population. In this setting, the study further aimed to collect data on critical predictors of user acceptance and technology adoption in education, including perceived usability, usefulness, and engagement, while also assessing training impacts. Methods: This study used a mixed methods, multisite approach to collect observational, self-reported, and biometric data from both training staff and trainers within a real-world ?on-base? training context in the ADF. Validated scales include the Presence Questionnaire and User Engagement Scale for perceived usefulness, usability, and engagement, as well as the State Mindfulness Scale and Relaxation Inventory, to gain insights into immediate training impacts for specific training modules. Additional surveys were specifically developed to assess implementation feedback, intention to use skills, and perceived training impact and value. Results: PE training was delivered to 189 ADF trainees over 372 training sessions. The platform was easy to use at an individual level and was feasible to deliver in a classroom setting. Trainee feedback consistently showed high levels of engagement and a sense of presence with the training content and environment. PE is overall perceived as an effective and useful training tool. Self-report and objective indices confirmed knowledge improvement, increased skill confidence, and increased competency after training. Specific training elements resulted in increased state mindfulness, increased physical relaxation, and reduced breathing rate. The ability to practice cognitive strategies in a diverse, private, and immersive training environment while in a group setting was highlighted as particularly valuable. Conclusions: This study found the VR-based platform (PE) to be a feasible stress management training solution for group-based training delivery in a defense population. Furthermore, the intended end users, both trainers and trainees, perceive the platform to be usable, useful, engaging, and effective for training, suggesting end-user acceptance and potential for technology adoption. UR - https://www.jmir.org/2023/1/e46368 UR - http://dx.doi.org/10.2196/46368 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930751 ID - info:doi/10.2196/46368 ER - TY - JOUR AU - Akhras, Aya AU - ElSaban, Mariam AU - Tamil?Selvan, Varshini AU - Alzaabi, Zain Shaika AU - Senok, Abiola? AU - Zary, Nabil AU - Ho, B. Samuel PY - 2023/11/6 TI - An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (?COVID-19 Rounds?): Cross-Sectional Study JO - JMIR Med Educ SP - e40264 VL - 9 KW - medical education KW - COVID-19 KW - technology-enhanced learning KW - distance learning KW - student engagement KW - 5E instructional model N2 - Background: The COVID-19 pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called ?COVID-19 Rounds? to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called ?COVID-19 Rounds? and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19?related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based ?COVID-19 Rounds? course. This program included web-based clinical experiences with physicians on actual rounds in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81%) out of 47 fourth-year medical students participated in this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale. Most students were satisfied with the course format (27/38, 71%), organization (31/38, 82%), and the learning experience (28/38, 74%) that the course offered. The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90%), providing weekly updates regarding emerging evidence (32/38, 84%), and enhancing understanding of the challenges of the pandemic (34/38, 90%). Satisfaction with distance learning was moderate (23/37, 62%), and a minority of students would have preferred an in-person version of the course (10/37, 27%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were also highlighted. UR - https://mededu.jmir.org/2023/1/e40264 UR - http://dx.doi.org/10.2196/40264 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856734 ID - info:doi/10.2196/40264 ER - TY - JOUR AU - Ozmen, Sevin AU - Amarnath, Arpana AU - Struijs, Sascha AU - de Wit, Leonore AU - Cuijpers, Pim PY - 2023/11/3 TI - A Guided Web-Based Intervention Targeting Procrastination in College Students: Protocol for an Open Trial JO - JMIR Res Protoc SP - e44907 VL - 12 KW - eHealth KW - feasibility KW - guidance KW - online intervention KW - procrastination KW - protocol N2 - Background: Academic procrastination is a widespread problem among college students. It is linked to poor academic performance and increased college dropout intentions, as well as several mental health problems such as depression, anxiety, and stress. Guided web-based interventions can help reduce procrastination. However, guidance by professional clinicians draws upon valuable and limited societal resources, and a more efficient, scalable form of guidance is needed. Guidance by trained clinical psychology students has not yet been examined. Objective: The aim of this open trial is to examine the feasibility and acceptability of a web-based procrastination intervention for college students under the guidance of student digital coaches (e-coaches). Methods: We developed a single-arm trial of a guided web-based intervention targeting procrastination for the Dutch student population. Guidance is delivered by trained clinical psychology students asynchronously in the form of textual feedback on intervention progress, with the aim of supporting and motivating the participant. Participants are recruited at 7 Dutch universities. Primary outcomes are intervention satisfaction, usability, and adherence, which are assessed by the Client Satisfaction Scale (CSQ-8), System Usability Scale (SUS-10), and number of completed modules, respectively. The primary outcomes will be examined by calculating descriptive statistics. Secondary outcomes are e-coach satisfaction and changes to procrastination, depression, stress, and quality of life from pre- to posttest and follow-up. Results: The project was funded in 2019, and recruitment began in January 2021. As of May 2023, a total of 985 participants were enrolled, of which 372 had completed the posttest and 192 had completed the follow-up. The expected date of analysis and publication of the results is 2024. Conclusions: The results are expected to contribute to the body of literature regarding eHealth in 3 ways. First, we will examine whether students who procrastinate adhere to and are satisfied with an eHealth intervention targeting this problem. Second, we will explore whether an intervention targeting procrastination can also decrease depression and stress. Lastly, we will investigate whether trained psychology students can effectively guide their peers in web-based interventions. Given the shortage of licensed psychologists, exploring alternative sources of guidance is much needed in order to provide students with the mental health support they need. International Registered Report Identifier (IRRID): DERR1-10.2196/44907 UR - https://www.researchprotocols.org/2023/1/e44907 UR - http://dx.doi.org/10.2196/44907 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921841 ID - info:doi/10.2196/44907 ER - TY - JOUR AU - Baglivo, Francesco AU - De Angelis, Luigi AU - Casigliani, Virginia AU - Arzilli, Guglielmo AU - Privitera, Pierpaolo Gaetano AU - Rizzo, Caterina PY - 2023/11/1 TI - Exploring the Possible Use of AI Chatbots in Public Health Education: Feasibility Study JO - JMIR Med Educ SP - e51421 VL - 9 KW - artificial intelligence KW - chatbots KW - medical education KW - vaccination KW - public health KW - medical students KW - large language model KW - generative AI KW - ChatGPT KW - Google Bard KW - AI chatbot KW - health education KW - health care KW - medical training KW - educational support tool KW - chatbot model N2 - Background: Artificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of health care and public health, including medical training. During the ?Hygiene and Public Health? course for fifth-year medical students, a practical training session was conducted on vaccination using AI chatbots as an educational supportive tool. Before receiving specific training on vaccination, the students were given a web-based test extracted from the Italian National Medical Residency Test. After completing the test, a critical correction of each question was performed assisted by AI chatbots. Objective: The main aim of this study was to identify whether AI chatbots can be considered educational support tools for training in public health. The secondary objective was to assess the performance of different AI chatbots on complex multiple-choice medical questions in the Italian language. Methods: A test composed of 15 multiple-choice questions on vaccination was extracted from the Italian National Medical Residency Test using targeted keywords and administered to medical students via Google Forms and to different AI chatbot models (Bing Chat, ChatGPT, Chatsonic, Google Bard, and YouChat). The correction of the test was conducted in the classroom, focusing on the critical evaluation of the explanations provided by the chatbot. A Mann-Whitney U test was conducted to compare the performances of medical students and AI chatbots. Student feedback was collected anonymously at the end of the training experience. Results: In total, 36 medical students and 5 AI chatbot models completed the test. The students achieved an average score of 8.22 (SD 2.65) out of 15, while the AI chatbots scored an average of 12.22 (SD 2.77). The results indicated a statistically significant difference in performance between the 2 groups (U=49.5, P<.001), with a large effect size (r=0.69). When divided by question type (direct, scenario-based, and negative), significant differences were observed in direct (P<.001) and scenario-based (P<.001) questions, but not in negative questions (P=.48). The students reported a high level of satisfaction (7.9/10) with the educational experience, expressing a strong desire to repeat the experience (7.6/10). Conclusions: This study demonstrated the efficacy of AI chatbots in answering complex medical questions related to vaccination and providing valuable educational support. Their performance significantly surpassed that of medical students in direct and scenario-based questions. The responsible and critical use of AI chatbots can enhance medical education, making it an essential aspect to integrate into the educational system. UR - https://mededu.jmir.org/2023/1/e51421 UR - http://dx.doi.org/10.2196/51421 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910155 ID - info:doi/10.2196/51421 ER - TY - JOUR AU - Bahattab, Awsan AU - Caviglia, Marta AU - Martini, Daniela AU - Hubloue, Ives AU - Della Corte, Francesco AU - Ragazzoni, Luca PY - 2023/10/30 TI - Scenario-Based e-Simulation Design for Global Health Education: Theoretical Foundation and Practical Recommendations JO - J Med Internet Res SP - e46639 VL - 25 KW - global health KW - education KW - medical KW - computer simulation KW - scenario-based learning KW - scenario-based e-simulation KW - simulation KW - design KW - training KW - development KW - medical educator UR - https://www.jmir.org/2023/1/e46639 UR - http://dx.doi.org/10.2196/46639 UR - http://www.ncbi.nlm.nih.gov/pubmed/37902810 ID - info:doi/10.2196/46639 ER - TY - JOUR AU - Kunitsu, Yuki PY - 2023/10/30 TI - The Potential of GPT-4 as a Support Tool for Pharmacists: Analytical Study Using the Japanese National Examination for Pharmacists JO - JMIR Med Educ SP - e48452 VL - 9 KW - natural language processing KW - generative pretrained transformer KW - GPT-4 KW - ChatGPT KW - artificial intelligence KW - AI KW - chatbot KW - pharmacy KW - pharmacist N2 - Background: The advancement of artificial intelligence (AI), as well as machine learning, has led to its application in various industries, including health care. AI chatbots, such as GPT-4, developed by OpenAI, have demonstrated potential in supporting health care professionals by providing medical information, answering examination questions, and assisting in medical education. However, the applicability of GPT-4 in the field of pharmacy remains unexplored. Objective: This study aimed to evaluate GPT-4?s ability to answer questions from the Japanese National Examination for Pharmacists (JNEP) and assess its potential as a support tool for pharmacists in their daily practice. Methods: The question texts and answer choices from the 107th and 108th JNEP, held in February 2022 and February 2023, were input into GPT-4. As GPT-4 cannot process diagrams, questions that included diagram interpretation were not analyzed and were initially given a score of 0. The correct answer rates were calculated and compared with the passing criteria of each examination to evaluate GPT-4?s performance. Results: For the 107th and 108th JNEP, GPT-4 achieved an accuracy rate of 64.5% (222/344) and 62.9% (217/345), respectively, for all questions. When considering only the questions that GPT-4 could answer, the accuracy rates increased to 78.2% (222/284) and 75.3% (217/287), respectively. The accuracy rates tended to be lower for physics, chemistry, and calculation questions. Conclusions: Although GPT-4 demonstrated the potential to answer questions from the JNEP and support pharmacists? capabilities, it also showed limitations in handling highly specialized questions, calculation questions, and questions requiring diagram recognition. Further evaluation is necessary to explore its applicability in real-world clinical settings, considering the complexities of patient scenarios and collaboration with health care professionals. By addressing these limitations, GPT-4 could become a more reliable tool for pharmacists in their daily practice. UR - https://mededu.jmir.org/2023/1/e48452 UR - http://dx.doi.org/10.2196/48452 UR - http://www.ncbi.nlm.nih.gov/pubmed/37837968 ID - info:doi/10.2196/48452 ER - TY - JOUR AU - Bahattab, Awsan AU - Hanna, Michel AU - Teo Voicescu, George AU - Hubloue, Ives AU - Della Corte, Francesco AU - Ragazzoni, Luca PY - 2023/10/24 TI - e-Learning Evaluation Framework and Tools for Global Health and Public Health Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e49955 VL - 12 KW - computer-assisted instruction KW - disaster medicine KW - disaster KW - e-learning KW - educational assessment KW - global health KW - medical education KW - public health KW - evaluation KW - scoping KW - review methods KW - review methodology KW - education KW - educational N2 - Background: There has been a significant increase in the use of e-learning for global and public health education recently, especially following the COVID-19 pandemic. e-Learning holds the potential to offer equal opportunities, overcoming barriers like physical limitations and training costs. However, its effectiveness remains debated, with institutions unprepared for the sudden shift during the pandemic. To effectively evaluate the outcomes of e-learning, a standardized and rigorous approach is necessary. However, the existing literature on this subject often lacks standardized assessment tools and theoretical foundations, leading to ambiguity in the evaluation process. Consequently, it becomes imperative to identify a clear theoretical foundation and practical approach for evaluating global and public health e-learning outcomes. Objective: This protocol for a scoping review aims to map the state of e-learning evaluation in global and public health education to determine the existing theoretical evaluation frameworks, methods, tools, and domains and the gaps in research and practice. Methods: The scoping review will be conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The initial search was performed in PubMed, Education Resource Information Center, Web of Science, and Scopus to identify peer-reviewed articles that report on the use of evaluation and assessment for e-learning training. The search strings combined the concepts of e-learning, public health, and health science education, along with evaluation and frameworks. After the initial search, a screening process will be carried out to determine the relevance of the identified studies to the research question. Data related to the characteristics of the included studies, the characteristics of the e-learning technology used in the studies, and the study outcomes will be extracted from the eligible articles. The extracted data will then undergo a structured, descriptive, quantitative, and qualitative content analysis to synthesize the information from the selected studies. Results:  Initial database searches yielded a total of 980 results. Duplicates have been removed, and title and abstract screening of the 805 remaining extracted articles are underway. Quantitative and qualitative findings from the reviewed articles will be presented to answer the study objective. Conclusions: This scoping review will provide global and public health educators with a comprehensive overview of the current state of e-learning evaluation. By identifying existing e-learning frameworks and tools, the findings will offer valuable guidance for further advancements in global and public health e-learning evaluation. The study will also enable the creation of a comprehensive, evidence-based e-learning evaluation framework and tools, which will improve the quality and accountability of global health and public health education. Ultimately, this will contribute to better health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49955 UR - https://www.researchprotocols.org/2023/1/e49955 UR - http://dx.doi.org/10.2196/49955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37874640 ID - info:doi/10.2196/49955 ER - TY - JOUR AU - Preiksaitis, Carl AU - Rose, Christian PY - 2023/10/20 TI - Opportunities, Challenges, and Future Directions of Generative Artificial Intelligence in Medical Education: Scoping Review JO - JMIR Med Educ SP - e48785 VL - 9 KW - medical education KW - artificial intelligence KW - ChatGPT KW - Bard KW - AI KW - educator KW - scoping KW - review KW - learner KW - generative N2 - Background: Generative artificial intelligence (AI) technologies are increasingly being utilized across various fields, with considerable interest and concern regarding their potential application in medical education. These technologies, such as Chat GPT and Bard, can generate new content and have a wide range of possible applications. Objective: This study aimed to synthesize the potential opportunities and limitations of generative AI in medical education. It sought to identify prevalent themes within recent literature regarding potential applications and challenges of generative AI in medical education and use these to guide future areas for exploration. Methods: We conducted a scoping review, following the framework by Arksey and O'Malley, of English language articles published from 2022 onward that discussed generative AI in the context of medical education. A literature search was performed using PubMed, Web of Science, and Google Scholar databases. We screened articles for inclusion, extracted data from relevant studies, and completed a quantitative and qualitative synthesis of the data. Results: Thematic analysis revealed diverse potential applications for generative AI in medical education, including self-directed learning, simulation scenarios, and writing assistance. However, the literature also highlighted significant challenges, such as issues with academic integrity, data accuracy, and potential detriments to learning. Based on these themes and the current state of the literature, we propose the following 3 key areas for investigation: developing learners? skills to evaluate AI critically, rethinking assessment methodology, and studying human-AI interactions. Conclusions: The integration of generative AI in medical education presents exciting opportunities, alongside considerable challenges. There is a need to develop new skills and competencies related to AI as well as thoughtful, nuanced approaches to examine the growing use of generative AI in medical education. UR - https://mededu.jmir.org/2023/1/e48785/ UR - http://dx.doi.org/10.2196/48785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48785 ER - TY - JOUR AU - Hu, Je-Ming AU - Liu, Feng-Cheng AU - Chu, Chi-Ming AU - Chang, Yu-Tien PY - 2023/10/18 TI - Health Care Trainees? and Professionals? Perceptions of ChatGPT in Improving Medical Knowledge Training: Rapid Survey Study JO - J Med Internet Res SP - e49385 VL - 25 KW - ChatGPT KW - large language model KW - medicine KW - perception evaluation KW - internet survey KW - structural equation modeling KW - SEM N2 - Background: ChatGPT is a powerful pretrained large language model. It has both demonstrated potential and raised concerns related to knowledge translation and knowledge transfer. To apply and improve knowledge transfer in the real world, it is essential to assess the perceptions and acceptance of the users of ChatGPT-assisted training. Objective: We aimed to investigate the perceptions of health care trainees and professionals on ChatGPT-assisted training, using biomedical informatics as an example. Methods: We used purposeful sampling to include all health care undergraduate trainees and graduate professionals (n=195) from January to May 2023 in the School of Public Health at the National Defense Medical Center in Taiwan. Subjects were asked to watch a 2-minute video introducing 5 scenarios about ChatGPT-assisted training in biomedical informatics and then answer a self-designed online (web- and mobile-based) questionnaire according to the Kirkpatrick model. The survey responses were used to develop 4 constructs: ?perceived knowledge acquisition,? ?perceived training motivation,? ?perceived training satisfaction,? and ?perceived training effectiveness.? The study used structural equation modeling (SEM) to evaluate and test the structural model and hypotheses. Results: The online questionnaire response rate was 152 of 195 (78%); 88 of 152 participants (58%) were undergraduate trainees and 90 of 152 participants (59%) were women. The ages ranged from 18 to 53 years (mean 23.3, SD 6.0 years). There was no statistical difference in perceptions of training evaluation between men and women. Most participants were enthusiastic about the ChatGPT-assisted training, while the graduate professionals were more enthusiastic than undergraduate trainees. Nevertheless, some concerns were raised about potential cheating on training assessment. The average scores for knowledge acquisition, training motivation, training satisfaction, and training effectiveness were 3.84 (SD 0.80), 3.76 (SD 0.93), 3.75 (SD 0.87), and 3.72 (SD 0.91), respectively (Likert scale 1-5: strongly disagree to strongly agree). Knowledge acquisition had the highest score and training effectiveness the lowest. In the SEM results, training effectiveness was influenced predominantly by knowledge acquisition and partially met the hypotheses in the research framework. Knowledge acquisition had a direct effect on training effectiveness, training satisfaction, and training motivation, with ? coefficients of .80, .87, and .97, respectively (all P<.001). Conclusions: Most health care trainees and professionals perceived ChatGPT-assisted training as an aid in knowledge transfer. However, to improve training effectiveness, it should be combined with empirical experts for proper guidance and dual interaction. In a future study, we recommend using a larger sample size for evaluation of internet-connected large language models in medical knowledge transfer. UR - https://www.jmir.org/2023/1/e49385 UR - http://dx.doi.org/10.2196/49385 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851495 ID - info:doi/10.2196/49385 ER - TY - JOUR AU - Yanagita, Yasutaka AU - Yokokawa, Daiki AU - Uchida, Shun AU - Tawara, Junsuke AU - Ikusaka, Masatomi PY - 2023/10/13 TI - Accuracy of ChatGPT on Medical Questions in the National Medical Licensing Examination in Japan: Evaluation Study JO - JMIR Form Res SP - e48023 VL - 7 KW - artificial intelligence KW - ChatGPT KW - GPT-4 KW - AI KW - National Medical Licensing Examination KW - Japanese KW - NMLE N2 - Background: ChatGPT (OpenAI) has gained considerable attention because of its natural and intuitive responses. ChatGPT sometimes writes plausible-sounding but incorrect or nonsensical answers, as stated by OpenAI as a limitation. However, considering that ChatGPT is an interactive AI that has been trained to reduce the output of unethical sentences, the reliability of the training data is high and the usefulness of the output content is promising. Fortunately, in March 2023, a new version of ChatGPT, GPT-4, was released, which, according to internal evaluations, was expected to increase the likelihood of producing factual responses by 40% compared with its predecessor, GPT-3.5. The usefulness of this version of ChatGPT in English is widely appreciated. It is also increasingly being evaluated as a system for obtaining medical information in languages other than English. Although it does not reach a passing score on the national medical examination in Chinese, its accuracy is expected to gradually improve. Evaluation of ChatGPT with Japanese input is limited, although there have been reports on the accuracy of ChatGPT?s answers to clinical questions regarding the Japanese Society of Hypertension guidelines and on the performance of the National Nursing Examination. Objective: The objective of this study is to evaluate whether ChatGPT can provide accurate diagnoses and medical knowledge for Japanese input. Methods: Questions from the National Medical Licensing Examination (NMLE) in Japan, administered by the Japanese Ministry of Health, Labour and Welfare in 2022, were used. All 400 questions were included. Exclusion criteria were figures and tables that ChatGPT could not recognize; only text questions were extracted. We instructed GPT-3.5 and GPT-4 to input the Japanese questions as they were and to output the correct answers for each question. The output of ChatGPT was verified by 2 general practice physicians. In case of discrepancies, they were checked by another physician to make a final decision. The overall performance was evaluated by calculating the percentage of correct answers output by GPT-3.5 and GPT-4. Results: Of the 400 questions, 292 were analyzed. Questions containing charts, which are not supported by ChatGPT, were excluded. The correct response rate for GPT-4 was 81.5% (237/292), which was significantly higher than the rate for GPT-3.5, 42.8% (125/292). Moreover, GPT-4 surpassed the passing standard (>72%) for the NMLE, indicating its potential as a diagnostic and therapeutic decision aid for physicians. Conclusions: GPT-4 reached the passing standard for the NMLE in Japan, entered in Japanese, although it is limited to written questions. As the accelerated progress in the past few months has shown, the performance of the AI will improve as the large language model continues to learn more, and it may well become a decision support system for medical professionals by providing more accurate information. UR - https://formative.jmir.org/2023/1/e48023 UR - http://dx.doi.org/10.2196/48023 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831496 ID - info:doi/10.2196/48023 ER - TY - JOUR AU - Bälter, Olle AU - Jemstedt, Andreas AU - Javan Abraham, Feben AU - Persson Osowski, Christine AU - Mugisha, Reuben AU - Bälter, Katarina PY - 2023/10/13 TI - Effect of Personalized Email-Based Reminders on Participants? Timeliness in an Online Education Program: Randomized Controlled Trial JO - JMIR Form Res SP - e43977 VL - 7 KW - online learning KW - personal reminders KW - timeliness KW - self-regulated learning KW - adult education KW - education KW - students KW - learning KW - email KW - online KW - tool KW - intervention KW - program N2 - Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students? study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination. Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time. Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course. Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one?s studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time. Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was?adding a few words with the page number the student ought to be on to a reminder?we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming. UR - https://formative.jmir.org/2023/1/e43977 UR - http://dx.doi.org/10.2196/43977 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831487 ID - info:doi/10.2196/43977 ER - TY - JOUR AU - Castellucci, Clara AU - Malorgio, Amos AU - Budowski, Dinah Alexandra AU - Akbas, Samira AU - Kolbe, Michaela AU - Grande, Bastian AU - Braun, Julia AU - Noethiger, B. Christoph AU - Spahn, R. Donat AU - Tscholl, Werner David AU - Roche, Raoul Tadzio PY - 2023/10/12 TI - Coagulation Management of Critically Bleeding Patients With Viscoelastic Testing Presented as a 3D-Animated Blood Clot (The Visual Clot): Randomized Controlled High-Fidelity Simulation Study JO - J Med Internet Res SP - e43895 VL - 25 KW - avatar technology KW - coagulation management KW - high-fidelity simulation KW - point-of-care testing KW - thrombelastography KW - user-centered design KW - Visual Clot N2 - Background: Guidelines recommend using viscoelastic coagulation tests to guide coagulation management, but interpreting the results remains challenging. Visual Clot, a 3D animated blood clot, facilitates interpretation through a user-centered and situation awareness?oriented design. Objective: This study aims to compare the effects of Visual Clot versus conventional viscoelastic test results (rotational thrombelastometry [ROTEM] temograms) on the coagulation management performance of anesthesia teams in critical bleeding situations. Methods: We conducted a prospective, randomized, high-fidelity simulation study in which anesthesia teams (consisting of a senior anesthesiologist, a resident anesthesiologist, and an anesthesia nurse) managed perioperative bleeding scenarios. Teams had either Visual Clot or ROTEM temograms available to perform targeted coagulation management. We analyzed the 15-minute simulations with post hoc video analysis. The primary outcome was correct targeted coagulation therapy. Secondary outcomes were time to targeted coagulation therapy, confidence, and workload. In addition, we have conducted a qualitative survey on user acceptance of Visual Clot. We used Poisson regression, Cox regression, and mixed logistic regression models, adjusted for various potential confounders, to analyze the data. Results: We analyzed 59 simulations. Teams using Visual Clot were more likely to deliver the overall targeted coagulation therapy correctly (rate ratio 1.56, 95% CI 1.00-2.47; P=.05) and administer the first targeted coagulation product faster (hazard ratio 2.58, 95% CI 1.37-4.85; P=.003). In addition, participants showed higher decision confidence with Visual Clot (odds ratio 3.60, 95% CI 1.49-8.71; P=.005). We found no difference in workload (coefficient ?0.03, 95% CI ?3.08 to 2.88; P=.99). Conclusions: Using Visual Clot led to a more accurate and faster-targeted coagulation therapy than using ROTEM temograms. We suggest that relevant viscoelastic test manufacturers consider augmenting their complex result presentation with intuitive, easy-to-understand visualization to ease users? burden from unnecessary cognitive load and enhance patient care. UR - https://www.jmir.org/2023/1/e43895 UR - http://dx.doi.org/10.2196/43895 UR - http://www.ncbi.nlm.nih.gov/pubmed/37824182 ID - info:doi/10.2196/43895 ER - TY - JOUR AU - Ozkara, Berksu Burak AU - Karabacak, Mert AU - Ozcan, Zeynep AU - Bisdas, Sotirios PY - 2023/10/6 TI - Adaptive Peer Tutoring and Insights From a Neurooncology Course JO - JMIR Med Educ SP - e48765 VL - 9 KW - COVID-19 KW - distance learning KW - medical education KW - mentoring KW - peer teaching KW - web-based tutoring UR - https://mededu.jmir.org/2023/1/e48765 UR - http://dx.doi.org/10.2196/48765 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801350 ID - info:doi/10.2196/48765 ER - TY - JOUR AU - Meskó, Bertalan PY - 2023/10/4 TI - Prompt Engineering as an Important Emerging Skill for Medical Professionals: Tutorial JO - J Med Internet Res SP - e50638 VL - 25 KW - artificial intelligence KW - AI KW - digital health KW - future KW - technology KW - ChatGPT KW - GPT-4 KW - large language models KW - language model KW - LLM KW - prompt KW - prompts KW - prompt engineering KW - AI tool KW - engineering KW - healthcare professional KW - decision-making KW - LLMs KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - NLP KW - natural language processing UR - https://www.jmir.org/2023/1/e50638 UR - http://dx.doi.org/10.2196/50638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792434 ID - info:doi/10.2196/50638 ER - TY - JOUR AU - Aksoy, Emin Mehmet AU - Özkan, Ekin Arun AU - Kitapcioglu, Dilek AU - Usseli, Tuba PY - 2023/9/28 TI - Comparing the Outcomes of Virtual Reality?Based Serious Gaming and Lecture-Based Training for Advanced Life Support Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e46964 VL - 11 KW - Advanced Cardiac Life Support KW - virtual reality KW - serious game KW - randomized controlled trial KW - Advanced Life Support N2 - Background: Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)?based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training. Objective: The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training. Methods: Participants were students from Acibadem Mehmet Ali Aydinlar University?s Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups? performances in this study. Results: The improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game?based training instead of classroom lectures. Conclusions: Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups? total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming. Trial Registration: ClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910 UR - https://games.jmir.org/2023/1/e46964 UR - http://dx.doi.org/10.2196/46964 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768719 ID - info:doi/10.2196/46964 ER - TY - JOUR AU - Flores-Cohaila, A. Javier AU - García-Vicente, Abigaíl AU - Vizcarra-Jiménez, F. Sonia AU - De la Cruz-Galán, P. Janith AU - Gutiérrez-Arratia, D. Jesús AU - Quiroga Torres, Geraldine Blanca AU - Taype-Rondan, Alvaro PY - 2023/9/28 TI - Performance of ChatGPT on the Peruvian National Licensing Medical Examination: Cross-Sectional Study JO - JMIR Med Educ SP - e48039 VL - 9 KW - medical education KW - generative pre-trained transformer KW - ChatGPT KW - licensing examination KW - assessment KW - Peru KW - Examen Nacional de Medicina KW - ENAM KW - learning model KW - artificial intelligence KW - AI KW - medical examination N2 - Background: ChatGPT has shown impressive performance in national medical licensing examinations, such as the United States Medical Licensing Examination (USMLE), even passing it with expert-level performance. However, there is a lack of research on its performance in low-income countries? national licensing medical examinations. In Peru, where almost one out of three examinees fails the national licensing medical examination, ChatGPT has the potential to enhance medical education. Objective: We aimed to assess the accuracy of ChatGPT using GPT-3.5 and GPT-4 on the Peruvian National Licensing Medical Examination (Examen Nacional de Medicina [ENAM]). Additionally, we sought to identify factors associated with incorrect answers provided by ChatGPT. Methods: We used the ENAM 2022 data set, which consisted of 180 multiple-choice questions, to evaluate the performance of ChatGPT. Various prompts were used, and accuracy was evaluated. The performance of ChatGPT was compared to that of a sample of 1025 examinees. Factors such as question type, Peruvian-specific knowledge, discrimination, difficulty, quality of questions, and subject were analyzed to determine their influence on incorrect answers. Questions that received incorrect answers underwent a three-step process involving different prompts to explore the potential impact of adding roles and context on ChatGPT?s accuracy. Results: GPT-4 achieved an accuracy of 86% on the ENAM, followed by GPT-3.5 with 77%. The accuracy obtained by the 1025 examinees was 55%. There was a fair agreement (?=0.38) between GPT-3.5 and GPT-4. Moderate-to-high-difficulty questions were associated with incorrect answers in the crude and adjusted model for GPT-3.5 (odds ratio [OR] 6.6, 95% CI 2.73-15.95) and GPT-4 (OR 33.23, 95% CI 4.3-257.12). After reinputting questions that received incorrect answers, GPT-3.5 went from 41 (100%) to 12 (29%) incorrect answers, and GPT-4 from 25 (100%) to 4 (16%). Conclusions: Our study found that ChatGPT (GPT-3.5 and GPT-4) can achieve expert-level performance on the ENAM, outperforming most of our examinees. We found fair agreement between both GPT-3.5 and GPT-4. Incorrect answers were associated with the difficulty of questions, which may resemble human performance. Furthermore, by reinputting questions that initially received incorrect answers with different prompts containing additional roles and context, ChatGPT achieved improved accuracy. UR - https://mededu.jmir.org/2023/1/e48039 UR - http://dx.doi.org/10.2196/48039 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768724 ID - info:doi/10.2196/48039 ER - TY - JOUR AU - Lumini, José Maria AU - Sousa, Rui Maria AU - Salazar, Berta AU - Martins, Teresa PY - 2023/9/25 TI - Assessing the Effectiveness of a Massive Open Online Course for Caregivers Amid the COVID-19 Pandemic: Methodological Study JO - JMIR Form Res SP - e48398 VL - 7 KW - caregivers KW - education KW - COVID-19 KW - distance KW - effectiveness KW - skill KW - safe care KW - health system KW - older people KW - family KW - social isolation KW - massive open online courses KW - care challenges N2 - Background: The COVID-19 pandemic has presented significant challenges to health care systems, particularly impacting the older population due to their vulnerability and increased susceptibility to severe complications. Many of the most vulnerable individuals rely on informal caregivers, who play a vital role in enabling them to continue living in their homes. However, social isolation and limited access to health services during the pandemic have made caregiving more difficult. In response, massive open online courses (MOOCs) have emerged as a training and support solution for caregivers. This study focuses on a MOOC developed to assist caregivers during the pandemic, aiming to enhance their knowledge of COVID-19 and prevention measures and promote effective self-care practices. Objective: The study?s aim is to develop and validate a MOOC integrating personal and housing hygiene measures to be adopted in self-care?related activities, surveillance, and monitoring by caregivers of the most vulnerable home-dwelling?dependent people, to provide safe care and prevent SARS-CoV-2 infection. Methods: A methodological study was developed. The content of the MOOC was developed based on scientific evidence and a Delphi study. The course was organized into 9 modules, addressing aspects related to safe self-care assistance and minimizing the risk of contagion. A convenience sample of 33 informal caregivers was recruited through a caregivers? association to verify the adequacy of the course. Knowledge questionnaires were administered before and after the course to assess the impact on caregivers? knowledge. The Family Caregiving Factors Inventory was used to evaluate caregiver resources, knowledge, expectations, and difficulties. Additionally, the technology acceptance model was applied to assess participants? satisfaction with the MOOC. Results: Prior to attending the MOOC, participants demonstrated an average knowledge level score of mean 14.94 (SD 2.72). After completing the course, this score significantly increased to mean 16.52 (SD 2.28), indicating an improvement in knowledge. Caregivers found the course accessible, valuable, and applicable to their caregiving roles. Feedback regarding the MOOC?s structure, illustrative videos, and language was overwhelmingly positive. Participants perceived the course as a valuable resource for decision-making in care delivery, leading to enhanced self-esteem and confidence. Conclusions: The MOOC has proven to be an effective tool for increasing caregivers? knowledge and empowering them in their roles. Remarkably, even low-literacy caregivers found the course valuable for its clear and understandable information. The MOOC demonstrated its adaptability to challenges faced during the pandemic, ensuring access to relevant information. This empowering strategy for caregivers has yielded positive outcomes. The MOOC represents a tool to support and empower informal caregivers, enabling them to provide optimal care during difficult times. UR - https://formative.jmir.org/2023/1/e48398 UR - http://dx.doi.org/10.2196/48398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37747772 ID - info:doi/10.2196/48398 ER - TY - JOUR AU - Yang, Han AU - Xiao, Xiang AU - Wu, Xuanyu AU - Fu, Xiaoxu AU - Du, Quanyu AU - Luo, Yan AU - Li, Bin AU - Zeng, Jinhao AU - Zhang, Yi PY - 2023/9/20 TI - Virtual Standardized Patients Versus Traditional Academic Training for Improving Clinical Competence Among Traditional Chinese Medicine Students: Prospective Randomized Controlled Trial JO - J Med Internet Res SP - e43763 VL - 25 KW - virtual standardized patients KW - clinical competence KW - traditional Chinese medicine KW - medical education N2 - Background: The practical training course of internal medicine of traditional Chinese medicine (PTC-IMTCM) is primarily based on traditional case teaching, which can be stressful for teachers. The use of virtual standardized patient (VSP) applications could be an alternative; however, there is limited evidence regarding their feasibility and effectiveness. Objective: This study aimed to build a VSP-TCM application according to the characteristics of PTC-IMTCM and the needs of students and to compare its efficacy with that of traditional teaching in improving TCM clinical competence among students. Methods: A prequestionnaire investigation was conducted before the course, and a VSP-TCM system was developed based on the results of the questionnaire. A randomized controlled trial was then conducted between February 26, 2020, and August 20, 2021. A total of 84 medical students were included and were divided into 2 groups: an observation group, trained with VSP-TCM (n=42, 50%), and a control group, trained with traditional academic training (n=42, 50%). Formative and summative assessments were conducted to evaluate teaching effectiveness. After completing the course, the students were administered a questionnaire to self-assess their satisfaction with the course. A questionnaire was also administered to 15 teachers to uncover their perspectives on VSP-TCM. Results: All participants completed the study. In the formative assessment, the VSP-TCM group performed better in medical interviewing ability (mean 7.19, SD 0.63, vs mean 6.83, SD 0.81; P=.04), clinical judgment (mean 6.48, SD 0.98, vs mean 5.86, SD 1.04; P=.006), and comprehensive ability (mean 6.71, SD 0.59, vs mean 6.40, SD 0.58; P=.02) than the control group. Similarly, in the summative evaluation, the VSP-TCM group performed better in the online systematic knowledge test (OSKT; mean 86.62, SD 2.71, vs mean 85.38, SD 2.62; P=.046), application of TCM technology (mean 87.86, SD 3.04, vs mean 86.19, SD 3.08; P=.02), TCM syndrome differentiation and therapeutic regimen (mean 90.93, SD 2.42, vs mean 89.60, SD 2.86; P=.03), and communication skills (mean 90.67, SD 4.52, vs mean 88.24, SD 4.56; P=.02) than the control group. There was no significant difference in medical writing between both groups (mean 75.07, SD 3.61, vs mean 75.71, SD 2.86; P=.37). The postcourse feedback questionnaire indicated that VSP-TCM can better enhance students? TCM thinking ability (n=39, 93%, vs n=37, 88%; P=.002), medical history collection (n=38, 90%, vs n=30, 72; P=.001), syndrome differentiation and treatment and critical thinking (n=38, 90%, vs n=37, 88%; P=.046), comprehensive clinical application ability (n=40, 95%, vs n=36, 86%; P=.009), interpersonal communication skills (n=36, 86%, vs n=28, 67%; P=.01), and autonomous learning ability (n=37, 88%, vs n=28, 67%; P=.01) than traditional academic training. Similarly, the teachers held a positive perspective on VSP-TCM. Conclusions: VSP-TCM enhances students? TCM clinical competence and dialectical thinking and improves their ability to work autonomously. Moreover, the VSP-TCM system is feasible, practical, and cost-effective and thus merits further promotion in TCM education. UR - https://www.jmir.org/2023/1/e43763 UR - http://dx.doi.org/10.2196/43763 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728989 ID - info:doi/10.2196/43763 ER - TY - JOUR AU - Helle, Nikolina AU - Vikman, Dubland Miriam AU - Dahl-Michelsen, Tone AU - Lie, Stangeland Silje PY - 2023/9/20 TI - Health Care and Social Work Students? Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study JO - JMIR Med Educ SP - e49372 VL - 9 KW - virtual reality KW - virtual reality simulation KW - learning KW - experiences KW - health care and social work KW - higher education KW - health care KW - social work N2 - Background: Virtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students? experiences with such a learning activity. Objective: The aim of this study was to explore occupational therapy, social education, nursing, and social work students? experiences with virtual reality simulation as a learning activity in an interdisciplinary subject. Methods: The data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke. Results: The analysis revealed 3 overall themes for students? experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students? experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students? learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity. Conclusions: Virtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services. UR - https://mededu.jmir.org/2023/1/e49372 UR - http://dx.doi.org/10.2196/49372 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728988 ID - info:doi/10.2196/49372 ER - TY - JOUR AU - Condron, Claire AU - Power, Mide AU - Mathew, Midhun AU - Lucey, M. Siobhan PY - 2023/9/20 TI - Gender Equality Training for Students in Higher Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e44584 VL - 12 KW - gender equality KW - student leaders KW - simulation-based education KW - communications skills KW - training KW - higher education KW - sustainable goal KW - scoping KW - review method KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses KW - search strategy KW - gender KW - equality KW - equalities KW - inclusion KW - diversity KW - postsecondary KW - student KW - teaching KW - coaching KW - teacher KW - educator N2 - Background: The principles of gender equality are integral to the goals, targets, and indicators of all sustainable development goals. Higher education institutes can be powerful agents for promoting gender equality, diversity, and inclusion not only in the higher education context but also in society as a whole. To address and overcome gender inequality in the higher education environment, experts posit that change needs to occur from day 1 of the student?s academic experience. To this end, training is required. A preliminary review of the literature indicates that multiple gender equality?based training programs or initiatives for students have been designed and evaluated in second and third-level education settings. Examples of educational activities undertaken include delivery of didactic teaching, participation in a face-to-face collaboration project, site visits, case studies, and coaching. Yet, our initial search indicated that, to date, a comprehensive review collating the available evidence on gender equality training for third-level students has not yet been carried out. Objective: Our review seeks to identify and explore the existing literature on gender equality training interventions for third-level students, with a particular emphasis on training content, methodology, and outcome evaluation. Methods: This scoping review will be structured using the Arskey and O?Malley?s 5-stage framework and will consider empirical research and other relevant published works that address gender equality training. Systematic searches will be carried out in 6 research databases and the gray literature using key search terms. Inclusion and exclusion criteria have been defined, and a data charting tool created to methodically extract information from selected literature. The free web software Rayyan will be used for primary screening where each reference will be screened in duplicate first by title, then abstract, and finally by full text. Results: This review forms part of the LIBRA (Balance) study and has received peer-reviewed grant funding from the Irish Higher Education Authority. LIBRA aims to use simulation-based education to develop a gender equality leadership training program for student leaders in higher education. The findings will be summarized in tabular form, and a narrative synthesis produced to inform curriculum development. Conclusions: This review seeks to inform curriculum design by reporting on the gender equality?enabling skills and leadership skills necessary to foster gender equality. This paper should inform recommendations for training and catalyze future research in this rapidly evolving area. International Registered Report Identifier (IRRID): DERR1-10.2196/44584 UR - https://www.researchprotocols.org/2023/1/e44584 UR - http://dx.doi.org/10.2196/44584 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728987 ID - info:doi/10.2196/44584 ER - TY - JOUR AU - Huang, ST Ryan AU - Lu, Qi Kevin Jia AU - Meaney, Christopher AU - Kemppainen, Joel AU - Punnett, Angela AU - Leung, Fok-Han PY - 2023/9/19 TI - Assessment of Resident and AI Chatbot Performance on the University of Toronto Family Medicine Residency Progress Test: Comparative Study JO - JMIR Med Educ SP - e50514 VL - 9 KW - medical education KW - medical knowledge exam KW - artificial intelligence KW - AI KW - natural language processing KW - NLP KW - large language model KW - LLM KW - machine learning, ChatGPT KW - GPT-3.5 KW - GPT-4 KW - education KW - language model KW - education examination KW - testing KW - utility KW - family medicine KW - medical residents KW - test KW - community N2 - Background: Large language model (LLM)?based chatbots are evolving at an unprecedented pace with the release of ChatGPT, specifically GPT-3.5, and its successor, GPT-4. Their capabilities in general-purpose tasks and language generation have advanced to the point of performing excellently on various educational examination benchmarks, including medical knowledge tests. Comparing the performance of these 2 LLM models to that of Family Medicine residents on a multiple-choice medical knowledge test can provide insights into their potential as medical education tools. Objective: This study aimed to quantitatively and qualitatively compare the performance of GPT-3.5, GPT-4, and Family Medicine residents in a multiple-choice medical knowledge test appropriate for the level of a Family Medicine resident. Methods: An official University of Toronto Department of Family and Community Medicine Progress Test consisting of multiple-choice questions was inputted into GPT-3.5 and GPT-4. The artificial intelligence chatbot?s responses were manually reviewed to determine the selected answer, response length, response time, provision of a rationale for the outputted response, and the root cause of all incorrect responses (classified into arithmetic, logical, and information errors). The performance of the artificial intelligence chatbots were compared against a cohort of Family Medicine residents who concurrently attempted the test. Results: GPT-4 performed significantly better compared to GPT-3.5 (difference 25.0%, 95% CI 16.3%-32.8%; McNemar test: P<.001); it correctly answered 89/108 (82.4%) questions, while GPT-3.5 answered 62/108 (57.4%) questions correctly. Further, GPT-4 scored higher across all 11 categories of Family Medicine knowledge. In 86.1% (n=93) of the responses, GPT-4 provided a rationale for why other multiple-choice options were not chosen compared to the 16.7% (n=18) achieved by GPT-3.5. Qualitatively, for both GPT-3.5 and GPT-4 responses, logical errors were the most common, while arithmetic errors were the least common. The average performance of Family Medicine residents was 56.9% (95% CI 56.2%-57.6%). The performance of GPT-3.5 was similar to that of the average Family Medicine resident (P=.16), while the performance of GPT-4 exceeded that of the top-performing Family Medicine resident (P<.001). Conclusions: GPT-4 significantly outperforms both GPT-3.5 and Family Medicine residents on a multiple-choice medical knowledge test designed for Family Medicine residents. GPT-4 provides a logical rationale for its response choice, ruling out other answer choices efficiently and with concise justification. Its high degree of accuracy and advanced reasoning capabilities facilitate its potential applications in medical education, including the creation of exam questions and scenarios as well as serving as a resource for medical knowledge or information on community services. UR - https://mededu.jmir.org/2023/1/e50514 UR - http://dx.doi.org/10.2196/50514 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725411 ID - info:doi/10.2196/50514 ER - TY - JOUR AU - Strout, Kelley AU - Schwartz-Mette, Rebecca AU - McNamara, Jade AU - Parsons, Kayla AU - Walsh, Dyan AU - Bonnet, Jen AU - O'Brien, M. Liam AU - Robinson, Kathryn AU - Sibley, Sean AU - Smith, Annie AU - Sapp, Maile AU - Sprague, Lydia AU - Sabegh, Sajedi Nima AU - Robinson, Kaitlin AU - Henderson, Amanda PY - 2023/9/8 TI - Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education JO - JMIR Res Protoc SP - e49020 VL - 12 KW - nursing workforce KW - academic performance KW - burnout KW - resilience KW - wellness KW - nursing KW - education KW - nursing education KW - protocol KW - nursing students KW - students KW - holistic KW - implementation KW - workforce N2 - Background: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. Objective: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. Results: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. Conclusions: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master?s nursing programs in the United States. International Registered Report Identifier (IRRID): DERR1-10.2196/49020 UR - https://www.researchprotocols.org/2023/1/e49020/ UR - http://dx.doi.org/10.2196/49020 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49020 ER - TY - JOUR AU - Simmons, Lisa AU - Barker, Ruth AU - Barnett, Fiona PY - 2023/8/31 TI - Evaluating Allied Health Clinical Placement Performance: Protocol for a Modified Delphi Study JO - JMIR Res Protoc SP - e44020 VL - 12 KW - clinical placement KW - cost of placement KW - learning outcomes KW - student experience KW - student-led health care services N2 - Background: University-affiliated student-led health care services have emerged in response to the challenges faced by universities in securing quality clinical placements for health care students. Evidence of the health care benefits and challenges of student-led health care services is growing, while evidence of clinical placement performance remains variable and not generalizable. Though there have been previous attempts to develop a framework for evaluation of clinical placement performance, concerns have been raised about the applicability of these frameworks across the various placement settings. Additionally, the perspectives of all key stakeholders on the critical areas of clinical placement performance have yet to be considered. Objective: This study?s objective is to gather information on areas of measurement related to student learning outcomes, experience of placement, and costs of placement and then develop consensus on which of those areas need to be included in a framework for evaluation of clinical placement performance within the context of student-led health care services. The aim of this paper is to outline a protocol for a modified Delphi study designed to gain consensus on what is important to measure when evaluating an allied health clinical placement. Methods: We will recruit up to 30 experts to a heterogeneous expert panel in a modified Delphi study. Experts will consist of those with firsthand experience either coordinating, supervising, or undertaking clinical placement. Purposive sampling will be used to ensure maximum variation in expert panel member characteristics. Experts? opinions will be sought on measuring student learning outcomes, student experience, and cost of clinical placement, and other areas of clinical placement performance that are considered important. Three rounds will be conducted to establish consensus on what is important to measure when evaluating clinical placement. Each round is anticipated to yield both quantitative data (eg, percentage of agreement) and qualitative data (eg, free-text responses). In each round, quantitative data will be analyzed descriptively and used to determine consensus, which will be defined as ?70% agreement. Qualitative responses will be analyzed thematically and used to inform the subsequent round. Findings of each round will be presented, both consensus data and qualitative responses in each subsequent round, to inform expert panel members and to elicit further rankings on areas of measurement yet to achieve consensus. Results: Data analysis is currently underway, with a planned publication in 2024. Conclusions: The modified Delphi approach, supported by existing research and its ability to gain consensus through multiround expert engagement, provides an appropriate methodology to inform the development of a framework for the evaluation of clinical placement performance in allied health service. International Registered Report Identifier (IRRID): DERR1-10.2196/44020 UR - https://www.researchprotocols.org/2023/1/e44020 UR - http://dx.doi.org/10.2196/44020 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651163 ID - info:doi/10.2196/44020 ER - TY - JOUR AU - Lau, Tiang Siew AU - Siah, Jiat Rosalind Chiew AU - Dzakirin Bin Rusli, Khairul AU - Loh, Liang Wen AU - Yap, Gwee John Yin AU - Ang, Emily AU - Lim, Ping Fui AU - Liaw, Ying Sok PY - 2023/8/30 TI - Design and Evaluation of Using Head-Mounted Virtual Reality for Learning Clinical Procedures: Mixed Methods Study JO - JMIR Serious Games SP - e46398 VL - 11 KW - user experience KW - acceptability KW - usability KW - virtual patient KW - clinical procedure KW - immersive KW - nursing student KW - virtual reality KW - education KW - performance N2 - Background: The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients? outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited. Objective: The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system. Methods: This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions. Results: Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort. Conclusions: The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses? knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes. UR - https://games.jmir.org/2023/1/e46398 UR - http://dx.doi.org/10.2196/46398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647108 ID - info:doi/10.2196/46398 ER - TY - JOUR AU - Manuel, K. Jennifer AU - Purcell, Natalie AU - Abadjian, Linda AU - Cardoos, Stephanie AU - Yalch, Matthew AU - Hill, Coleen AU - McCarthy, Brittan AU - Bertenthal, Daniel AU - McGrath, Sarah AU - Seal, Karen PY - 2023/8/28 TI - Virtual Worlds Technology to Enhance Training for Primary Care Providers in Assessment and Management of Posttraumatic Stress Disorder Using Motivational Interviewing: Pilot Randomized Controlled Trial JO - JMIR Med Educ SP - e42862 VL - 9 KW - primary care KW - posttraumatic stress disorder KW - PTSD KW - motivational interviewing KW - virtual training KW - training KW - virtual KW - stress KW - disorder KW - treatment KW - patient KW - assessment KW - communication KW - feasibility KW - acceptability KW - efficacy N2 - Background: Many individuals with posttraumatic stress disorder (PTSD) first present to primary care rather than specialty mental health care. Primary care providers often lack the training required to assess and treat patients with PTSD. Virtual trainings have emerged as a convenient and effective way of training primary care providers in PTSD assessment and communication methods (ie, motivational interviewing [MI]). Objective: The aim of this study was to conduct a pilot randomized controlled trial of a synchronous Virtual Worlds (VW; a virtual world where learners were immersed as avatars) training versus an asynchronous web-based training on PTSD and MI, comparing the feasibility, acceptability, usability, and preliminary efficacy of 2 different training platforms among primary care providers. Methods: Participating primary care providers were randomized to a VW and a web-based PTSD training. Outcomes were collected at baseline, posttraining, and 90-days follow-up. Standardized patient interviews measured participants? communication skills in assessing and managing patients with PTSD symptoms. Results: Compared to the web-based training, the VW training platform achieved larger learning gains in MI (ie, partnership and empathy) and in discussing pharmacotherapy and psychotherapy for PTSD. Both VW and web-based trainings led to increases in PTSD knowledge and primary care providers? self-confidence. Conclusions: The asynchronous web-based PTSD training improved PTSD-related knowledge and self-confidence but was not as effective as the VW immersive experience in teaching MI or clinical management. Because VW training is synchronous and new for many learners, it required more time, facilitation, and technical support. As computer technology improves, VW educational interventions may become more feasible, particularly in teaching clinical skills. Trial Registration: ClinicalTrials.gov NCT03898271; https://tinyurl.com/mu479es5 UR - https://mededu.jmir.org/2023/1/e42862 UR - http://dx.doi.org/10.2196/42862 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639299 ID - info:doi/10.2196/42862 ER - TY - JOUR AU - Hong, Chengang AU - Wang, Liping PY - 2023/8/21 TI - Virtual Reality Technology in Nursing Professional Skills Training: Bibliometric Analysis JO - JMIR Serious Games SP - e44766 VL - 11 KW - virtual reality KW - VR KW - nursing professional skills KW - bibliometric analysis KW - visual content analysis KW - extended reality KW - XR KW - augmented reality KW - AR KW - mixed reality N2 - Background: Nursing professional skills training has undergone significant transformation due to the exponential growth of computer and medical technology. The innovative use of virtual reality (VR) in nursing education has emerged as a cutting-edge technical support technique that has gained attention as a highly effective method for improving nurse training quality. Objective: This study aims to review the current status of VR technology in nursing professional skills training, research hotspots, and emerging trends in the last 15 years. Methods: The Web of Science Core Collection database was used to search for literature on VR technology in nursing professional skills training covering the period from 2006 to 2022. Biblioshiny (K-Synth Srl) was used to import and convert the records to Bibliometrix (K-Synth Srl) for analysis, and R (R Core Team) was used for descriptive bibliometric analysis. VOSviewer (Leiden University) was used to cluster co-occurring keywords, and Scimago Graphica (version 1.0.16; Scimago Lab) was used to generate a geographical visualization of published countries and regions. Results: A total of 1073 papers were analyzed, indicating a surge in research on the application of VR in nursing professional skills training in recent years, as evidenced by a positive trend in annual publication of relevant literature. The majority of studies were from the United States (n=340) and Canada (n=107), and Margaret Verkuyl was the most prolific author, leading the way with 9 publications. Furthermore, ?Computerized Virtual Patients in Health Professions Education: a Systematic Review and Meta-Analysis? was the most frequently cited reference. Keywords such as education, simulation, skills, students, and care were most commonly used by researchers. Conclusions: The bibliometric analysis provides a comprehensive overview of the use of VR in nursing professional skills training, indicating that VR-based training is an effective means of improving the skills and competencies of nursing students and professionals alike. The COVID-19 pandemic has reinforced the importance of developing VR-based distance education, despite challenges such as integrating virtual and real-world training and mitigating safety risks. UR - https://games.jmir.org/2023/1/e44766 UR - http://dx.doi.org/10.2196/44766 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603389 ID - info:doi/10.2196/44766 ER - TY - JOUR AU - Lee, Hyeonhoon PY - 2023/8/17 TI - Using ChatGPT as a Learning Tool in Acupuncture Education: Comparative Study JO - JMIR Med Educ SP - e47427 VL - 9 KW - ChatGPT KW - educational tool KW - artificial intelligence KW - acupuncture KW - AI KW - personalized education KW - students N2 - Background: ChatGPT (Open AI) is a state-of-the-art artificial intelligence model with potential applications in the medical fields of clinical practice, research, and education. Objective: This study aimed to evaluate the potential of ChatGPT as an educational tool in college acupuncture programs, focusing on its ability to support students in learning acupuncture point selection, treatment planning, and decision-making. Methods: We collected case studies published in Acupuncture in Medicine between June 2022 and May 2023. Both ChatGPT-3.5 and ChatGPT-4 were used to generate suggestions for acupuncture points based on case presentations. A Wilcoxon signed-rank test was conducted to compare the number of acupuncture points generated by ChatGPT-3.5 and ChatGPT-4, and the overlapping ratio of acupuncture points was calculated. Results: Among the 21 case studies, 14 studies were included for analysis. ChatGPT-4 generated significantly more acupuncture points (9.0, SD 1.1) compared to ChatGPT-3.5 (5.6, SD 0.6; P<.001). The overlapping ratios of acupuncture points for ChatGPT-3.5 (0.40, SD 0.28) and ChatGPT-4 (0.34, SD 0.27; P=.67) were not significantly different. Conclusions: ChatGPT may be a useful educational tool for acupuncture students, providing valuable insights into personalized treatment plans. However, it cannot fully replace traditional diagnostic methods, and further studies are needed to ensure its safe and effective implementation in acupuncture education. UR - https://mededu.jmir.org/2023/1/e47427 UR - http://dx.doi.org/10.2196/47427 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590034 ID - info:doi/10.2196/47427 ER - TY - JOUR AU - Dalavaye, Nishaanth AU - Baskaran, Ravanth AU - Mukhopadhyay, Srinjay AU - Gamage, Peramuna Movin AU - Ng, Vincent AU - Sharif, Hama AU - Rutherford, Stephen PY - 2023/8/17 TI - Exploring the Educational Value of Popular Culture in Web-Based Medical Education: Pre-Post Study on Teaching Jaundice Using ?The Simpsons? JO - JMIR Med Educ SP - e44789 VL - 9 KW - educational innovation KW - jaundice KW - medical education KW - popular culture KW - web-based teaching N2 - Background: The potential of popular culture as a tool for knowledge delivery and enhancing engagement in education is promising but not extensively studied. Furthermore, concerns exist regarding learning fatigue due to increased reliance on videoconferencing platforms following the COVID-19 pandemic. To ensure effective web-based teaching sessions that maintain attention spans and enhance understanding, innovative solutions are necessary. Objective: This study aims to evaluate the use of specific popular culture case studies to enhance student engagement in a web-based near-peer teaching session. Methods: We delivered a web-based teaching session to undergraduate medical students in the United Kingdom. The session included clinical vignettes and single-best-answer questions using characters from ?The Simpsons? television show as patient analogies for various causes of jaundice. A pre-post survey, employing a 7-point Likert scale, was distributed to gather data from participants. Results: A total of 53 survey responses were collected. Participants reported significantly improved understanding of jaundice after the session compared to before the session (median 6, IQR 5-6 vs median 4, IQR 3-4.5; P<.001). The majority of participants agreed that the inclusion of ?The Simpsons? characters enhanced their knowledge and made the teaching session more memorable and engaging (memorability: median 6, IQR 5-7; engagement: median 6, IQR 5-7). Conclusions: When appropriately integrated, popular culture can effectively engage students and improve self-perceived knowledge retention. ?The Simpsons? characters can be used pedagogically and professionally as patient analogies to deliver teaching on the topic of jaundice. UR - https://mededu.jmir.org/2023/1/e44789 UR - http://dx.doi.org/10.2196/44789 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590059 ID - info:doi/10.2196/44789 ER - TY - JOUR AU - Wang, Jiamin AU - Zhen, Xuemei AU - Coyte, C. Peter AU - Shao, Di AU - Zhao, Ni AU - Chang, Lele AU - Feng, Yujia AU - Sun, Xiaojie PY - 2023/8/16 TI - Association Between Online Health Information?Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China JO - J Med Internet Res SP - e46953 VL - 25 KW - online health information?seeking behaviors KW - patient delay KW - diagnostic delay KW - treatment delay KW - mixed methods study N2 - Background: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information?seeking (OHIS) behaviors by caregivers. Objective: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children?s health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers? OHIS behaviors impacted the cancer care pathway by influencing caregivers? symptom appraisal before the first medical contact and caregivers? acceptance of health care providers? diagnostic and treatment decisions. Conclusions: Our ?ndings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers? cancer symptom appraisal before the first medical contact. UR - https://www.jmir.org/2023/1/e46953 UR - http://dx.doi.org/10.2196/46953 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585244 ID - info:doi/10.2196/46953 ER - TY - JOUR AU - Stanich, Jessica AU - Sunga, Kharmene AU - Loprinzi-Brauer, Caitlin AU - Ginsburg, Alexander AU - Ingram, Cory AU - Bellolio, Fernanda AU - Cabrera, Daniel PY - 2023/8/16 TI - Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study JO - JMIR Med Educ SP - e43710 VL - 9 KW - palliative care KW - emergency medicine KW - gaming simulation KW - resident education KW - medical education KW - residency KW - end of life KW - palliative KW - dying KW - death KW - interpersonal skill N2 - Background: Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. Objective: We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. Methods: This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool?Modified survey to evaluate perceived effectiveness in teaching end-of-life management. Results: Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool?Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient?s condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. Conclusions: This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management. UR - https://mededu.jmir.org/2023/1/e43710 UR - http://dx.doi.org/10.2196/43710 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585258 ID - info:doi/10.2196/43710 ER - TY - JOUR AU - Safranek, W. Conrad AU - Sidamon-Eristoff, Elizabeth Anne AU - Gilson, Aidan AU - Chartash, David PY - 2023/8/14 TI - The Role of Large Language Models in Medical Education: Applications and Implications JO - JMIR Med Educ SP - e50945 VL - 9 KW - large language models KW - ChatGPT KW - medical education KW - LLM KW - artificial intelligence in health care KW - AI KW - autoethnography UR - https://mededu.jmir.org/2023/1/e50945 UR - http://dx.doi.org/10.2196/50945 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578830 ID - info:doi/10.2196/50945 ER - TY - JOUR AU - Deutsch, E. Judith AU - Palmieri, L. John AU - Gorin, Holly AU - Wendell, Augustus AU - Wohn, Yvette Donghee AU - Damodaran, Harish PY - 2023/8/10 TI - Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study JO - JMIR Med Educ SP - e44361 VL - 9 KW - physical therapy KW - education KW - teaching tool KW - simulation-based learning KW - computer-aided instruction KW - standardized assessment KW - clinical reasoning KW - sensors N2 - Background: The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale. Objective: This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability. Methods: A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education. Results: The faculty members? and students? positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability. Conclusions: The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption. UR - https://mededu.jmir.org/2023/1/e44361 UR - http://dx.doi.org/10.2196/44361 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561552 ID - info:doi/10.2196/44361 ER - TY - JOUR AU - McQuade, N. Casey AU - Simonson, G. Michael AU - Ehrenberger, A. Kristen AU - Kohli, Amar PY - 2023/8/9 TI - Developing a Web-Based Asynchronous Case Discussion Format on Social Media to Teach Clinical Reasoning: Mixed Methods Study JO - JMIR Med Educ SP - e45277 VL - 9 KW - case discussion KW - case report KW - clinical reasoning KW - clinical vignette KW - junior doctor KW - junior physician KW - medical education KW - medical student KW - morning report KW - report style KW - resident KW - social media KW - trainee KW - Twitter N2 - Background: Case-based learning conferences are valuable to trainees, but growing clinical demands hinder consistent attendance. Social media increasingly acts as a venue for trainees to supplement their education asynchronously. We designed and implemented a web-based asynchronous clinical case discussion series on the Twitter social media platform to fill this educational gap. Objective: The aim of this mixed methods study is to examine the nature of interactions among web-based case discussion participants and assess local attitudes regarding the educational intervention. Methods: Starting in February 2018, we posted clinical vignettes to a dedicated Twitter account with the prompt ?What else do you want to know?? to stimulate discussion. The authors replied in real time when case discussion participants requested additional details. Additional data about the case were posted at regular intervals to the discussion thread to advance the overall case discussion. Participants were asked to explain their reasoning and support their conclusions when appropriate. Web-based engagement was assessed using Twitter Analytics. Participants? posts were qualitatively analyzed for themes, with special attention to examples of using clinical reasoning skills. A codebook of types of participant posts and interactions was refined iteratively. Local engagement and attitudes at our institution were assessed by surveying internal medicine trainees (n=182) and faculty (n=165) after 6 months. Results: Over a 6-month period, 11 live case discussions were engaged with by users 1773 times. A total of 86 Twitter profiles spanning 22 US states and 6 countries contributed to discussions among participants and the authors. Participants from all training levels were present, ranging from students to faculty. Interactions among participants and the case moderators were most commonly driven by clinical reasoning, including hypothesis-driven information gathering, discussing the differential diagnosis, and data interpretation or organization. Of 71 respondents to the local survey, 29 (41%) reported having a Twitter account. Of the 29 respondents with Twitter accounts, 17 (59%) reported participating in the case discussions. Respondents agreed that case participation increased both their clinical reasoning skills (15/17, 88%) and clinical knowledge (13/17, 76%). Conclusions: A social media?based serialized case discussion was a feasible asynchronous teaching method for engaging web-based learners of all levels in a clinical reasoning discussion. Further study should examine what factors drive trainee participation in web-based case discussions and under what circumstances asynchronous discussion might be preferred over in-person teaching activities. UR - https://mededu.jmir.org/2023/1/e45277 UR - http://dx.doi.org/10.2196/45277 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556191 ID - info:doi/10.2196/45277 ER - TY - JOUR AU - Borchert, J. Robin AU - Hickman, R. Charlotte AU - Pepys, Jack AU - Sadler, J. Timothy PY - 2023/8/7 TI - Performance of ChatGPT on the Situational Judgement Test?A Professional Dilemmas?Based Examination for Doctors in the United Kingdom JO - JMIR Med Educ SP - e48978 VL - 9 KW - ChatGPT KW - language models KW - Situational Judgement Test KW - medical education KW - artificial intelligence KW - language model KW - exam KW - examination KW - SJT KW - judgement KW - reasoning KW - communication KW - chatbot N2 - Background: ChatGPT is a large language model that has performed well on professional examinations in the fields of medicine, law, and business. However, it is unclear how ChatGPT would perform on an examination assessing professionalism and situational judgement for doctors. Objective: We evaluated the performance of ChatGPT on the Situational Judgement Test (SJT): a national examination taken by all final-year medical students in the United Kingdom. This examination is designed to assess attributes such as communication, teamwork, patient safety, prioritization skills, professionalism, and ethics. Methods: All questions from the UK Foundation Programme Office?s (UKFPO?s) 2023 SJT practice examination were inputted into ChatGPT. For each question, ChatGPT?s answers and rationales were recorded and assessed on the basis of the official UK Foundation Programme Office scoring template. Questions were categorized into domains of Good Medical Practice on the basis of the domains referenced in the rationales provided in the scoring sheet. Questions without clear domain links were screened by reviewers and assigned one or multiple domains. ChatGPT's overall performance, as well as its performance across the domains of Good Medical Practice, was evaluated. Results: Overall, ChatGPT performed well, scoring 76% on the SJT but scoring full marks on only a few questions (9%), which may reflect possible flaws in ChatGPT?s situational judgement or inconsistencies in the reasoning across questions (or both) in the examination itself. ChatGPT demonstrated consistent performance across the 4 outlined domains in Good Medical Practice for doctors. Conclusions: Further research is needed to understand the potential applications of large language models, such as ChatGPT, in medical education for standardizing questions and providing consistent rationales for examinations assessing professionalism and ethics. UR - https://mededu.jmir.org/2023/1/e48978 UR - http://dx.doi.org/10.2196/48978 UR - http://www.ncbi.nlm.nih.gov/pubmed/37548997 ID - info:doi/10.2196/48978 ER - TY - JOUR AU - Guo, Joyce AU - Blyth, Phil AU - Clifford, Kari AU - Hooper, Nikki AU - Crawford, Haemish PY - 2023/8/2 TI - Transfer Validity of Pediatric Supracondylar Humeral Fracture Pin Placement Practice on In-Theater Performance by Orthopedic Trainees Using an Augmented Reality Simulator: Protocol for a Pilot Interventional Cohort Study With a Retrospective Comparator Cohort JO - JMIR Res Protoc SP - e38282 VL - 12 KW - pediatric orthopedics KW - augmented reality simulator KW - supracondylar humeral fractures KW - closed reduction and percutaneous pinning KW - transfer validity KW - fracture KW - surgeons KW - education KW - practice KW - trainees KW - pediatric KW - orthopedic KW - training KW - surgical procedure N2 - Background: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray?guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of ?see one, do one, teach one? are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. Objective: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. Methods: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort?s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. Results: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). Conclusions: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb International Registered Report Identifier (IRRID): DERR1-10.2196/38282 UR - https://www.researchprotocols.org/2023/1/e38282 UR - http://dx.doi.org/10.2196/38282 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531159 ID - info:doi/10.2196/38282 ER - TY - JOUR AU - Alexander-Savino, V. Carolina AU - Morrell, S. Dean AU - Mervak, E. Julie AU - Bowers, V. Edith PY - 2023/7/31 TI - Characteristics of Dermatology Residency Program Morbidity and Mortality Conferences: A Survey of Program Directors JO - JMIR Dermatol SP - e45194 VL - 6 KW - morbidity and mortality conference KW - MMC KW - dermatology residency KW - Accreditation Council of Graduate Medical Education KW - ACGME KW - medical education KW - graduate medical education KW - quality improvement KW - health quality KW - quality assurance UR - https://derma.jmir.org/2023/1/e45194 UR - http://dx.doi.org/10.2196/45194 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632923 ID - info:doi/10.2196/45194 ER - TY - JOUR AU - Raumer-Monteith, Lauren AU - Kennedy, Madonna AU - Ball, Lauren PY - 2023/7/27 TI - Web-Based Learning for General Practitioners and Practice Nurses Regarding Behavior Change: Qualitative Descriptive Study JO - JMIR Med Educ SP - e45587 VL - 9 KW - continuing professional development KW - continuing medical education KW - web-based KW - e-learning KW - behavior change KW - general practitioner KW - practice nurse KW - nurse KW - medical education KW - professional development KW - general practice KW - web-based learning KW - remote learning KW - adoption KW - perspective KW - health care professional N2 - Background: Supporting patients to live well by optimizing behavior is a core tenet of primary health care. General practitioners and practice nurses experience barriers in providing behavior change interventions to patients for lifestyle behaviors, including low self-efficacy in their ability to enact change. Web-based learning technologies are readily available for general practitioners and practice nurses; however, opportunities to upskill in behavior change are still limited. Understanding what influences general practitioners? and practice nurses? adoption of web-based learning is crucial to enhancing the quality and impact of behavior change interventions in primary health care. Objective: This study aimed to explore general practitioners? and practice nurses? perceptions regarding web-based learning to support patients with behavior change. Methods: A qualitative, cross-sectional design was used involving web-based, semistructured interviews with general practitioners and practice nurses in Queensland, Australia. The interviews were recorded and transcribed using the built-in Microsoft Teams transcription software. Inductive coding was used to generate codes from the interview data for thematic analysis. Results: In total, there were 11 participants in this study, including general practitioners (n=4) and practice nurses (n=7). Three themes emerged from the data analysis: (1) reflecting on the provider of the Healthy Lifestyles suite; (2) valuing the web-based learning content and presentation; and (3) experiencing barriers and facilitators to using the Healthy Lifestyles suite. Conclusions: Provider reputation, awareness of availability, resources, content quality, usability, cost, and time influence adoption of web-based learning. Perceived quality is associated with culturally tailored information, resources, a balance of information and interactivity, plain language, user-friendly navigation, appealing visual presentation, communication examples, and simple models. Free web-based learning that features progress saving and module lengths of less than 2 hours alleviate perceived time and cost barriers. Learning providers may benefit by including these features in their future behavior change web-based learning for general practitioners and practice nurses. UR - https://mededu.jmir.org/2023/1/e45587 UR - http://dx.doi.org/10.2196/45587 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498657 ID - info:doi/10.2196/45587 ER - TY - JOUR AU - Lu, Qi Kevin Jia AU - Meaney, Christopher AU - Guo, Elaine AU - Leung, Fok-Han PY - 2023/7/27 TI - Evaluating the Applicability of Existing Lexicon-Based Sentiment Analysis Techniques on Family Medicine Resident Feedback Field Notes: Retrospective Cohort Study JO - JMIR Med Educ SP - e41953 VL - 9 KW - medical education KW - medical resident KW - feedback KW - field note KW - text mining KW - data mining KW - sentiment analysis KW - lexicon KW - lexical KW - dictionary KW - dictionaries KW - vocabulary KW - resident KW - medical student KW - medical trainee KW - residency KW - utility KW - feasibility N2 - Background: Field notes, a form for resident-preceptor clinical encounter feedback, are widely adopted across Canadian medical residency training programs for documenting residents? performance. This process generates a sizeable cumulative collection of feedback text, which is difficult for medical education faculty to navigate. As sentiment analysis is a subfield of text mining that can efficiently synthesize the polarity of a text collection, sentiment analysis may serve as an innovative solution. Objective: This study aimed to examine the feasibility and utility of sentiment analysis using 3 popular sentiment lexicons on medical resident field notes. Methods: We used a retrospective cohort design, curating text data from University of Toronto medical resident field notes gathered over 2 years (from July 2019 to June 2021). Lexicon-based sentiment analysis was applied using 3 standardized dictionaries, modified by removing ambiguous words as determined by a medical subject matter expert. Our modified lexicons assigned words from the text data a sentiment score, and we aggregated the word-level scores to a document-level polarity score. Agreement between dictionaries was assessed, and the document-level polarity was correlated with the overall preceptor rating of the clinical encounter under assessment. Results: Across the 3 original dictionaries, approximately a third of labeled words in our field note corpus were deemed ambiguous and were removed to create modified dictionaries. Across the 3 modified dictionaries, the mean sentiment for the ?Strengths? section of the field notes was mildly positive, while it was slightly less positive in the ?Areas of Improvement? section. We observed reasonable agreement between dictionaries for sentiment scores in both field note sections. Overall, the proportion of positively labeled documents increased with the overall preceptor rating, and the proportion of negatively labeled documents decreased with the overall preceptor rating. Conclusions: Applying sentiment analysis to systematically analyze field notes is feasible. However, the applicability of existing lexicons is limited in the medical setting, even after the removal of ambiguous words. Limited applicability warrants the need to generate new dictionaries specific to the medical education context. Additionally, aspect-based sentiment analysis may be applied to navigate the more nuanced structure of texts when identifying sentiments. Ultimately, this will allow for more robust inferences to discover opportunities for improving resident teaching curriculums. UR - https://mededu.jmir.org/2023/1/e41953 UR - http://dx.doi.org/10.2196/41953 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498660 ID - info:doi/10.2196/41953 ER - TY - JOUR AU - Liaw, Ying Sok AU - Tan, Zhi Jian AU - Bin Rusli, Dzakirin Khairul AU - Ratan, Rabindra AU - Zhou, Wentao AU - Lim, Siriwan AU - Lau, Ching Tang AU - Seah, Betsy AU - Chua, Ling Wei PY - 2023/7/26 TI - Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training: Randomized Controlled Study JO - J Med Internet Res SP - e47748 VL - 25 KW - artificial intelligence KW - interprofessional education KW - interprofessional communication KW - sepsis care KW - team training KW - virtual reality KW - simulation KW - AI KW - health care education KW - nursing student KW - nursing education KW - medical education N2 - Background: Interprofessional communication is needed to enhance the early recognition and management of patients with sepsis. Preparing medical and nursing students using virtual reality simulation has been shown to be an effective learning approach for sepsis team training. However, its scalability is constrained by unequal cohort sizes between medical and nursing students. An artificial intelligence (AI) medical team member can be implemented in a virtual reality simulation to engage nursing students in sepsis team training. Objective: This study aimed to evaluate the effectiveness of an AI-powered doctor versus a human-controlled doctor in training nursing students for sepsis care and interprofessional communication. Methods: A randomized controlled trial study was conducted with 64 nursing students who were randomly assigned to undertake sepsis team training with an AI-powered doctor (AI-powered group) or with medical students using virtual reality simulation (human-controlled group). Participants from both groups were tested on their sepsis and communication performance through simulation-based assessments (posttest). Participants? sepsis knowledge and self-efficacy in interprofessional communication were also evaluated before and after the study interventions. Results: A total of 32 nursing students from each group completed the simulation-based assessment, sepsis and communication knowledge test, and self-efficacy questionnaire. Compared with the baseline scores, both the AI-powered and human-controlled groups demonstrated significant improvements in communication knowledge (P=.001) and self-efficacy in interprofessional communication (P<.001) in posttest scores. For sepsis care knowledge, a significant improvement in sepsis care knowledge from the baseline was observed in the AI-powered group (P<.001) but not in the human-controlled group (P=.16). Although no significant differences were found in sepsis care performance between the groups (AI-powered group: mean 13.63, SD 4.23, vs human-controlled group: mean 12.75, SD 3.85, P=.39), the AI-powered group (mean 9.06, SD 1.78) had statistically significantly higher sepsis posttest knowledge scores (P=.009) than the human-controlled group (mean 7.75, SD 2.08). No significant differences were found in interprofessional communication performance between the 2 groups (AI-powered group: mean 29.34, SD 8.37, vs human-controlled group: mean 27.06, SD 5.69, P=.21). However, the human-controlled group (mean 69.6, SD 14.4) reported a significantly higher level of self-efficacy in interprofessional communication (P=.008) than the AI-powered group (mean 60.1, SD 13.3). Conclusions: Our study suggested that AI-powered doctors are not inferior to human-controlled virtual reality simulations with respect to sepsis care and interprofessional communication performance, which supports the viability of implementing AI-powered doctors to achieve scalability in sepsis team training. Our findings also suggested that future innovations should focus on the sociability of AI-powered doctors to enhance users? interprofessional communication training. Perhaps in the nearer term, future studies should examine how to best blend AI-powered training with human-controlled virtual reality simulation to optimize clinical performance in sepsis care and interprofessional communication. Trial Registration: ClinicalTrials.gov NCT05953441; https://clinicaltrials.gov/study/NCT05953441 UR - https://www.jmir.org/2023/1/e47748 UR - http://dx.doi.org/10.2196/47748 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494112 ID - info:doi/10.2196/47748 ER - TY - JOUR AU - Xu, Jianing AU - Qu, Mingyu AU - Dong, Xuejie AU - Chen, Yihe AU - Yin, Hongfan AU - Qu, Fangge AU - Zhang, Lin PY - 2023/7/26 TI - Tele-Instruction Tool for Multiple Lay Responders Providing Cardiopulmonary Resuscitation in Telehealth Emergency Dispatch Services: Mixed Methods Study JO - J Med Internet Res SP - e46092 VL - 25 KW - cardiac arrest KW - lay responder KW - teamwork KW - telehealth KW - telephone-assisted cardiopulmonary resuscitation N2 - Background: Telephone-assisted cardiopulmonary resuscitation (T-CPR) has proven to be a crucial intervention in enhancing the ability of lay responders to perform cardiopulmonary resuscitation (CPR) during telehealth emergency services. While the majority of established T-CPR protocols primarily focus on guiding individual rescuers, there is a lack of emphasis on instructing and coordinating multiple lay responders to perform resuscitation collaboratively. Objective: This study aimed to develop an innovative team-based tele-instruction tool to efficiently organize and instruct multiple lay responders on the CPR process and to evaluate the effectiveness and feasibility of the tool. Methods: We used a mixed methods design in this study. We conducted a randomized controlled simulation trial to conduct the quantitative analysis. The intervention groups used the team-based tele-instruction tool for team resuscitation, while the control groups did not have access to the tool. Baseline resuscitation was performed during the initial phase (phase I test). Subsequently, all teams watched a team-based CPR education training video and finished a 3-person practice session with teaching followed by a posttraining test (phase II test). In the qualitative analysis, we randomly selected an individual from each team and 4 experts in emergency medical services to conduct semistructured interviews. The purpose of these interviews was to evaluate the effectiveness and feasibility of this tool. Results: The team-based tele-instruction tool significantly improved the quality of chest compression in both phase I and phase II tests. The average compression rates were more appropriate in the intervention groups compared to the control groups (median 104.5, IQR 98.8-111.8 min?1 vs median 112, IQR 106-120.8 min?1; P=.04 in phase I and median 117.5, IQR 112.3-125 min?1 vs median 111, IQR 105.3-119 min?1; P=.03 in phase II). In the intervention group, there was a delay in the emergency response time compared to that in the control group (time to first chest compression: median 20, IQR 15-24.8 seconds vs median 25, IQR 20.5-40.3 seconds; P=.03; time to open the airway: median 48, IQR 36.3-62 seconds vs median 73.5, IQR 54.5-227.8 seconds; P=.01). However, this delay was partially mitigated after the phase II test. The qualitative results confirmed the compatibility and generalizability of the team-based tele-instruction tool, demonstrating its ability to effectively guide multiple lay responders through teamwork and effective communication with telecommunicators. Conclusions: The use of the team-based tele-instruction tool offers an effective solution to enhance the quality of chest compression among multiple lay responders. This tool facilitated the organization of resuscitation teams by dispatchers and enabled efficient cooperation. Further assessment of the widespread adoption and practical application of the team-based tele-instruction tools in real-life rescue scenarios within the telehealth emergency services system is warranted. UR - https://www.jmir.org/2023/1/e46092 UR - http://dx.doi.org/10.2196/46092 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494107 ID - info:doi/10.2196/46092 ER - TY - JOUR AU - Gisondi, Albert Michael AU - Keyes, Timothy AU - Zucker, Shana AU - Bumgardner, Deila PY - 2023/7/21 TI - Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework JO - JMIR Med Educ SP - e47777 VL - 9 KW - lesbian, gay, bisexual, transgender, queer KW - LGBTQ+ KW - queer KW - faculty development KW - medical education KW - continuing education KW - sexual and gender minority KW - web-based learning KW - asynchronous learning KW - education technology KW - diversity, equity, inclusion KW - DEI N2 - Background: Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population. Objective: We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course. Methods: We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions. Results: Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care. Conclusions: Teaching LGBTQ+ Health improved participants? knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added. UR - https://mededu.jmir.org/2023/1/e47777 UR - http://dx.doi.org/10.2196/47777 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477962 ID - info:doi/10.2196/47777 ER - TY - JOUR AU - Gilson, Aidan AU - Safranek, W. Conrad AU - Huang, Thomas AU - Socrates, Vimig AU - Chi, Ling AU - Taylor, Andrew Richard AU - Chartash, David PY - 2023/7/13 TI - Authors? Reply to: Variability in Large Language Models? Responses to Medical Licensing and Certification Examinations JO - JMIR Med Educ SP - e50336 VL - 9 KW - natural language processing KW - NLP KW - MedQA KW - generative pre-trained transformer KW - GPT KW - medical education KW - chatbot KW - artificial intelligence KW - AI KW - education technology KW - ChatGPT KW - conversational agent KW - machine learning KW - large language models KW - knowledge assessment UR - https://mededu.jmir.org/2023/1/e50336 UR - http://dx.doi.org/10.2196/50336 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440299 ID - info:doi/10.2196/50336 ER - TY - JOUR AU - Epstein, H. Richard AU - Dexter, Franklin PY - 2023/7/13 TI - Variability in Large Language Models? Responses to Medical Licensing and Certification Examinations. Comment on ?How Does ChatGPT Perform on the United States Medical Licensing Examination? The Implications of Large Language Models for Medical Education and Knowledge Assessment? JO - JMIR Med Educ SP - e48305 VL - 9 KW - natural language processing KW - NLP KW - MedQA KW - generative pre-trained transformer KW - GPT KW - medical education KW - chatbot KW - artificial intelligence KW - AI KW - education technology KW - ChatGPT KW - Google Bard KW - conversational agent KW - machine learning KW - large language models KW - knowledge assessment UR - https://mededu.jmir.org/2023/1/e48305 UR - http://dx.doi.org/10.2196/48305 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440293 ID - info:doi/10.2196/48305 ER - TY - JOUR AU - Gardiner, Heather AU - Siminoff, Laura AU - Gordon, J. Elisa AU - Alolod, Gerard AU - Richardson, Briana AU - Schupler, Melanie AU - Benitez, Amanda AU - Hernandez, Ilda AU - Guinansaca, Nancy AU - Ramos, Lori AU - Bergeron, D. Caroline AU - Pappaterra, Lianette AU - Norden, Robert AU - Daly, Theresa PY - 2023/7/10 TI - Direct and Indirect Effects of a Web-Based Educational and Communication Skills Intervention ?Promotoras de Donación? to Increase Donor Designation in Latinx Communities: Evaluation Study JO - J Med Internet Res SP - e37140 VL - 25 KW - Latinx KW - Latino KW - Latina KW - Spanish KW - Hispanic organ donation KW - organ donor KW - donor registration KW - donor designation KW - education KW - e-learning KW - digital learning KW - promotoras KW - program evaluation KW - community outreach KW - community engagement KW - awareness N2 - Background: Latinx populations are severely underrepresented among organ donors compared with the non-Hispanic White population. The Promotoras de Donación e-learning module was developed to train Latinx lay health educators (ie, promotoras) to discuss deceased organ donation and promote donor designation within their communities. Objective: This paper described the results of 2 studies designed to assess the direct and indirect effects of the module on promotoras? and mature Latinas? organ donation and donor designation knowledge, attitudes, and behaviors. Methods: In partnership with 4 community-based promotoras organizations, we designed 2 nonrandomized, quasiexperimental pragmatic studies to evaluate the Promotoras de Donación e-learning module, with participating promotoras and mature Latinas serving as their own controls. Brief surveys were administered to participating promotoras before and after module completion to assess changes in organ donation knowledge and support and communication confidence (study 1). Promotoras participating in the first study were asked to hold at least 2 group conversations about organ donation and donor designation with mature Latinas (study 2); paper-pencil surveys were completed by all participants before and after the group conversations. Descriptive statistics, means and SDs, and counts and percentages were used as appropriate to categorize the samples. Paired sample 2-tailed t test was used to assess changes in knowledge of and support for organ donation and confidence in discussing donation and promoting donor designation from pre- to posttest. Results: Overall, 40 promotoras completed this module (study 1). Increases in organ donation knowledge (mean 6.0, SD 1.9 to mean 6.2, SD 2.9) and support (mean 3.4, SD 0.9 to mean 3.6, SD 0.9) were observed from pre- to posttest; however, these changes did not reach statistical significance. A statistically significant increase in communication confidence was found (mean 692.1, SD 232.4 to mean 852.3, SD 139.7; P=.01). The module was well received, with most participants deeming it well organized, presenting new information, and providing realistic and helpful portrayals of donation conversations. A total of 52 group discussions with 375 attendees were led by 25 promotoras (study 2). The trained promotora-led group discussions about organ donation resulted in increased support for organ donation in promotoras and mature Latinas from pre- to posttest. Knowledge of the steps to become an organ donor and belief that the process is easy to perform increased in mature Latinas from pre- to posttest by 30.7% and 15.2%, respectively. In total, 5.6% (21/375) of attendees submitted completed organ donation registration forms. Conclusions: This evaluation provides preliminary support for the module?s direct and indirect effects on organ donation knowledge, attitudes, and behaviors. The need for additional modifications to and future evaluations of the module are discussed. UR - https://www.jmir.org/2023/1/e37140 UR - http://dx.doi.org/10.2196/37140 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428526 ID - info:doi/10.2196/37140 ER - TY - JOUR AU - Darnell, C. Julia AU - Lou, Mimi AU - Goldstone, W. Lisa PY - 2023/7/10 TI - Evaluating Change in Student Pharmacists? Familiarity, Attitudes, Comfort, and Knowledge as a Result of Integrating Digital Health Topics Into a Case Conference Series: Cohort Study JO - JMIR Med Educ SP - e43313 VL - 9 KW - digital health KW - telehealth KW - digital therapeutics KW - mobile health applications KW - wearable health technologies KW - pharmacy education KW - medical education KW - patient cases KW - technology KW - education KW - digital KW - survey KW - intervention N2 - Background: The use of technology in health care, often referred to as digital health, has expanded rapidly because of the need to provide remote care during the COVID-19 pandemic. In light of this rapid boom, it is clear that health care professionals need to be trained in these technologies in order to provide high-level care. Despite the growing number of technologies used across health care, digital health is not a commonly taught topic in health care curricula. Several pharmacy organizations have called attention to the need to teach digital health to student pharmacists; however, there is currently no consensus on best methods to do so. Objective: The objective of this study was to determine if there was a significant change in student pharmacist scores on the Digital Health Familiarity, Attitudes, Comfort, and Knowledge Scale (DH-FACKS) after exposure to digital health topics in a yearlong discussion?based case conference series. Methods: Student pharmacists? initial comfort, attitudes, and knowledge were gathered by a baseline DH-FACKS score at the beginning of the fall semester. Digital health concepts were integrated into a number of cases in the case conference course series throughout the academic year. The DH-FACKS was administered again to students after completion of the spring semester. Results were matched, scored, and analyzed to assess any difference in DH-FACKS scores. Results: A total of 91 of 373 students completed both the pre- and postsurvey (response rate of 24%). Using a scale from 1 to 10, the mean student-reported knowledge of digital health increased from 4.5 (SD 2.5) before intervention to 6.6 (SD 1.6) after intervention (P<.001) and the mean self-reported comfort increased from 4.7 (SD 2.5) before intervention to 6.7 (SD 1.8) after intervention (P<.001). There was a significant increase in scores for all 4 elements of the DH-FACKS. The mean familiarity scores increased from 11.6 (SD 3.7) to 15.8 (SD 2.2), out of a maximum of 20 (P<.001). The mean attitudes scores increased from 15.6 (SD 2.1) to 16.5 (SD 1.9), out of a maximum of 20 (P=.001). The mean comfort scores increased from 10.1 (SD 3.9) to 14.8 (SD 3.1), out of a maximum of 20 (P<.001). The mean knowledge scores increased from 9.9 (SD 3.4) to 12.8 (SD 3.9), out of a maximum of 20 (P<.001). Conclusions: Including digital health topics in a case conference series is an effective and approachable way of providing education on important digital health concepts to students. Students experienced an increase in familiarity, attitudes, comfort, and knowledge after the yearlong intervention. As case-based discussions are an important component of most pharmacy and other medical curricula, this method can be easily applied by other programs that wish to give their students practice applying their knowledge of digital health to complex case-based scenarios. UR - https://mededu.jmir.org/2023/1/e43313 UR - http://dx.doi.org/10.2196/43313 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428523 ID - info:doi/10.2196/43313 ER - TY - JOUR AU - Takagi, Soshi AU - Watari, Takashi AU - Erabi, Ayano AU - Sakaguchi, Kota PY - 2023/6/29 TI - Performance of GPT-3.5 and GPT-4 on the Japanese Medical Licensing Examination: Comparison Study JO - JMIR Med Educ SP - e48002 VL - 9 KW - ChatGPT KW - Chat Generative Pre-trained Transformer KW - GPT-4 KW - Generative Pre-trained Transformer 4 KW - artificial intelligence KW - AI KW - medical education KW - Japanese Medical Licensing Examination KW - medical licensing KW - clinical support KW - learning model N2 - Background: The competence of ChatGPT (Chat Generative Pre-Trained Transformer) in non-English languages is not well studied. Objective: This study compared the performances of GPT-3.5 (Generative Pre-trained Transformer) and GPT-4 on the Japanese Medical Licensing Examination (JMLE) to evaluate the reliability of these models for clinical reasoning and medical knowledge in non-English languages. Methods: This study used the default mode of ChatGPT, which is based on GPT-3.5; the GPT-4 model of ChatGPT Plus; and the 117th JMLE in 2023. A total of 254 questions were included in the final analysis, which were categorized into 3 types, namely general, clinical, and clinical sentence questions. Results: The results indicated that GPT-4 outperformed GPT-3.5 in terms of accuracy, particularly for general, clinical, and clinical sentence questions. GPT-4 also performed better on difficult questions and specific disease questions. Furthermore, GPT-4 achieved the passing criteria for the JMLE, indicating its reliability for clinical reasoning and medical knowledge in non-English languages. Conclusions: GPT-4 could become a valuable tool for medical education and clinical support in non?English-speaking regions, such as Japan. UR - https://mededu.jmir.org/2023/1/e48002 UR - http://dx.doi.org/10.2196/48002 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384388 ID - info:doi/10.2196/48002 ER - TY - JOUR AU - Horst, Rebecca AU - Witsch, Lea-Mara AU - Hazunga, Rayford AU - Namuziya, Natasha AU - Syakantu, Gardner AU - Ahmed, Yusuf AU - Cherkaoui, Omar AU - Andreadis, Petros AU - Neuhann, Florian AU - Barteit, Sandra PY - 2023/6/29 TI - Evaluating the Effectiveness of Interactive Virtual Patients for Medical Education in Zambia: Randomized Controlled Trial JO - JMIR Med Educ SP - e43699 VL - 9 KW - global health KW - Zambia KW - health care workers KW - medical skills KW - e-logbook, digital global health N2 - Background: Zambia is facing a severe shortage of health care workers, particularly in rural areas. Innovative educational programs and infrastructure have been established to bridge this gap; however, they encounter substantial challenges because of constraints in physical and human resources. In response to these shortcomings, strategies such as web-based and blended learning approaches have been implemented, using virtual patients (VPs) as a means to promote interactive learning at the Levy Mwanawasa Medical University (LMMU) in Zambia. Objective: This study aimed to evaluate the students? knowledge acquisition and acceptance of 2 VP medical topics as a learning tool on a Zambian higher education e-learning platform. Methods: Using a mixed methods design, we assessed knowledge acquisition using pre- and posttests. In a randomized controlled trial setting, students were assigned (1:1) to 2 medical topics (topic 1: appendicitis and topic 2: severe acute malnutrition) and then to 4 different learning tools within their respective exposure groups: VPs, textbook content, preselected e-learning materials, and self-guided internet materials. Acceptance was evaluated using a 15-item questionnaire with a 5-point Likert scale. Results: A total of 63 third- and fourth-year Bachelor of Science clinical science students participated in the study. In the severe acute malnutrition?focused group, participants demonstrated a significant increase in knowledge within the textbook group (P=.01) and the VP group (P=.01). No substantial knowledge gain was observed in the e-learning group or the self-guided internet group. For the appendicitis-focused group, no statistically significant difference in knowledge acquisition was detected among the 4 intervention groups (P=.62). The acceptance of learning materials exhibited no substantial difference between the VP medical topics and other learning materials. Conclusions: In the context of LMMU, our study found that VPs were well accepted and noninferior to traditional teaching methods. VPs have the potential to serve as an engaging learning resource and can be integrated into blended learning approaches at LMMU. However, further research is required to investigate the long-term knowledge gain and the acceptance and effectiveness of VPs in medical education. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR202211594568574; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=20413 UR - https://mededu.jmir.org/2023/1/e43699 UR - http://dx.doi.org/10.2196/43699 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384369 ID - info:doi/10.2196/43699 ER - TY - JOUR AU - Brehon, Katelyn AU - MacIsaac, Rob AU - Bhatia, Zahra AU - Buck, Taryn AU - Charbonneau, Rebecca AU - Crochetiere, Steven AU - Donia, Scott AU - Daoust, Jason AU - Ho, Chester AU - Kainth, Hardeep AU - Loewen, Janee AU - Lorch, Brandice AU - Mastrodimos, Kiesha AU - Neunzig, Brittney AU - Papathanassoglou, Elizabeth AU - Parmar, Rajvir AU - Pohar Manhas, Kiran AU - Tenove, Terry AU - Velji, Elysha AU - Loyola-Sanchez, Adalberto PY - 2023/6/23 TI - Outcomes of Implementing a Webinar-Based Strategy to Improve Spinal Cord Injury Knowledge and Community Building: Convergent Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e46575 VL - 10 KW - spinal cord injury KW - telehealth KW - webinars KW - mixed methods KW - implementation N2 - Background: COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. Objective: This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. Methods: The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. Results: A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2% (31/234) of the participants completed the postwebinar survey, and 23% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. Conclusions: The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken. UR - https://rehab.jmir.org/2023/1/e46575 UR - http://dx.doi.org/10.2196/46575 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351945 ID - info:doi/10.2196/46575 ER - TY - JOUR AU - Mesko, Bertalan PY - 2023/6/22 TI - The ChatGPT (Generative Artificial Intelligence) Revolution Has Made Artificial Intelligence Approachable for Medical Professionals JO - J Med Internet Res SP - e48392 VL - 25 KW - artificial intelligence KW - digital health KW - future KW - technology KW - ChatGPT KW - medical practice KW - large language model KW - language model KW - generative KW - conversational agent KW - conversation agents KW - chatbot KW - generated text KW - computer generated KW - medical education KW - continuing education KW - professional development KW - curriculum KW - curricula UR - https://www.jmir.org/2023/1/e48392 UR - http://dx.doi.org/10.2196/48392 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347508 ID - info:doi/10.2196/48392 ER - TY - JOUR AU - Tsai, Huey-Pin AU - Lin, Che-Wei AU - Lin, Ying-Jun AU - Yeh, Chun-Sheng AU - Shan, Yan-Shen PY - 2023/6/21 TI - Novel Software for High-level Virological Testing: Self-Designed Immersive Virtual Reality Training Approach JO - J Med Internet Res SP - e44538 VL - 25 KW - design KW - immersive KW - virtual reality KW - VR KW - high-level clinical virology KW - skill training KW - testing KW - virology KW - virological KW - medical education KW - clinical practice KW - simulation KW - biotechnology KW - molecular KW - detection KW - pathogen KW - development KW - software KW - teaching N2 - Background: To ensure the timely diagnosis of emerging infectious diseases, high-tech molecular biotechnology is often used to detect pathogens and has gradually become the gold standard for virological testing. However, beginners and students are often unable to practice their skills due to the higher costs associated with high-level virological testing, the increasing complexity of the equipment, and the limited number of specimens from patients. Therefore, a new training program is necessary to increase training and reduce the risk of test failure. Objective: The aim of the study is to (1) develop and implement a virtual reality (VR) software for simulated and interactive high-level virological testing that can be applied in clinical practice and skills building or training settings and (2) evaluate the VR simulation?s effectiveness on reaction, learning, and behavior of the students (trainees). Methods: Viral nucleic acid tests on a BD MAX instrument were selected for our VR project because it is a high-tech automatic detection system. There was cooperation between teachers of medical technology and biomedical engineering. Medical technology teachers were responsible for designing the lesson plan, and the biomedical engineering personnel developed the VR software. We designed a novel VR teaching software to simulate cognitive learning via various procedure scenarios and interactive models. The VR software contains 2D VR ?cognitive test and learning? lessons and 3D VR ?practical skills training? lessons. We evaluated students? learning effectiveness pre- and posttraining and then recorded their behavior patterns when answering questions, performing repeated exercises, and engaging in clinical practice. Results: The results showed that the use of the VR software met participants? needs and enhanced their interest in learning. The average posttraining scores of participants exposed to 2D and 3D VR training were significantly higher than participants who were exposed solely to traditional demonstration teaching (P<.001). Behavioral assessments of students pre- and posttraining showed that students exposed to VR-based training to acquire relevant knowledge of advanced virological testing exhibited significantly improved knowledge of specific items posttraining (P<.01). A higher participant score led to fewer attempts when responding to each item in a matching task. Thus, VR can enhance students? understanding of difficult topics. Conclusions: The VR program designed for this study can reduce the costs associated with virological testing training, thus, increasing their accessibility for students and beginners. It can also reduce the risk of viral infections particularly during disease outbreaks (eg, the COVID-19 pandemic) and also enhance students? learning motivation to strengthen their practical skills. UR - https://www.jmir.org/2023/1/e44538 UR - http://dx.doi.org/10.2196/44538 UR - http://www.ncbi.nlm.nih.gov/pubmed/37342081 ID - info:doi/10.2196/44538 ER - TY - JOUR AU - Shah, Harsh AU - Patel, Jay AU - Yasobant, Sandul AU - Saxena, Deepak AU - Saha, Somen AU - Sinha, Anish AU - Bhavsar, Priya AU - Patel, Yogesh AU - Modi, Bhavesh AU - Nimavat, Pankaj AU - Kapadiya, Dixit AU - Fancy, Manish PY - 2023/6/19 TI - Capacity Building, Knowledge Enhancement, and Consultative Processes for Development of a Digital Tool (Ni-kshay SETU) to Support the Management of Patients with Tuberculosis: Exploratory Qualitative Study JO - J Med Internet Res SP - e45400 VL - 25 KW - capacity building KW - Ni-kshay SETU KW - National Tuberculosis Elimination Program KW - digital health KW - India KW - tuberculosis N2 - Background: Achieving the target for eliminating tuberculosis (TB) in India by 2025, 5 years ahead of the global target, critically depends on strengthening the capacity of human resources as one of the key components of the health system. Due to the rapid updates of standards and protocols, the human resources for TB health care suffer from a lack of understanding of recent updates and acquiring necessary knowledge. Objective: Despite an increasing focus on the digital revolution in health care, there is no such platform available to deliver the key updates in national TB control programs with easy access. Thus, the aim of this study was to explore the development and evolution of a mobile health tool for capacity building of the Indian health system?s workforce to better manage patients with TB. Methods: This study involved two phases. The first phase was based on a qualitative investigation, including personal interviews to understand the basic requirements of staff working in the management of patients with TB, followed by participatory consultative meetings with stakeholders to validate and develop the content for the mobile health app. Qualitative information was collected from the Purbi Singhbhum and Ranchi districts of Jharkhand and Gandhinagar, and from the Surat districts of Gujarat State. In the second phase, a participatory design process was undertaken as part of the content creation and validation exercises. Results: The first phase collected information from 126 health care staff, with a mean age of 38.4 (SD 8.9) years and average work experience of 8.9 years. The assessment revealed that more than two-thirds of participants needed further training and lacked knowledge of the most current updates to TB program guidelines. The consultative process determined the need for a digital solution in easily accessible formats and ready reckoner content to deliver practical solutions to address operational issues for implementation of the program. Ultimately, the digital platform named Ni-kshay SETU (Support to End Tuberculosis) was developed to support the knowledge enhancement of health care workers. Conclusions: The development of staff capacity is vital to the success or failure of any program or intervention. Having up-to-date information provides confidence to health care staff when interacting with patients in the community and aids in making quick judgments when handling case scenarios. Ni-kshay SETU represents a novel digital capacity-building platform for enhancing human resource skills in achieving the goal of TB elimination. UR - https://www.jmir.org/2023/1/e45400 UR - http://dx.doi.org/10.2196/45400 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335610 ID - info:doi/10.2196/45400 ER - TY - JOUR AU - Stamer, Tjorven AU - Steinhäuser, Jost AU - Flägel, Kristina PY - 2023/6/19 TI - Artificial Intelligence Supporting the Training of Communication Skills in the Education of Health Care Professions: Scoping Review JO - J Med Internet Res SP - e43311 VL - 25 KW - communication KW - education KW - artificial intelligence KW - machine learning KW - health care KW - skill KW - use KW - academic KW - students KW - training KW - cost KW - cost-effective KW - health care professional N2 - Background: Communication is a crucial element of every health care profession, rendering communication skills training in all health care professions as being of great importance. Technological advances such as artificial intelligence (AI) and particularly machine learning (ML) may support this cause: it may provide students with an opportunity for easily accessible and readily available communication training. Objective: This scoping review aimed to summarize the status quo regarding the use of AI or ML in the acquisition of communication skills in academic health care professions. Methods: We conducted a comprehensive literature search across the PubMed, Scopus, Cochrane Library, Web of Science Core Collection, and CINAHL databases to identify articles that covered the use of AI or ML in communication skills training of undergraduate students pursuing health care profession education. Using an inductive approach, the included studies were organized into distinct categories. The specific characteristics of the studies, methods and techniques used by AI or ML applications, and main outcomes of the studies were evaluated. Furthermore, supporting and hindering factors in the use of AI and ML for communication skills training of health care professionals were outlined. Results: The titles and abstracts of 385 studies were identified, of which 29 (7.5%) underwent full-text review. Of the 29 studies, based on the inclusion and exclusion criteria, 12 (3.1%) were included. The studies were organized into 3 distinct categories: studies using AI and ML for text analysis and information extraction, studies using AI and ML and virtual reality, and studies using AI and ML and the simulation of virtual patients, each within the academic training of the communication skills of health care professionals. Within these thematic domains, AI was also used for the provision of feedback. The motivation of the involved agents played a major role in the implementation process. Reported barriers to the use of AI and ML in communication skills training revolved around the lack of authenticity and limited natural flow of language exhibited by the AI- and ML-based virtual patient systems. Furthermore, the use of educational AI- and ML-based systems in communication skills training for health care professionals is currently limited to only a few cases, topics, and clinical domains. Conclusions: The use of AI and ML in communication skills training for health care professionals is clearly a growing and promising field with a potential to render training more cost-effective and less time-consuming. Furthermore, it may serve learners as an individualized and readily available exercise method. However, in most cases, the outlined applications and technical solutions are limited in terms of access, possible scenarios, the natural flow of a conversation, and authenticity. These issues still stand in the way of any widespread implementation ambitions. UR - https://www.jmir.org/2023/1/e43311 UR - http://dx.doi.org/10.2196/43311 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335593 ID - info:doi/10.2196/43311 ER - TY - JOUR AU - Rouleau, Geneviève AU - Thiruganasambandamoorthy, Venkatesh AU - Wu, Kelly AU - Ghaedi, Bahareh AU - Nguyen, Anh Phuong AU - Desveaux, Laura PY - 2023/6/13 TI - Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid Physicians in the Clinical Management of Patients With Syncope: Systematic Theoretical and User-Centered Design Approach JO - JMIR Hum Factors SP - e44089 VL - 10 KW - emergency medicine KW - physicians KW - qualitative research KW - risk management KW - syncope KW - user-centered design N2 - Background: The Canadian Syncope Risk Score (CSRS) was developed to improve syncope management in emergency department settings. Evidence-based tools often fail to have the intended impact because of suboptimal uptake or poor implementation. Objective: In this paper, we aimed to describe the process of developing evidence-based implementation strategies to support the deployment and use of the CSRS in real-world emergency department settings to improve syncope management among physicians. Methods: We followed a systematic approach for intervention development, including identifying who needs to do what differently, identifying the barriers and enablers to be addressed, and identifying the intervention components and modes of delivery to overcome the identified barriers. We used the Behaviour Change Wheel to guide the selection of implementation strategies. We engaged CSRS end users (ie, emergency medicine physicians) in a user-centered design approach to generate and refine strategies. This was achieved over a series of 3 qualitative user-centered design workshops lasting 90 minutes each with 3 groups of emergency medicine physicians. Results: A total of 14 physicians participated in the workshops. The themes were organized according to the following intervention development steps: theme 1?identifying and refining barriers and theme 2?identifying the intervention components and modes of delivery. Theme 2 was subdivided into two subthemes: (1) generating high-level strategies and developing strategies prototypes and (2) refining and testing strategies. The main strategies identified to overcome barriers included education in the format of meetings, videos, journal clubs, and posters (to address uncertainty around when and how to apply the CSRS); the development of a web-based calculator and integration into the electronic medical record (to address uncertainty in how to apply the CSRS); a local champion (to address the lack of team buy-in); and the dissemination of evidence summaries and feedback through email communications (to address a lack of evidence about impact). Conclusions: The ability of the CSRS to effectively improve patient safety and syncope management relies on broad buy-in and uptake across physicians. To ensure that the CSRS is well positioned for impact, a comprehensive suite of strategies was identified to address known barriers. UR - https://humanfactors.jmir.org/2023/1/e44089 UR - http://dx.doi.org/10.2196/44089 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310783 ID - info:doi/10.2196/44089 ER - TY - JOUR AU - Tokali?, Ru?ica AU - Poklepovi? Peri?i?, Tina AU - Maru?i?, Ana PY - 2023/6/6 TI - Similar Outcomes of Web-Based and Face-to-Face Training of the GRADE Approach for the Certainty of Evidence: Randomized Controlled Trial JO - J Med Internet Res SP - e43928 VL - 25 KW - Grading of Recommendations Assessment, Development and Evaluation KW - GRADE KW - education KW - online KW - face-to-face KW - evidence-based medicine KW - guideline KW - randomized controlled trial KW - RCT KW - randomized KW - evidence KW - assessment KW - teaching KW - medical education KW - research method KW - online education KW - library science KW - information science KW - medical librarian N2 - Background: The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach is a system for transparent evaluation of the certainty of evidence used in clinical practice guidelines and systematic reviews. GRADE is a key part of evidence-based medicine (EBM) training of health care professionals. Objective: This study aimed to compare web-based and face-to-face methods of teaching the GRADE approach for evidence assessment. Methods: A randomized controlled trial was conducted on 2 delivery modes of GRADE education integrated into a course on research methodology and EBM with third-year medical students. Education was based on the Cochrane Interactive Learning ?Interpreting the findings? module, which had a duration of 90 minutes. The web-based group received the web-based asynchronous training, whereas the face-to-face group had an in-person seminar with a lecturer. The main outcome measure was the score on a 5-question test that assessed confidence interval interpretation and overall certainty of evidence, among others. Secondary outcomes included writing a recommendation for practice and course satisfaction. Results: In all, 50 participants received the web-based intervention, and 47 participants received the face-to-face intervention. The groups did not differ in the overall scores for the Cochrane Interactive Learning test, with a median of 2 (95% CI 1.0-2.0) correct answers for the web-based group and 2 (95% CI 1.3-3.0) correct answers for the face-to-face group. Both groups gave the most correct answers to the question about rating a body of evidence (35/50, 70% and 24/47, 51% for the web-based and face-to-face group, respectively). The face-to-face group better answered the question about the overall certainty of evidence question. The understanding of the Summary of Findings table did not differ significantly between the groups, with a median of 3 correct answers to 4 questions for both groups (P=.352). The writing style for the recommendations for practice also did not differ between the 2 groups. Students? recommendations mostly reflected the strengths of the recommendations and focused on the target population, but they used passive words and rarely mentioned the setting for the recommendation. The language of the recommendations was mostly patient centered. Course satisfaction was high in both groups. Conclusions: Training in the GRADE approach could be equally effective when delivered asynchronously on the web or face-to-face. Trial Registration: Open Science Framework akpq7; https://osf.io/akpq7/ UR - https://www.jmir.org/2023/1/e43928 UR - http://dx.doi.org/10.2196/43928 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279050 ID - info:doi/10.2196/43928 ER - TY - JOUR AU - Knudsen, Høxbro Marie AU - Breindahl, Niklas AU - Dalsgaard, Tor-Salve AU - Isbye, Dan AU - Mølbak, Grethe Anne AU - Tiwald, Gerhard AU - Svendsen, Søndergaard Morten Bo AU - Konge, Lars AU - Bergström, Joanna AU - Todsen, Tobias PY - 2023/6/6 TI - Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study JO - J Med Internet Res SP - e45210 VL - 25 KW - virtual reality KW - simulation-based education KW - undergraduate medical education KW - emergency medicine KW - assessment, acute medicine KW - Messick framework KW - medical education KW - head-mounted display KW - medical student KW - emergency N2 - Background: Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. Objective: This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. Methods: Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant?s total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups? mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups? standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach ? of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). Conclusions: This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment. UR - https://www.jmir.org/2023/1/e45210 UR - http://dx.doi.org/10.2196/45210 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279049 ID - info:doi/10.2196/45210 ER - TY - JOUR AU - Karabacak, Mert AU - Ozkara, Berksu Burak AU - Margetis, Konstantinos AU - Wintermark, Max AU - Bisdas, Sotirios PY - 2023/6/6 TI - The Advent of Generative Language Models in Medical Education JO - JMIR Med Educ SP - e48163 VL - 9 KW - generative language model KW - artificial intelligence KW - medical education KW - ChatGPT KW - academic integrity KW - AI-driven feedback KW - stimulation KW - evaluation KW - technology KW - learning environment KW - medical student UR - https://mededu.jmir.org/2023/1/e48163 UR - http://dx.doi.org/10.2196/48163 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279048 ID - info:doi/10.2196/48163 ER - TY - JOUR AU - Kumwichar, Ponlagrit PY - 2023/5/29 TI - Enhancing Learning About Epidemiological Data Analysis Using R for Graduate Students in Medical Fields With Jupyter Notebook: Classroom Action Research JO - JMIR Med Educ SP - e47394 VL - 9 KW - learning KW - Jupyter KW - R KW - epidemiology KW - data analysis KW - medical education KW - graduate student KW - longitudinal data analysis KW - graduate education KW - implementation N2 - Background: Graduate students in medical fields must learn about epidemiology and data analysis to conduct their research. R is a software environment used to develop and run packages for statistical analysis; it can be challenging for students to learn because of compatibility with their computers and problems with package installations. Jupyter Notebook was used to run R, which enhanced the graduate students? ability to learn epidemiological data analysis by providing an interactive and collaborative environment that allows for more efficient and effective learning. Objective: This study collected class reflections from students and their lecturer in the class ?Longitudinal Data Analysis Using R,? identified problems that occurred, and illustrated how Jupyter Notebook can solve those problems. Methods: The researcher analyzed issues encountered in the previous class and devised solutions using Jupyter Notebook. These solutions were then implemented and applied to a new group of students. Reflections from the students were regularly collected and documented in an electronic form. The comments were then thematically analyzed and compared to those of the prior cohort. Results: Improvements that were identified included the ease of using Jupyter R for data analysis without needing to install packages, increased student questioning due to curiosity, and students having the ability to immediately use all code functions. After using Jupyter Notebook, the lecturer could stimulate interest more effectively and challenge students. Furthermore, they highlighted that students responded to questions. The student feedback shows that learning R with Jupyter Notebook was effective in stimulating their interest. Based on the feedback received, it can be inferred that using Jupyter Notebook to learn R is an effective approach for equipping students with an all-encompassing comprehension of longitudinal data analysis. Conclusions: The use of Jupyter Notebook can improve graduate students? learning experience for epidemiological data analysis by providing an interactive and collaborative environment that is not affected by compatibility issues with different operating systems and computers. UR - https://mededu.jmir.org/2023/1/e47394 UR - http://dx.doi.org/10.2196/47394 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247206 ID - info:doi/10.2196/47394 ER - TY - JOUR AU - Yu, Ying AU - Xiao, Lily AU - Ullah, Shahid AU - Meyer, Claudia AU - Wang, Jing AU - Pot, Margriet Anne AU - Shifaza, Fathimath PY - 2023/5/29 TI - The Experiences of Informal Caregivers of People With Dementia in Web-Based Psychoeducation Programs: Systematic Review and Metasynthesis JO - JMIR Aging SP - e47152 VL - 6 KW - informal caregivers KW - dementia KW - psychoeducation KW - online KW - web based KW - qualitative research KW - systematic review KW - metasynthesis N2 - Background: Informal caregivers of people living with dementia experience a higher level of physical and mental stress compared with other types of caregivers. Psychoeducation programs are viewed as beneficial for building caregivers? knowledge and skills and for decreasing caregiver stress. Objective: This review aimed to synthesize the experiences and perceptions of informal caregivers of people with dementia when participating in web-based psychoeducation programs and the factors that enable and impede informal caregivers? engagement in web-based psychoeducation programs. Methods: This review followed the Joanna Briggs Institute protocol of systematic review and meta-aggregation of qualitative studies. We searched 4 English databases, 4 Chinese databases, and 1 Arabic database in July 2021. Results: A total of 9 studies written in English were included in this review. From these studies, 87 findings were extracted and grouped into 20 categories. These categories were further synthesized into 5 findings: web-based learning as an empowering experience, peer support, satisfactory and unsatisfactory program content, satisfactory and unsatisfactory technical design, and challenges encountered in web-based learning. Conclusions: High-quality and carefully designed web-based psychoeducation programs offered positive experiences for informal caregivers of people living with dementia. To meet broader caregiver education and support needs, program developers should consider information quality and relevancy, the support offered, individual needs, flexibility in delivery, and connectedness between peers and program facilitators. UR - https://aging.jmir.org/2023/1/e47152 UR - http://dx.doi.org/10.2196/47152 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247218 ID - info:doi/10.2196/47152 ER - TY - JOUR AU - Silver, K. Julie PY - 2023/5/25 TI - Six Practical Strategies to Mentor and Sponsor Women in Academic Medicine JO - J Med Internet Res SP - e47799 VL - 25 KW - diversity KW - women KW - women in medicine KW - mentorship KW - sponsorship KW - academic medicine UR - https://www.jmir.org/2023/1/e47799 UR - http://dx.doi.org/10.2196/47799 UR - http://www.ncbi.nlm.nih.gov/pubmed/37227763 ID - info:doi/10.2196/47799 ER - TY - JOUR AU - Bojic, Iva AU - Mammadova, Maleyka AU - Ang, Chin-Siang AU - Teo, Lung Wei AU - Diordieva, Cristina AU - Pienkowska, Anita AU - Ga?evi?, Dragan AU - Car, Josip PY - 2023/5/17 TI - Empowering Health Care Education Through Learning Analytics: In-depth Scoping Review JO - J Med Internet Res SP - e41671 VL - 25 KW - distance education and web-based learning KW - distributed learning environments KW - data science applications in education KW - 21st century abilities KW - cooperative and collaborative learning KW - COVID-19 KW - education KW - digital KW - data KW - student N2 - Background: Digital education has expanded since the COVID-19 pandemic began. A substantial amount of recent data on how students learn has become available for learning analytics (LA). LA denotes the ?measurement, collection, analysis, and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs.? Objective: This scoping review aimed to examine the use of LA in health care professions education and propose a framework for the LA life cycle. Methods: We performed a comprehensive literature search of 10 databases: MEDLINE, Embase, Web of Science, ERIC, Cochrane Library, PsycINFO, CINAHL, ICTP, Scopus, and IEEE Explore. In total, 6 reviewers worked in pairs and performed title, abstract, and full-text screening. We resolved disagreements on study selection by consensus and discussion with other reviewers. We included papers if they met the following criteria: papers on health care professions education, papers on digital education, and papers that collected LA data from any type of digital education platform. Results: We retrieved 1238 papers, of which 65 met the inclusion criteria. From those papers, we extracted some typical characteristics of the LA process and proposed a framework for the LA life cycle, including digital education content creation, data collection, data analytics, and the purposes of LA. Assignment materials were the most popular type of digital education content (47/65, 72%), whereas the most commonly collected data types were the number of connections to the learning materials (53/65, 82%). Descriptive statistics was mostly used in data analytics in 89% (58/65) of studies. Finally, among the purposes for LA, understanding learners? interactions with the digital education platform was cited most often in 86% (56/65) of papers and understanding the relationship between interactions and student performance was cited in 63% (41/65) of papers. Far less common were the purposes of optimizing learning: the provision of at-risk intervention, feedback, and adaptive learning was found in 11, 5, and 3 papers, respectively. Conclusions: We identified gaps for each of the 4 components of the LA life cycle, with the lack of an iterative approach while designing courses for health care professions being the most prevalent. We identified only 1 instance in which the authors used knowledge from a previous course to improve the next course. Only 2 studies reported that LA was used to detect at-risk students during the course?s run, compared with the overwhelming majority of other studies in which data analysis was performed only after the course was completed. UR - https://www.jmir.org/2023/1/e41671 UR - http://dx.doi.org/10.2196/41671 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195746 ID - info:doi/10.2196/41671 ER - TY - JOUR AU - Chan, Yi Evelyn Hui AU - Chan, Yan Vernice Hui AU - Roed, Jannie AU - Chen, Yun Julie PY - 2023/5/15 TI - Observed Interactions, Challenges, and Opportunities in Student-Led, Web-Based Near-Peer Teaching for Medical Students: Interview Study Among Peer Learners and Peer Teachers JO - JMIR Med Educ SP - e40716 VL - 9 KW - peer teaching KW - peer-assisted learning KW - medical student KW - medical education KW - web-based education KW - distance learning N2 - Background: Near-peer teaching (NPT) is becoming an increasingly popular pedagogical tool in health professions education. Despite the shift in formal medical education from face-to-face teaching toward encompassing web-based learning activities, NPT has not experienced a similar transition. Apart from the few reports on NPT programs hastily converted to web-based learning in light of the COVID-19 pandemic, no studies to date have explored web-based learning in the specific context of NPT. Objective: This qualitative study examined the nature of interactions among peer learners (PLs), peer teachers (PTs), and the learning content in a student-led, web-based NPT program for medical students. Methods: A 5-month-long voluntary NPT program to support first- and second-year medical students? biomedical science learning in the undergraduate medical curriculum was designed by 2 senior-year medical students and delivered by 25 PTs with 84 PLs participating. In total, 9 PLs and 3 PTs underwent individual semistructured interviews at the end of the program to explore general NPT experience, reasons for joining NPT, the effectiveness of NPT, the demand and importance of NPT, and the feasibility of incorporating NPT in the formal curriculum. Interview transcripts were analyzed using a thematic analysis approach. Results: The first general theme focused on the nature of student-student, student-teacher, and student-content interactions. Although PLs were engaged in web-based NPT, there was minimal interaction between students, as most PLs preferred to learn passively and remain anonymous. PLs believed the web-based NPT learning process to be a unidirectional transmission of knowledge from teacher to learner, with the teacher responsible for driving the interactions. This was in sharp contrast to PTs? expectation that both parties shared responsibility for learning in a collaborative effort. The second general theme identified the advantages and disadvantages of delivering NPT on a web platform, which were mainly convenience and teaching skills development and poor interactivity, respectively. Conclusions: Student-led, web-based NPT offers a flexible and comfortable means of delivering academic and nonacademic guidance to medical students. However, the web-based mode of delivery presents unique challenges in facilitating meaningful interactions among PLs, PTs, and subject content. A blended learning approach may be best suited for this form of student-led NPT program to optimize its efficacy. UR - https://mededu.jmir.org/2023/1/e40716 UR - http://dx.doi.org/10.2196/40716 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184931 ID - info:doi/10.2196/40716 ER - TY - JOUR AU - Saly, Lauren AU - Provvidenza, Christine AU - Al-Hakeem, Hiba AU - Hickling, Andrea AU - Stevens, Sara AU - Kakonge, Lisa AU - Hunt, W. Anne AU - Bennett, Sheila AU - Martinussen, Rhonda AU - Scratch, E. Shannon PY - 2023/5/15 TI - The Teach-ABI Professional Development Module for Educators About Pediatric Acquired Brain Injury: Mixed Method Usability Study JO - JMIR Hum Factors SP - e43129 VL - 10 KW - acquired brain injury KW - educators KW - professional development KW - usability testing KW - satisfaction testing KW - knowledge translation KW - usability KW - death KW - disability KW - children KW - development KW - Ontario KW - research KW - online KW - school N2 - Background: Acquired brain injury (ABI) is a leading cause of death and disability in children and can lead to lasting cognitive, physical, and psychosocial outcomes that affect school performance. Students with an ABI experience challenges returning to school due in part to lack of educator support and ABI awareness. A lack of knowledge and training contribute to educators feeling unprepared to support students with ABI. Teach-ABI, an online professional development module, was created to enhance educators? ABI knowledge and awareness to best support students. Using a case-based approach, Teach-ABI explains what an ABI is, identifies challenges for students with ABI in the classroom, discusses the importance of an individualized approach to supporting students with ABI, and describes how to support a student with an ABI in the classroom. Objective: This study aims to assess the usability of and satisfaction with Teach-ABI by elementary school educators. The following questions were explored: (1) Can elementary school teachers use and navigate Teach-ABI?, (2) Are the content and features of Teach-ABI satisfactory?, and (3) What modifications are needed to improve Teach-ABI? Methods: Elementary school educators currently employed or in training to be employed in Ontario elementary schools were recruited. Using Zoom, individual online meetings with a research team member were held, where educators actively reviewed Teach-ABI. Module usability was evaluated through qualitative analysis of think-aloud data and semistructured interviews, direct observation, user success rate during task completion, and the System Usability Scale (SUS) scores. The usability benchmark selected was 70% of participants performing more than half of module tasks independently. Results: A total of 8 female educators participated in the study. Educators were classroom (n=7) and preservice (n=1) teachers from public (n=7) and private (n=1) school boards. In terms of task performance, more than 85% of participants (ie, 7/8) independently completed 10 out of 11 tasks and 100% of participants independently completed 7 out of 11 tasks, demonstrating achievement of the module usability goal. The average overall SUS score was 86.25, suggesting a high satisfaction level with the perceived usability of Teach-ABI. Overall, participants found Teach-ABI content valuable, useful, and aligned with the realities of their profession. Participants appreciated the visual design, organization, and varying use of education strategies within Teach-ABI. Opportunities for enhancement included broadening content case examples of students with ABI and enhancing the accessibility of the content. Conclusions: Validated usability measures combined with qualitative methodology revealed educators? high level of satisfaction with the design, content, and navigation of Teach-ABI. Educators engaged with the module as active participants in knowledge construction, as they reflected, questioned, and connected content to their experiences and knowledge. This study established strong usability and satisfaction with Teach-ABI and demonstrated the importance of usability testing in building online professional development modules. UR - https://humanfactors.jmir.org/2023/1/e43129 UR - http://dx.doi.org/10.2196/43129 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184920 ID - info:doi/10.2196/43129 ER - TY - JOUR AU - Tanaka, Hiroki AU - Saga, Takeshi AU - Iwauchi, Kota AU - Honda, Masato AU - Morimoto, Tsubasa AU - Matsuda, Yasuhiro AU - Uratani, Mitsuhiro AU - Okazaki, Kosuke AU - Nakamura, Satoshi PY - 2023/4/27 TI - The Validation of Automated Social Skills Training in Members of the General Population Over 4 Weeks: Comparative Study JO - JMIR Form Res SP - e44857 VL - 7 KW - social skills training KW - conversational agents KW - role-play KW - feedback KW - multimodal KW - long-term training effects N2 - Background: Social skills training by human trainers is a well-established method of teaching appropriate social and communication skills and strengthening social self-efficacy. Specifically, human social skills training is a fundamental approach to teaching and learning the rules of social interaction. However, it is cost-ineffective and offers low accessibility, since the number of professional trainers is limited. A conversational agent is a system that can communicate with a human being in a natural language. We proposed to overcome the limitations of current social skills training with conversational agents. Our system is capable of speech recognition, response selection, and speech synthesis and can also generate nonverbal behaviors. We developed a system that incorporated automated social skills training that completely adheres to the training model of Bellack et al through a conversational agent. Objective: This study aimed to validate the training effect of a conversational agent?based social skills training system in members of the general population during a 4-week training session. We compare 2 groups (with and without training) and hypothesize that the trained group?s social skills will improve. Furthermore, this study sought to clarify the effect size for future larger-scale evaluations, including a much larger group of different social pathological phenomena. Methods: For the experiment, 26 healthy Japanese participants were separated into 2 groups, where we hypothesized that group 1 (system trained) will make greater improvement than group 2 (nontrained). System training was done as a 4-week intervention where the participants visit the examination room every week. Each training session included social skills training with a conversational agent for 3 basic skills. We evaluated the training effect using questionnaires in pre- and posttraining evaluations. In addition to the questionnaires, we conducted a performance test that required the social cognition and expression of participants in new role-play scenarios. Blind ratings by third-party trainers were made by watching recorded role-play videos. A nonparametric Wilcoxson Rank Sum test was performed for each variable. Improvement between pre- and posttraining evaluations was used to compare the 2 groups. Moreover, we compared the statistical significance from the questionnaires and ratings between the 2 groups. Results: Of the 26 recruited participants, 18 completed this experiment: 9 in group 1 and 9 in group 2. Those in group 1 achieved significant improvement in generalized self-efficacy (P=.02; effect size r=0.53). We also found a significant decrease in state anxiety presence (P=.04; r=0.49), measured by the State-Trait Anxiety Inventory (STAI). For ratings by third-party trainers, speech clarity was significantly strengthened in group 1 (P=.03; r=0.30). Conclusions: Our findings reveal the usefulness of the automated social skills training after a 4-week training period. This study confirms a large effect size between groups on generalized self-efficacy, state anxiety presence, and speech clarity. UR - https://formative.jmir.org/2023/1/e44857 UR - http://dx.doi.org/10.2196/44857 UR - http://www.ncbi.nlm.nih.gov/pubmed/37103996 ID - info:doi/10.2196/44857 ER - TY - JOUR AU - Zlamal, Jaroslav AU - Roth Gjevjon, Edith AU - Fossum, Mariann AU - Steindal, A. Simen AU - Nes, Gonçalves Andréa Aparecida PY - 2023/4/26 TI - A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study JO - JMIR Form Res SP - e43300 VL - 7 KW - technology KW - guidance model KW - critical thinking KW - feasibility KW - nursing KW - nursing education KW - medical education KW - nursing student KW - digital intervention KW - mobile app KW - clinical practice N2 - Background: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP?N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. Objective: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. Methods: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. Results: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. Conclusions: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP?N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID): RR2-10.2196/31646 UR - https://formative.jmir.org/2023/1/e43300 UR - http://dx.doi.org/10.2196/43300 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099377 ID - info:doi/10.2196/43300 ER - TY - JOUR AU - Weidener, Lukas AU - Fischer, Michael PY - 2023/4/24 TI - Artificial Intelligence Teaching as Part of Medical Education: Qualitative Analysis of Expert Interviews JO - JMIR Med Educ SP - e46428 VL - 9 KW - AI technology KW - artificial intelligence KW - clinical context KW - expert interviews KW - health care KW - medical curriculum KW - medical education KW - medical school KW - medical student KW - medicine N2 - Background: The use of artificial intelligence (AI) in medicine is expected to increase significantly in the upcoming years. Advancements in AI technology have the potential to revolutionize health care, from aiding in the diagnosis of certain diseases to helping with treatment decisions. Current literature suggests the integration of the subject of AI in medicine as part of the medical curriculum to prepare medical students for the opportunities and challenges related to the use of the technology within the clinical context. Objective: We aimed to explore the relevant knowledge and understanding of the subject of AI in medicine and specify curricula teaching content within medical education. Methods: For this research, we conducted 12 guideline-based expert interviews. Experts were defined as individuals who have been engaged in full-time academic research, development, or teaching in the field of AI in medicine for at least 5 years. As part of the data analysis, we recorded, transcribed, and analyzed the interviews using qualitative content analysis. We used the software QCAmap and inductive category formation to analyze the data. Results: The qualitative content analysis led to the formation of three main categories (?Knowledge,? ?Interpretation,? and ?Application?) with a total of 9 associated subcategories. The experts interviewed cited knowledge and an understanding of the fundamentals of AI, statistics, ethics, and privacy and regulation as necessary basic knowledge that should be part of medical education. The analysis also showed that medical students need to be able to interpret as well as critically reflect on the results provided by AI, taking into account the associated risks and data basis. To enable the application of AI in medicine, medical education should promote the acquisition of practical skills, including the need for basic technological skills, as well as the development of confidence in the technology and one?s related competencies. Conclusions: The analyzed expert interviews? results suggest that medical curricula should include the topic of AI in medicine to develop the knowledge, understanding, and confidence needed to use AI in the clinical context. The results further imply an imminent need for standardization of the definition of AI as the foundation to identify, define, and teach respective content on AI within medical curricula. UR - https://mededu.jmir.org/2023/1/e46428 UR - http://dx.doi.org/10.2196/46428 UR - http://www.ncbi.nlm.nih.gov/pubmed/36946094 ID - info:doi/10.2196/46428 ER - TY - JOUR AU - Moretti, Valentina AU - Brunelli, Laura AU - Conte, Alessandro AU - Valdi, Giulia AU - Guelfi, Renza Maria AU - Masoni, Marco AU - Anelli, Filippo AU - Arnoldo, Luca PY - 2023/4/18 TI - A Web Tool to Help Counter the Spread of Misinformation and Fake News: Pre-Post Study Among Medical Students to Increase Digital Health Literacy JO - JMIR Med Educ SP - e38377 VL - 9 KW - infodemic KW - fake news KW - education KW - digital health literacy KW - medical education KW - medical student KW - health information KW - social media KW - health literacy KW - online learning KW - digital education KW - COVID-19 N2 - Background: The COVID-19 pandemic was accompanied by the spread of uncontrolled health information and fake news, which also quickly became an infodemic. Emergency communication is a challenge for public health institutions to engage the public during disease outbreaks. Health professionals need a high level of digital health literacy (DHL) to cope with difficulties; therefore, efforts should be made to address this issue starting from undergraduate medical students. Objective: The aim of this study was to investigate the DHL skills of Italian medical students and the effectiveness of an informatics course offered by the University of Florence (Italy). This course focuses on assessing the quality of medical information using the ?dottoremaeveroche? (DMEVC) web resource offered by the Italian National Federation of Orders of Surgeons and Dentists, and on health information management. Methods: A pre-post study was conducted at the University of Florence between November and December 2020. First-year medical students participated in a web-based survey before and after attending the informatics course. The DHL level was self-assessed using the eHealth Literacy Scale for Italy (IT-eHEALS) tool and questions about the features and quality of the resources. All responses were rated on a 5-point Likert scale. Change in the perception of skills was assessed using the Wilcoxon test. Results: A total of 341 students participated in the survey at the beginning of the informatics course (women: n=211, 61.9%; mean age 19.8, SD 2.0) and 217 of them (64.2%) completed the survey at the end of the course. At the first assessment, the DHL level was moderate, with a mean total score of the IT-eHEALS of 2.9 (SD 0.9). Students felt confident about finding health-related information on the internet (mean score of 3.4, SD 1.1), whereas they doubted the usefulness of the information they received (mean score of 2.0, SD 1.0). All scores improved significantly in the second assessment. The overall mean score of the IT-eHEALS significantly increased (P<.001) to 4.2 (SD 0.6). The item with the highest score related to recognizing the quality of health information (mean score of 4.5, SD 0.7), whereas confidence in the practical application of the information received remained the lowest (mean of 3.7, SD 1.1) despite improvement. Almost all students (94.5%) valued the DMEVC as an educational tool. Conclusions: The DMEVC tool was effective in improving medical students? DHL skills. Effective tools and resources such as the DMEVC website should be used in public health communication to facilitate access to validated evidence and understanding of health recommendations. UR - https://mededu.jmir.org/2023/1/e38377 UR - http://dx.doi.org/10.2196/38377 UR - http://www.ncbi.nlm.nih.gov/pubmed/36996010 ID - info:doi/10.2196/38377 ER - TY - JOUR AU - Owusu, Boampong Lydia AU - Scheepers, Nicholin AU - Tenza, Sabelile Immaculate PY - 2023/4/7 TI - Utilization of Research in Clinical Nursing and Midwifery Practice in Ghana: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e45067 VL - 12 KW - clinical practice KW - educators KW - evidence-based practice KW - health facilities KW - managers KW - midwife KW - midwives KW - nurses KW - nursing practice KW - nursing KW - research utilization N2 - Background: The International Council of Nurses? 2021 code of ethics mandates nurses to provide evidence-informed care to patients. Globally, using research evidence has led to improvement in nursing and midwifery practice, according to the World Health Organization. A study in Ghana found that 25.3% (n=40) of nurses and midwives use research in clinical care. Research utilization (RU) increases therapeutic effectiveness, improves health outcomes, and enhances the personal and professional development of clinicians. However, it is uncertain the extent to which nurses and midwives are prepared, skilled, and supported to utilize research in clinical care in Ghana. Objective: This study aims to develop a conceptual framework that can facilitate RU among clinical nurses and midwives in Ghanaian health facilities. Methods: This will be a cross-sectional study with a concurrent mixed methods approach. It will be conducted in 6 hospitals and 4 nursing educational institutions in Kumasi, Ghana. The study has 4 objectives which will be executed in 3 phases. Phase 1 follows a quantitative approach to describe the knowledge, attitudes, and practices of clinical nurses and midwives on the use of research in their practice. Using a web-based survey, 400 nurses and midwives working in 6 health facilities will be recruited. Data analysis will be conducted using SPSS, with statistical significance set at .05. Qualitative methodology, using focus group discussions with clinical nurses and midwives, will be conducted to identify the factors influencing their RU. In phase 2, focus group discussions will be used to examine and describe how nurse educators in 4 nursing and midwifery educational institutions prepare nurses and midwives for RU during their education. Views of nurse managers on the RU in Ghanaian health care facilities will be explored in the second section of this phase through one-on-one interviews. Inductive thematic analysis will be used to analyze the qualitative data, and Lincoln and Guba?s principles of trustworthiness will be applied. In phase 3, the stages of model development proposed by Chinn and Kramer; and Walker and Avant will be used to triangulate findings from all objectives and formulate a conceptual framework. Results: Data collection started in December 2022. Publication of the results will begin in April 2023. Conclusions: RU in clinical practice has become an acceptable practice in nursing and midwifery. It is critical that nursing and midwifery professionals in sub-Saharan Africa shift their practice to embrace the global movement. This proposed conceptual framework will empower nurses and midwives to improve their practice of RU. International Registered Report Identifier (IRRID): DERR1-10.2196/45067 UR - https://www.researchprotocols.org/2023/1/e45067 UR - http://dx.doi.org/10.2196/45067 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027196 ID - info:doi/10.2196/45067 ER - TY - JOUR AU - Chong, Meng Kah AU - Yang, Hsiang-Wen AU - He, Hsien-Chin AU - Lien, Wan-Ching AU - Yang, Mei-Fen AU - Chi, Chien-Yu AU - Chen, Yen-Pin AU - Huang, Chien-Hua AU - Ko, Chow-In Patrick PY - 2023/4/5 TI - The Effectiveness of Online-Only Blended Cardiopulmonary Resuscitation Training: Static-Group Comparison Study JO - J Med Internet Res SP - e42325 VL - 25 KW - basic life support KW - cardiopulmonary resuscitation education KW - distance learning KW - self-directed learning KW - deliberate practice KW - blended learning KW - digital health intervention KW - virtual learning KW - virtual education KW - online course KW - digital training KW - online learning KW - classroom-based blended learning KW - educational outcomes KW - remote education KW - remote learning KW - static-group comparison study KW - online lectures KW - cardiopulmonary resuscitation KW - resuscitation N2 - Background: Basic life support (BLS) education is essential for improving bystander cardiopulmonary resuscitation (CPR) rates, but the imparting of such education faces obstacles during the outbreak of emerging infectious diseases, such as COVID-19. When face-to-face teaching is limited, distance learning?blended learning (BL) or an online-only model?is encouraged. However, evidence regarding the effect of online-only CPR training is scarce, and comparative studies on classroom-based BL (CBL) are lacking. While other strategies have recommended self-directed learning and deliberate practice to enhance CPR education, no previous studies have incorporated all of these instructional methods into a BLS course. Objective: This study aimed to demonstrate a novel BLS training model?remote practice BL (RBL)?and compare its educational outcomes with those of the conventional CBL model. Methods: A static-group comparison study was conducted. It included RBL and CBL courses that shared the same paradigm, comprising online lectures, a deliberate practice session with Little Anne quality CPR (QCPR) manikin feedback, and a final assessment session. In the main intervention, the RBL group was required to perform distant self-directed deliberate practice and complete the final assessment via an online video conference. Manikin-rated CPR scores were measured as the primary outcome; the number of retakes of the final examination was the secondary outcome. Results: A total of 52 and 104 participants from the RBL and CBL groups, respectively, were eligible for data analysis. A comparison of the 2 groups revealed that there were more women in the RBL group than the CBL group (36/52, 69.2% vs 51/104, 49%, respectively; P=.02). After adjustment, there were no significant differences in scores for QCPR release (96.9 vs 96.4, respectively; P=.61), QCPR depth (99.2 vs 99.5, respectively; P=.27), or QCPR rate (94.9 vs 95.5, respectively; P=.83). The RBL group spent more days practicing before the final assessment (12.4 vs 8.9 days, respectively; P<.001) and also had a higher number of retakes (1.4 vs 1.1 times, respectively; P<.001). Conclusions: We developed a remote practice BL?based method for online-only distant BLS CPR training. In terms of CPR performance, using remote self-directed deliberate practice was not inferior to the conventional classroom-based instructor-led method, although it tended to take more time to achieve the same effect. Trial Registration: Not applicable. UR - https://www.jmir.org/2023/1/e42325 UR - http://dx.doi.org/10.2196/42325 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018023 ID - info:doi/10.2196/42325 ER - TY - JOUR AU - Kobak, Kenneth AU - Shear, Katherine M. AU - Skritskaya, A. Natalia AU - Bloom, Colleen AU - Bottex, Gaelle PY - 2023/3/27 TI - A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study JO - JMIR Med Educ SP - e44246 VL - 9 KW - grief KW - prolonged grief disorder KW - evidence-based practice KW - mental health training KW - therapist training KW - new technology KW - web-based training KW - dissemination KW - e-learning N2 - Background: Prolonged grief disorder (PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural or social expectations and interferes with functioning. The COVID-19 epidemic has resulted in increased rates of PGD, and few clinicians feel confident in treating this condition. PGD therapy (PGDT) is a simple, short-term, and evidence-based treatment developed in tandem with the validation of the PGD diagnosis. To facilitate the dissemination of PGDT training, we developed a web-based therapist tutorial that includes didactic training on PGDT concepts and principles as well as web-based multimedia patient scenarios and examples of clinical implementation of PGDT. Objective: We aimed to evaluate user satisfaction with the tutorial and whether the tutorial increased trainees? knowledge of PGDT principles and procedures. Moreover, we included a small number of pilot questions to evaluate the PGDT-related clinical skills. Methods: This study evaluated tutorial learning using a pre- and poststudy design. Participants were recruited from professional organization mailing lists, announcements to graduates of the Columbia School of Social Work, and through word of mouth. After signing consent, participants completed a brief demographic survey, a 55-item multiple-choice prestudy test on the concepts and principles of PGD and PGDT covered in the tutorial, and a 4-item pilot web-based prestudy test to gauge PGD clinical implementation skills. The link to the course content was then activated, and participants were given 8 weeks to complete the 11-module tutorial containing information, web-based exercises, simulated patient and video examples, and self-tests. Results: Overall, 406 clinicians signed consent, and 236 (58.1%) started the tutorial. Of these, 83.1% (196/236) completed all 11 modules. Trainee scores on our PDGT assessment improved substantially from pretraining to the postmodule assessment, with the total number of correct answers increasing from a mean of 29 (SD 5.5; 52.7% correct) to 36.7 (SD 5.2; 66.7% correct; t195=18.93; P<.001). In addition, the trainee?s implementation scores on 4 clinical vignettes increased from 2.6 (SD 0.7) correct out of 4 to 3.1 (SD 0.4) out of 4 (t188=7.02; P<.001). Effect sizes (Cohen d) were 1.44 (95% CI 1.23-1.65) for PDGT assessment and 1.06 (95% CI 0.84-1.29) for implementation. Trainees found the tutorial interesting, enjoyable, clearly presented, and useful for professional development. They endorsed a mean score of 3.7 (SD 0.47) on a 1 to 4 scale of agreement with recommending the course to others and feeling satisfied with the tutorial, and a mean of 3.3 (SD 0.57) with feeling able to apply the skills with clients. Conclusions: This pilot study provides support for the usefulness of this web-based training for teaching clinicians how to administer PGDT. The addition of patient scenarios for clinical implementation strategies holds promise for increasing the effectiveness of PGDT training and other evidence-based treatments. Trial Registration: ClinicalTrials.gov NCT05121792; https://www.clinicaltrials.gov/ct2/show/NCT05121792 UR - https://mededu.jmir.org/2023/1/e44246 UR - http://dx.doi.org/10.2196/44246 UR - http://www.ncbi.nlm.nih.gov/pubmed/36972105 ID - info:doi/10.2196/44246 ER - TY - JOUR AU - Kanzow, Philipp AU - Schmidt, Dennis AU - Herrmann, Manfred AU - Wassmann, Torsten AU - Wiegand, Annette AU - Raupach, Tobias PY - 2023/3/27 TI - Use of Multiple-Select Multiple-Choice Items in a Dental Undergraduate Curriculum: Retrospective Study Involving the Application of Different Scoring Methods JO - JMIR Med Educ SP - e43792 VL - 9 KW - dental education KW - education system KW - educational assessment KW - educational measurement KW - examination KW - k of n KW - Kprim KW - K? KW - MTF KW - Multiple-True-False KW - Pick-N KW - scoring KW - scoring system KW - Type X KW - undergraduate KW - undergraduate curriculum KW - undergraduate education N2 - Background: Scoring and awarding credit are more complex for multiple-select items than for single-choice items. Forty-one different scoring methods were retrospectively applied to 2 multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF]) from existing examination data. Objective: This study aimed to calculate and compare the mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above the pass level (?0.6). Methods: Items and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing examination data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using the Kruskal-Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P<.05). Results: We analyzed 1931 marking events of 48 Pick-N items and 828 marking events of 18 MTF items. For both item types, scoring results widely differed between scoring methods (minimum: 0.02, maximum: 0.98; P<.001). Both the use of an inappropriate item type (34 items) and the presence of cues (30 items) impacted the scoring results. Inappropriately used Pick-N items resulted in lower mean raw scores (0.88 vs 0.93; P<.001), while inappropriately used MTF items resulted in higher mean raw scores (0.88 vs 0.85; P=.001). Mean raw scores were higher for MTF items with cues than for those without cues (0.91 vs 0.8; P<.001), while mean raw scores for Pick-N items with and without cues did not differ (0.89 vs 0.90; P=.09). Item quality also impacted the likelihood of resulting scores at or above the pass level (odds ratio ?6.977). Conclusions: Educators should pay attention when using multiple-select multiple-choice items and select the most appropriate item type. Different item types, different scoring methods, and presence of cues are likely to impact examinees? scores and overall examination results. UR - https://mededu.jmir.org/2023/1/e43792 UR - http://dx.doi.org/10.2196/43792 UR - http://www.ncbi.nlm.nih.gov/pubmed/36841970 ID - info:doi/10.2196/43792 ER - TY - JOUR AU - Solberg, Trygg Marianne AU - Sørensen, Lene Anne AU - Clarke, Sara AU - Nes, Goncalves Andrea Aparecida PY - 2023/3/23 TI - Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students JO - JMIR Med Educ SP - e42512 VL - 9 KW - advanced practice nurse KW - nursing education KW - virtual reflection group KW - teaching design KW - critical care KW - active learning approach N2 - Background: Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master?s degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs? competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students? achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs? development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. Objective: This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students? development of the required competence to become APNs in critical care. Methods: This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. Results: The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. Conclusions: Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs? required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education. UR - https://mededu.jmir.org/2023/1/e42512 UR - http://dx.doi.org/10.2196/42512 UR - http://www.ncbi.nlm.nih.gov/pubmed/36951919 ID - info:doi/10.2196/42512 ER - TY - JOUR AU - Lie, Stangeland Silje AU - Røykenes, Kari AU - Sæheim, Aleksandra AU - Groven, Synne Karen PY - 2023/3/20 TI - Developing a Virtual Reality Educational Tool to Stimulate Emotions for Learning: Focus Group Study JO - JMIR Form Res SP - e41829 VL - 7 KW - virtual reality KW - 360° video KW - learning KW - experiences KW - emotions KW - health care and social work higher education N2 - Background: By watching 360° videos in virtual reality headsets, students may experience being immersed in the portrayed situation. There is a paucity of empirical studies on the application of immersive 360° videos watched in virtual reality headsets for students in health care and social work education and the pedagogical theory guiding the development of such educational tools. This led to our interest in exploring how a virtual reality educational tool involving 360° videos can stimulate emotions and how this can be used as a pedagogical tool in these educational programs. Objective: The aim of this study was to explore the experiences of faculty members and students regarding a prototype 360° video watched in virtual reality headsets during the development phase of an educational project. We addressed the following research questions: How does the virtual reality prototype stimulate emotions? How can virtual reality be used in higher education for health care and social work students? Methods: We used a qualitative design and collected data through focus group interviews with project participants. The data were analyzed using qualitative content analysis. Results: Our analysis identified 2 main themes in participants? experiences with the virtual reality prototype. The first theme highlights that when participants experienced watching the 360° video in a virtual reality headset, it stimulated their emotions as an authentic professional experience would. The second theme, contextualization of virtual reality, highlights participants? perceptions of how the virtual reality experience should be incorporated into a safe educational context. Conclusions: Our findings suggest that 360° videos with human actors who use eye contact with the camera can trigger emotions in the viewer and therefore serve as a pedagogic tool that can create authentic professional experiences for students. The participants expressed the view that the virtual reality educational tool could be used to prepare students for real-life practice in health care and social work. However, they underlined that 360° videos in virtual reality need to be contextualized in educational programs to create a safe environment for learning and to ensure follow-up on the emotions such experiences can trigger in students. Our results highlight the perceived importance of allowing students to reflect on the virtual reality experience in a safe setting and of follow-up by faculty members. In-person follow-up with students can be resource intensive for programs with large numbers of students and makes it challenging to offer repeated training, something that has been identified as one of the benefits of virtual reality. UR - https://formative.jmir.org/2023/1/e41829 UR - http://dx.doi.org/10.2196/41829 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939819 ID - info:doi/10.2196/41829 ER - TY - JOUR AU - Dadich, Ann AU - Wells, Rebecca AU - Williams, J. Sharon AU - Taskin, Nazim AU - Coskun, Mustafa AU - Grenier, Corinne AU - Ponsignon, Frederic AU - Scahill, Shane AU - Best, Stephanie PY - 2023/3/15 TI - Cues Disseminated by Professional Associations That Represent 5 Health Care Professions Across 5 Nations: Lexical Analysis of Tweets JO - J Med Internet Res SP - e42927 VL - 25 KW - professional associations KW - social media KW - professional identity KW - collaboration KW - knowledge translation N2 - Background: Collaboration across health care professions is critical in efficiently and effectively managing complex and chronic health conditions, yet interprofessional care does not happen automatically. Professional associations have a key role in setting a profession?s agenda, maintaining professional identity, and establishing priorities. The associations? external communication is commonly undertaken through social media platforms, such as Twitter. Despite the valuable insights potentially available into professional associations through such communication, to date, their messaging has not been examined. Objective: This study aimed to identify the cues disseminated by professional associations that represent 5 health care professions spanning 5 nations. Methods: Using a back-iterative application programming interface methodology, public tweets were sourced from professional associations that represent 5 health care professions that have key roles in community-based health care: general practice, nursing, pharmacy, physiotherapy, and social work. Furthermore, the professional associations spanned Australia, Canada, New Zealand, the United Kingdom, and the United States. A lexical analysis was conducted of the tweets using Leximancer (Leximancer Pty Ltd) to clarify relationships within the discourse. Results: After completing a lexical analysis of 50,638 tweets, 7 key findings were identified. First, the discourse was largely devoid of references to interprofessional care. Second, there was no explicit discourse pertaining to physiotherapists. Third, although all the professions represented in this study support patients, discourse pertaining to general practitioners was most likely to be connected with that pertaining to patients. Fourth, tweets pertaining to pharmacists were most likely to be connected with discourse pertaining to latest and research. Fifth, tweets about social workers were unlikely to be connected with discourse pertaining to health or care. Sixth, notwithstanding a few exceptions, the findings across the different nations were generally similar, suggesting their generality. Seventh and last, tweets pertaining to physiotherapists were most likely to refer to discourse pertaining to profession. Conclusions: The findings indicate that health care professional associations do not use Twitter to disseminate cues that reinforce the importance of interprofessional care. Instead, they largely use this platform to emphasize what they individually deem to be important and advance the interests of their respective professions. Therefore, there is considerable opportunity for professional associations to assert how the profession they represent complements other health care professions and how the professionals they represent can enact interprofessional care for the benefit of patients and carers. UR - https://www.jmir.org/2023/1/e42927 UR - http://dx.doi.org/10.2196/42927 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920443 ID - info:doi/10.2196/42927 ER - TY - JOUR AU - Bhatti, Faheem AU - Mowforth, Oliver AU - Butler, Max AU - Bhatti, Zainab AU - Rafati Fard, Amir AU - Kuhn, Isla AU - Davies, M. Benjamin PY - 2023/3/15 TI - Meeting the Shared Goals of a Student-Selected Component: Pilot Evaluation of a Collaborative Systematic Review JO - JMIR Med Educ SP - e39210 VL - 9 KW - medical education KW - medical student KW - research training KW - research methodology KW - systematic review KW - methodology KW - review KW - collaboration KW - collaborative KW - medical school KW - medical librarian KW - library science KW - information science KW - search strategy KW - student-selected component KW - curriculum KW - curricula N2 - Background: Research methodology is insufficiently featured in undergraduate medical curricula. Student-selected components are designed to offer some research opportunities but frequently fail to meet student or supervisor expectations, such as completion or publication. We hypothesized that a collaborative, educational approach to a systematic review (SR), whereby medical students worked together, may improve student experience and increase success. Objective: This study aimed to establish whether offering a small team of students the opportunity to take part in the screening phase of SRs led by an experienced postgraduate team could enhance the learning experience of students, overcome the barriers to successful research engagement, and deliver published output. Methods: Postgraduate researchers from the University of Cambridge led a team of 14 medical students to work on 2 neurosurgical SRs. One student was appointed as the lead for each SR. All students were provided with training on SR methodology and participated in title and abstract screening using Rayyan software. Students completed prepilot, midscreening, and postscreening questionnaires on their research background, perceptions, knowledge, confidence, and experience. Questions were scored on a Likert scale of 1 (strongly disagree) to 10 (strongly agree). Results: Of the 14 students involved, 29% (n=4) reported that they had received sufficient training in research methodology at medical school. Positive trends in student knowledge, confidence, and experience of SR methodology were noted across the 3 questionnaire time points. Mean responses to ?I am satisfied with the level of guidance I am receiving,? ?I am enjoying being involved in the SR process,? and ?I could not gain this understanding of research from passive learning e.g., textbook or lecture? were greater than 8.0 at all time points. Students reported ?being involved in this research has made me more likely to do research in the future? (mean 8.57, SD 1.50) and that ?this collaborative SR improved my research experience? (mean 8.50, SD 1.56). Conclusions: This collaborative approach appears to be a potentially useful method of providing students with research experience; however, it requires further evaluation. UR - https://mededu.jmir.org/2023/1/e39210 UR - http://dx.doi.org/10.2196/39210 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920459 ID - info:doi/10.2196/39210 ER - TY - JOUR AU - Soares-Pinto, Igor AU - Braga, Pinto Ana Margarida AU - Santos, Araujo Isabel Maria Ribeiro Morais AU - Ferreira, Gomes Natália Maria Ribeiro AU - Silva, e. Sandra Cristina da Rocha AU - Alves, Jorge Paulo PY - 2023/3/13 TI - eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study JO - JMIR Hum Factors SP - e39826 VL - 10 KW - self-care KW - ostomy KW - nurses KW - health education KW - telemedicine KW - eHealth N2 - Background: The construction of an elimination stoma has a physical, psychological, and social impact on the person. The development of stoma self-care competence contributes to the adaptation to a new health condition and improvement of quality of life. eHealth refers to everything associated with information and communication technology and health care, including telemedicine, mobile health, and health informatics. The use of eHealth platforms by the person with an ostomy, as a digital application that includes websites and mobile phone apps, can bring scientific knowledge and well-informed practices to individuals, families, and communities. It also allows functionalities that enable the person to describe and identify early signs and symptoms and precursors of complications and to be guided to an adequate health response for their problems. Objective: This study aimed to define the most relevant content and features to promote ostomy self-care integrated into an eHealth platform as a digital app or website to be used by patients for self-management of stoma care. Methods: We developed a descriptive, exploratory study with a qualitative approach using the focus group methodology, which was oriented to reach a consensus of at least 80%. A convenience sample of 7 participants consisting of stomatherapy nurses was used. The focus group discussion was recorded, and field notes were taken. The focus group meeting was fully transcribed, and a qualitative analysis was performed. The research question was: Which content and features for ostomy self-care promotion should be integrated into an eHealth platform as a digital app or website? Results: An eHealth platform, which can be a smartphone app or website, for people with ostomy should provide content aimed at promoting self-care, namely in the field of knowledge and self-monitoring, as well as the possibility of interacting with a stomatherapy care nurse. Conclusions: The stomatherapy nurse has a decisive role in promoting adaptation to life with a stoma, namely through the promotion of stoma self-care. Technological evolution has emerged as a useful tool to enhance nursing interventions and promote self-care competence. The development of an eHealth platform aimed at promoting ostomy self-care should include the capabilities for telehealth and help with decision-making regarding self-monitoring and seeking differentiated care. UR - https://humanfactors.jmir.org/2023/1/e39826 UR - http://dx.doi.org/10.2196/39826 UR - http://www.ncbi.nlm.nih.gov/pubmed/36912879 ID - info:doi/10.2196/39826 ER - TY - JOUR AU - Liu, Wa Justina Yat AU - Yin, Yue-Heng AU - Kor, Kin Patrick Pui AU - Cheung, Ki Daphne Sze AU - Zhao, Yan Ivy AU - Wang, Shanshan AU - Su, Jing Jing AU - Christensen, Martin AU - Tyrovolas, Stefanos AU - Leung, M. Angela Y. PY - 2023/3/6 TI - The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis JO - J Med Internet Res SP - e39989 VL - 25 KW - immersive virtual reality KW - virtual reality KW - effects KW - undergraduate health care education KW - systematic review KW - meta-synthesis N2 - Background: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students? competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. Objective: This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. Methods: MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students? learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. Results: A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. Conclusions: This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. Trial Registration: International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706 UR - https://www.jmir.org/2023/1/e39989 UR - http://dx.doi.org/10.2196/39989 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877550 ID - info:doi/10.2196/39989 ER - TY - JOUR AU - Lee, Yau Jason Wen AU - Bello, Fernando PY - 2023/3/6 TI - Readiness of Health Care Professionals in Singapore to Teach Online and Their Technology-Related Teaching Needs: Quantitative Cross-sectional Pilot Study JO - JMIR Med Educ SP - e42281 VL - 9 KW - online readiness in teaching KW - technology for learning KW - faculty development KW - training need KW - technology-enhanced learning KW - readiness KW - teaching KW - medical education KW - health care education KW - teacher KW - online environment KW - online teaching KW - teaching skill KW - educator N2 - Background: With the increasing acceptance of face-to-face classes transitioning to web-based learning due to COVID-19, there is an increasing need to have educators trained and equipped to teach online. The ability to teach in-person may not necessarily mean that one is ready teach in a web-based environment. Objective: The objective of our study was to investigate the readiness of health care professionals in Singapore to teach online and their technology-related teaching needs. Methods: This was a quantitative cross-sectional pilot study conducted among health care administrative staff and professionals in medicine, nursing, allied health, and dentistry. Participants were recruited via an open invitation email to all staff members of Singapore?s largest group of health care institutions. Data were collected using a web-based questionnaire. Differences in the readiness of the professionals to teach online were analyzed using analysis of variance, and a 1-sided independent sample t test was performed to analyze the differences between respondents younger than 40 years and those older than 41 years. Results: A total of 169 responses was analyzed. Full-time academic faculty members scored the highest for readiness to teach online (2.97), followed by nursing professionals (2.91), medicine professionals (2.88), administrative staff members (2.83), and allied health professionals (2.76). However, there was no statistically significant difference (P=.77) among all the respondents in their readiness to teach online. There was an agreement among all professionals in their need for software tools to teach; in particular, there was a significant difference in the software needs among the professionals for streaming videos (P=.01). There was no statistically significant difference in the readiness to teach online between those younger than 40 years and those older than 41 years (P=.48). Conclusions: Our study shows that there are still some gaps in terms of readiness to teach online among health care professionals. Our findings can be used by policy makers and faculty developers to identify opportunities for development among their educators so that they are ready to teach online with the appropriate software tools. UR - https://mededu.jmir.org/2023/1/e42281 UR - http://dx.doi.org/10.2196/42281 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877546 ID - info:doi/10.2196/42281 ER - TY - JOUR AU - Mahling, Moritz AU - Wunderlich, Robert AU - Steiner, Daniel AU - Gorgati, Eleonora AU - Festl-Wietek, Teresa AU - Herrmann-Werner, Anne PY - 2023/3/3 TI - Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study JO - J Med Internet Res SP - e43649 VL - 25 KW - emergency medicine KW - resuscitation KW - virtual reality KW - simulation KW - undergraduate medical education KW - Germany KW - medical education KW - virtual training KW - digital learning KW - medical student N2 - Background: Virtual reality (VR)?based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. Objective: The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. Methods: The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. Results: A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. Conclusions: In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine. UR - https://www.jmir.org/2023/1/e43649 UR - http://dx.doi.org/10.2196/43649 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867440 ID - info:doi/10.2196/43649 ER - TY - JOUR AU - Mallakin, Maryam AU - Dery, Christina AU - Vaillancourt, Samuel AU - Gupta, Sahil AU - Sellen, Katherine PY - 2023/3/3 TI - Web-Based Co-design in Health Care: Considerations for Renewed Participation JO - Interact J Med Res SP - e36765 VL - 12 KW - web-based design research KW - co-design KW - web-based co-design KW - virtual platform KW - virtual learning platforms KW - internet research ethics KW - collaboration KW - health communication KW - sensemaking KW - health design KW - tangible tools and games UR - https://www.i-jmr.org/2023/1/e36765 UR - http://dx.doi.org/10.2196/36765 UR - http://www.ncbi.nlm.nih.gov/pubmed/36595738 ID - info:doi/10.2196/36765 ER - TY - JOUR AU - Bieri, Julie AU - Tuor, Carlotta AU - Nendaz, Mathieu AU - L Savoldelli, Georges AU - Blondon, Katherine AU - Schiffer, Eduardo AU - Zamberg, Ido PY - 2023/3/2 TI - Implementation of a Student-Teacher?Based Blended Curriculum for the Training of Medical Students for Nasopharyngeal Swab and Intramuscular Injection: Mixed Methods Pre-Post and Satisfaction Surveys JO - JMIR Med Educ SP - e38870 VL - 9 KW - peer-learning KW - educator KW - education method KW - knowledge acquisition KW - training KW - student-teacher KW - COVID-19 KW - nasal swab KW - vaccine KW - injection KW - skill assessment KW - skill development KW - vaccination KW - blended learning KW - blended education KW - hybrid education KW - medical education KW - pandemic KW - teaching KW - health care sector KW - medical student KW - hybrid learning KW - online learning KW - digital education KW - online education KW - online course KW - online class KW - simulation N2 - Background: The COVID-19 pandemic caused a major disruption in the health care sector with increased workload and the need for new staff to assist with screening and vaccination tasks. Within this context, teaching medical students to perform intramuscular injections and nasal swabs could help address workforce needs. Although several recent studies discuss medical students? role and integration in clinical activities during the pandemic, knowledge gaps exist concerning their role and potential benefit in designing and leading teaching activities during this period. Objective: The aim of our study was to prospectively assess the impact in terms of confidence, cognitive knowledge, and perceived satisfaction of a student-teacher?designed educational activity consisting of nasopharyngeal swabs and intramuscular injections for the training of second-year medical students in the Faculty of Medicine, University of Geneva, Switzerland. Methods: This was a mixed methods pre-post surveys and satisfaction survey study. Activities were designed using evidence-based teaching methodologies based on the SMART (specific, measurable, achievable, realistic, and timely) criteria. All second-year medical students who did not participate in the activity?s old format were recruited unless they explicitly stated that they wanted to opt out. Pre-post activity surveys were designed to assess perception of confidence and cognitive knowledge. An additional survey was designed to assess satisfaction in the mentioned activities. Instructional design was blended with a presession e-learning activity and a 2-hour practice session with simulators. Results: Between December 13, 2021, and January 25, 2022, a total of 108 second-year medical students were recruited; 82 (75.9%) students participated in the preactivity survey and 73 (67.6%) in the postactivity survey. Students? confidence in performing intramuscular injections and nasal swabs significantly increased on a 5-point Likert scale for both procedures?from 3.31 (SD 1.23) and 3.59 (SD 1.13) before the activity to 4.45 (SD 0.62) and 4.32 (SD 0.76) after the activity (P<.001), respectively. Perceptions of cognitive knowledge acquisition also significantly increased for both activities. For the nasopharyngeal swab, knowledge acquisition concerning indications increased from 2.7 (SD 1.24) to 4.15 (SD 0.83), and for the intramuscular injection, knowledge acquisition concerning indications increased from 2.64 (SD 1.1) to 4.34 (SD 0.65) (P<.001). Knowledge of contraindications for both activities increased from 2.43 (SD 1.1) to 3.71 (SD 1.12) and from 2.49 (SD 1.13) to 4.19 (SD 0.63), respectively (P<.001). High satisfaction rates were reported for both activities. Conclusions: Student-teacher?based blended activities for training novice medical students in commonly performed procedural skills seem effective for increasing their confidence and cognitive knowledge and should be further integrated within a medical school curriculum. Blended learning instructional design increases students? satisfaction about clinical competency activities. Future research should elucidate the impact of student-teacher?designed and student-teacher?led educational activities. UR - https://mededu.jmir.org/2023/1/e38870 UR - http://dx.doi.org/10.2196/38870 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862500 ID - info:doi/10.2196/38870 ER - TY - JOUR AU - Papan, Cihan AU - Schmitt, Monika AU - Becker, L. Sören PY - 2023/2/27 TI - Teaching Medical Microbiology With a Web-Based Course During the COVID-19 Pandemic: Retrospective Before-and-After Study JO - JMIR Med Educ SP - e39680 VL - 9 KW - SARS-CoV-2 KW - COVID-19 KW - online learning KW - web-based learning KW - web-based course KW - medical students KW - medical microbiology KW - microbiology KW - medical education KW - medical school KW - online teaching KW - online course KW - online class KW - online instruction KW - distance learning KW - distant learning KW - performance KW - student KW - learning outcome KW - perception KW - opinion KW - attitude KW - examination KW - practical course N2 - Background: The COVID-19 pandemic has imposed unprecedented hurdles on health care systems and medical faculties alike. Lecturers of practical courses at medical schools have been confronted with the challenge of transferring knowledge remotely. Objective: We sought to evaluate the effects of a web-based medical microbiology course on learning outcomes and student perceptions. Methods: During the summer term of 2020, medical students at Saarland University, Germany, participated in a web-based medical microbiology course. Teaching content comprised clinical scenarios, theoretical knowledge, and instructive videos on microbiological techniques. Test performance, failure rate, and student evaluations, which included open-response items, for the web-based course were compared to those of the on-site course from the summer term of 2019. Results: Student performance was comparable between both the online-only group and the on-site comparator for both the written exam (n=100 and n=131, respectively; average grade: mean 7.6, SD 1.7 vs mean 7.3, SD 1.8; P=.20) and the oral exam (n=86 and n=139, respectively; average grade: mean 33.6, SD 4.9 vs mean 33.4, SD 4.8; P=.78). Failure rate did not significantly differ between the online-only group and the comparator group (2/84, 2.4% vs 4/120, 3.3%). While lecturer expertise was rated similarly as high by students in both groups (mean 1.47, SD 0.62 vs mean 1.27, SD 0.55; P=.08), students who took the web-based course provided lower scores for interdisciplinarity (mean 1.7, SD 0.73 vs mean 2.53, SD 1.19; P<.001), opportunities for interaction (mean 1.46, SD 0.67 vs mean 2.91, SD 1.03; P<.001), and the extent to which the educational objectives were defined (mean 1.61, SD 0.76 vs mean 3.41, SD 0.95; P<.001). Main critiques formulated within the open-response items concerned organizational deficits. Conclusions: Web-based courses in medical microbiology are a feasible teaching option, especially in the setting of a pandemic, leading to similar test performances in comparison to on-site courses. The lack of interaction and the sustainability of acquired manual skills warrant further research. UR - https://mededu.jmir.org/2023/1/e39680 UR - http://dx.doi.org/10.2196/39680 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848212 ID - info:doi/10.2196/39680 ER - TY - JOUR AU - Skinner, Ann Nadine AU - Job, Nophiwe AU - Krause, Julie AU - Frankel, Ariel AU - Ward, Victoria AU - Johnston, Sewan Jamie PY - 2023/2/23 TI - The Use of Open-Source Online Course Content for Training in Public Health Emergencies: Mixed Methods Case Study of a COVID-19 Course Series for Health Professionals JO - JMIR Med Educ SP - e42412 VL - 9 KW - global health education KW - digital education KW - digital health KW - COVID-19 pandemic KW - health care access KW - partnerships for health KW - community health workers KW - remote learning N2 - Background: The onset of the COVID-19 pandemic generated an urgent need for credible and actionable information to guide public health responses. The massive open-source online course (MOOC) format may be a valuable path for disseminating timely and widely accessible training for health professionals during public health crises; however, the reach and effectiveness of health worker?directed online courses during the pandemic remain largely unexplored. Objective: This study investigated the use of an open-source online course series designed to provide critical COVID-19 knowledge to frontline health workers and public health professionals globally. The study investigated how open-source online educational content can be optimized to support knowledge sharing among health professionals in public health emergencies, particularly in resource-limited contexts. Methods: The study examined global course enrollment patterns (N=2185) and performed in-depth interviews with a purposive subsample of health professionals enrolled in the course series (N=12) to investigate the sharing of online content in pandemic responses. Interviewed learners were from Ethiopia, India, Kenya, Liberia, Malawi, Rwanda, Thailand, Uganda, the United Arab Emirates, and the United States. Inductive analysis and constant comparative methods were used to systematically code data and identify key themes emerging from interview data. Results: The analysis revealed that the online course content helped fill a critical gap in trustworthy COVID-19 information for pandemic responses and was shared through health worker professional and personal networks. Enrollment patterns and qualitative data illustrate how health professionals shared information within their professional networks. While learners shared the knowledge they gained from the course, they expressed a need for contextualized information to more effectively educate others in their networks and in their communities. Due to technological and logistical barriers, participants did not attempt to adapt the content to share with others. Conclusions: This study illustrates that health professional networks can facilitate the sharing of online open-source health education content; however, to fully leverage potential benefits, additional support is required to facilitate the adaptation of course content to more effectively reach communities globally. UR - https://mededu.jmir.org/2023/1/e42412 UR - http://dx.doi.org/10.2196/42412 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735834 ID - info:doi/10.2196/42412 ER - TY - JOUR AU - Bucalon, Bernard AU - Whitelock-Wainwright, Emma AU - Williams, Chris AU - Conley, Jeanette AU - Veysey, Martin AU - Kay, Judy AU - Shaw, Tim PY - 2023/2/16 TI - Thought Leader Perspectives on the Benefits, Barriers, and Enablers for Routinely Collected Electronic Health Data to Support Professional Development: Qualitative Study JO - J Med Internet Res SP - e40685 VL - 25 KW - practice analytics KW - data visualization KW - continuing professional development KW - professional practice KW - reflective practice KW - lifelong learning KW - electronic health records KW - EHR N2 - Background: Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. Objective: This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. Methods: We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. Results: Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. Conclusions: Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle. UR - https://www.jmir.org/2023/1/e40685 UR - http://dx.doi.org/10.2196/40685 UR - http://www.ncbi.nlm.nih.gov/pubmed/36795463 ID - info:doi/10.2196/40685 ER - TY - JOUR AU - Musa, Dahlia AU - Gonzalez, Laura AU - Penney, Heidi AU - Daher, Salam PY - 2023/2/15 TI - Technology Acceptance and Authenticity in Interactive Simulation: Experimental Study JO - JMIR Med Educ SP - e40040 VL - 9 KW - health care simulation KW - interactivity KW - remote learning KW - video KW - technology acceptance KW - authenticity KW - nursing education KW - active learning KW - passive learning N2 - Background: Remote and virtual simulations have gained prevalence during the COVID-19 pandemic as institutions maintain social distancing measures. Because of the challenges of cost, flexibility, and feasibility in traditional mannequin simulation, many health care educators have used videos as a remote simulation modality; however, videos provide minimal interactivity. Objective: In this study, we aimed to evaluate the role of interactivity in students? simulation experiences. We analyzed students? perceptions of technology acceptance and authenticity in interactive and noninteractive simulations. Methods: Undergraduate nursing students participated in interactive and noninteractive simulations. The interactive simulation was conducted using interactive video simulation software that we developed, and the noninteractive simulation consisted of passively playing a video of the simulation. After each simulation, the students completed a 10-item technology acceptance questionnaire and 6-item authenticity questionnaire. The data were analyzed using the Wilcoxon signed-rank test. In addition, we performed an exploratory analysis to compare technology acceptance and authenticity in interactive local and remote simulations using the Mann-Whitney U test. Results: Data from 29 students were included in this study. Statistically significant differences were found between interactive and noninteractive simulations for overall technology acceptance (P<.001) and authenticity (P<.001). Analysis of the individual questionnaire items showed statistical significance for 3 out of the 10 technology acceptance items (P=.002, P=.002, and P=.004) and 5 out of the 6 authenticity items (P<.001, P<.001, P=.001, P=.003, and P=.005). The interactive simulation scored higher than the noninteractive simulation in all the statistically significant comparisons. Our exploratory analysis revealed that local simulation may promote greater perceptions of technology acceptance (P=.007) and authenticity (P=.027) than remote simulation. Conclusions: Students? perceptions of technology acceptance and authenticity were greater in interactive simulation than in noninteractive simulation. These results support the importance of interactivity in students? simulation experiences, especially in remote or virtual simulations in which students? involvement may be less active. UR - https://mededu.jmir.org/2023/1/e40040 UR - http://dx.doi.org/10.2196/40040 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790842 ID - info:doi/10.2196/40040 ER - TY - JOUR AU - Henshall, Catherine AU - Davey, Zoe AU - Srikesavan, Cynthia AU - Hart, Liam AU - Butcher, Dan AU - Cipriani, Andrea PY - 2023/2/14 TI - Implementation of a Web-Based Resilience Enhancement Training for Nurses: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e43771 VL - 25 KW - burnout KW - COVID-19 KW - health care setting KW - health care staff KW - health care provider KW - mental health KW - mental well-being KW - nurses KW - nursing KW - pilot trial KW - psychological health KW - resilience training KW - resilience KW - web-based health KW - web-based training N2 - Background: Global workforce challenges faced by health care providers are linked to low levels of job satisfaction, recruitment, retention, and well-being, with detrimental impacts on patient care outcomes. Resilience-building programs can provide support for staff who endure highly stressful environments, enhance resilience, and support recruitment and retention, with web-based formats being key to increasing accessibility. Objective: We aimed to examine participants? engagement with a newly developed Resilience Enhancement Online Training for Nurses (REsOluTioN), explore its acceptability, and compare levels of resilience and psychological well-being in nurses who completed REsOluTioN with those who did not. Methods: We carried out a pilot randomized trial (1:1), conducted at a single site (mental health and community trust in South England) between August 2021 and May 2022. Local research ethics approvals were obtained. Nurses were invited to participate and were randomly assigned to a waitlist group or REsOluTioN group. Training lasted for 4 weeks, consisting of prereading, web-based facilitated sessions, and mentorship support. We evaluated trial engagement, acceptability of training, and pre-post changes in resilience, measured by the Brief Resilience Scale, and psychological well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale. Qualitative participant feedback was collected. Consolidated Standards of Reporting Trials 2010 extension guidelines for reporting pilot and feasibility trials were used. Results: Of 108 participants recruited, 93 completed the study. Participants? mean age was 44 (SD 10.85) years. Most participants were female (n=95, 88.8%), White (n=95, 88.8%), and worked in community settings (n=91, 85.0%). Sixteen facilitated and 150 mentoring sessions took place. Most REsOluTioN program participants reported the sessions helped improve their resilience (n=24, 72.8%), self-confidence (n=24, 72.7%), ability to provide good patient care (n=25, 75.8%), relationships with colleagues (n=24, 72.7%), and communication skills (n=25, 75.8%). No statistically significant differences between training and control groups and time on well-being (F1,91=1.44, P=.23, partial ?2=0.02) and resilience scores (F1,91=0.33, P=.57, partial ?2=0.004) were revealed; however, there were positive trends toward improvement in both. Nurse participants engaged with the REsOluTioN program and found it acceptable. Most found web-based training and mentoring useful and enjoyed learning, reflection, networking, and participatory sessions. Conclusions: The REsOluTioN program was acceptable, engaging, perceived as useful, and nurses were keen for it to be implemented to optimize resilience, psychological health, communication, and workplace environments. The study has evidenced that it is acceptable to implement web-based resilience programs with similar design features within busy health care settings, indicating a need for similar programs to be carefully evaluated. Mentorship support may also be a key in optimizing resilience. Trial limitations include small sample size and reduced statistical power; a multicenter randomized controlled trial could test effectiveness of the training on a larger scale. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): RR2-10.2196/37015 UR - https://www.jmir.org/2023/1/e43771 UR - http://dx.doi.org/10.2196/43771 UR - http://www.ncbi.nlm.nih.gov/pubmed/36787181 ID - info:doi/10.2196/43771 ER - TY - JOUR AU - Gupta, Sanchit AU - Wilcocks, Kyle AU - Matava, Clyde AU - Wiegelmann, Julian AU - Kaustov, Lilia AU - Alam, Fahad PY - 2023/2/14 TI - Creating a Successful Virtual Reality?Based Medical Simulation Environment: Tutorial JO - JMIR Med Educ SP - e41090 VL - 9 KW - virtual reality KW - innovation KW - digital health KW - simulation KW - medical education KW - medical training KW - tutorial KW - how-to KW - curriculum UR - https://mededu.jmir.org/2023/1/e41090 UR - http://dx.doi.org/10.2196/41090 UR - http://www.ncbi.nlm.nih.gov/pubmed/36787169 ID - info:doi/10.2196/41090 ER - TY - JOUR AU - Perrin, Julien AU - Meeus, Amélie AU - Broseus, Julien AU - Morieux, Pierre-Jean AU - Di Ceglie, Valentine AU - Gravoulet, Julien AU - D'Aveni, Maud PY - 2023/2/13 TI - A Serious Game About Hematology for Health Care Workers (SUPER HEMO): Development and Validation Study JO - JMIR Serious Games SP - e40350 VL - 11 KW - educational technology KW - hematology KW - health care students KW - education KW - teaching KW - validation KW - methodological study KW - video support tool KW - continuing education KW - serious games KW - educational games N2 - Background: Complete blood count (CBC) and hemostatic screening tests are among the most commonly prescribed blood tests worldwide. All health care workers (nurse practitioners, pharmacists, dentists, midwives, and physicians) are expected to correctly interpret the results in their daily practice. Currently, the undergraduate hematology curriculum consists predominantly of lecture-based teaching. Because hematology combines basic science (blood cells and hemostasis physiology) and clinical skills, students report that they do not easily master hematology with only lecture-based teaching. Having interviewed students at the University of Lorraine, we considered it necessary to develop new teaching approaches and methods. Objective: We aimed to develop and validate a serious game about CBC analysis for health care students. Our primary objective was to help students perceive hematology as being a playful and easy topic and for them to feel truly involved in taking care of their patients by analyzing blood tests. We considered that this game-based approach would be attractive to students as an addition to the classic lecture-based approach and improve their knowledge and skills in hematology. Methods: We developed an adventure game called SUPER HEMO, a video game in which the player assumes the role of a protagonist in an interactive story driven by exploration and problem-solving tests. Following validation with beta testing by a panel of volunteer students, we used a novel, integrated teaching approach. We added 1.5 hours of gaming to the standard curriculum for a small group of volunteer students. Physician and pharmacy students in their third year at a single French university were invited to attend this extracurricular course. Pregame and postgame tests and satisfaction surveys were immediately recorded. Final hematology exam results were analyzed. Results: A total of 86 of 324 physician students (26.5%) and 67 of 115 pharmacy students (58%) opted to participate. Median scores on the pre- and posttests were 6 out of 10 versus 7 out of 10, respectively, for the physician students, (P<.001) and 7.5 out of 10 versus 8 out of 10, respectively, for the pharmacy students (P<.001). At the final hematology evaluation, physician students who played SUPER HEMO had a slightly better median score than those who did not: 13 out of 20 versus 12 out of 20, respectively (P=.002). Pharmacy students who played SUPER HEMO had a median score of 21.75 out of 30; this was not significantly different from pharmacy students who did not play SUPER HEMO (20/30; P=.12). Among the participants who answered the survey (n=143), more than 86% (123/143) believed they had strengthened their knowledge and nearly 80% (114/143) of them had fun. Conclusions: Feedback from this game session provided evidence to support the integration of interactive teaching methods in undergraduate hematology teaching. The development of SUPER HEMO is intended to be completed so that it can become a support tool for continuing education. UR - https://games.jmir.org/2023/1/e40350 UR - http://dx.doi.org/10.2196/40350 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780215 ID - info:doi/10.2196/40350 ER - TY - JOUR AU - Gilson, Aidan AU - Safranek, W. Conrad AU - Huang, Thomas AU - Socrates, Vimig AU - Chi, Ling AU - Taylor, Andrew Richard AU - Chartash, David PY - 2023/2/8 TI - How Does ChatGPT Perform on the United States Medical Licensing Examination (USMLE)? The Implications of Large Language Models for Medical Education and Knowledge Assessment JO - JMIR Med Educ SP - e45312 VL - 9 KW - natural language processing KW - NLP KW - MedQA KW - generative pre-trained transformer KW - GPT KW - medical education KW - chatbot KW - artificial intelligence KW - education technology KW - ChatGPT KW - conversational agent KW - machine learning KW - USMLE N2 - Background: Chat Generative Pre-trained Transformer (ChatGPT) is a 175-billion-parameter natural language processing model that can generate conversation-style responses to user input. Objective: This study aimed to evaluate the performance of ChatGPT on questions within the scope of the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 exams, as well as to analyze responses for user interpretability. Methods: We used 2 sets of multiple-choice questions to evaluate ChatGPT?s performance, each with questions pertaining to Step 1 and Step 2. The first set was derived from AMBOSS, a commonly used question bank for medical students, which also provides statistics on question difficulty and the performance on an exam relative to the user base. The second set was the National Board of Medical Examiners (NBME) free 120 questions. ChatGPT?s performance was compared to 2 other large language models, GPT-3 and InstructGPT. The text output of each ChatGPT response was evaluated across 3 qualitative metrics: logical justification of the answer selected, presence of information internal to the question, and presence of information external to the question. Results: Of the 4 data sets, AMBOSS-Step1, AMBOSS-Step2, NBME-Free-Step1, and NBME-Free-Step2, ChatGPT achieved accuracies of 44% (44/100), 42% (42/100), 64.4% (56/87), and 57.8% (59/102), respectively. ChatGPT outperformed InstructGPT by 8.15% on average across all data sets, and GPT-3 performed similarly to random chance. The model demonstrated a significant decrease in performance as question difficulty increased (P=.01) within the AMBOSS-Step1 data set. We found that logical justification for ChatGPT?s answer selection was present in 100% of outputs of the NBME data sets. Internal information to the question was present in 96.8% (183/189) of all questions. The presence of information external to the question was 44.5% and 27% lower for incorrect answers relative to correct answers on the NBME-Free-Step1 (P<.001) and NBME-Free-Step2 (P=.001) data sets, respectively. Conclusions: ChatGPT marks a significant improvement in natural language processing models on the tasks of medical question answering. By performing at a greater than 60% threshold on the NBME-Free-Step-1 data set, we show that the model achieves the equivalent of a passing score for a third-year medical student. Additionally, we highlight ChatGPT?s capacity to provide logic and informational context across the majority of answers. These facts taken together make a compelling case for the potential applications of ChatGPT as an interactive medical education tool to support learning. UR - https://mededu.jmir.org/2023/1/e45312 UR - http://dx.doi.org/10.2196/45312 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753318 ID - info:doi/10.2196/45312 ER - TY - JOUR AU - Martin-Sanchez, Fernando AU - Lázaro, Martín AU - López-Otín, Carlos AU - Andreu, L. Antoni AU - Cigudosa, Cruz Juan AU - Garcia-Barbero, Milagros PY - 2023/2/7 TI - Personalized Precision Medicine for Health Care Professionals: Development of a Competency Framework JO - JMIR Med Educ SP - e43656 VL - 9 KW - personalized precision medicine KW - professional competence KW - domains KW - determinants of health KW - digitalization KW - communication KW - bioethics KW - digital health N2 - Background: Personalized precision medicine represents a paradigm shift and a new reality for the health care system in Spain, with training being fundamental for its full implementation and application in clinical practice. In this sense, health care professionals face educational challenges related to the acquisition of competencies to perform their professional practice optimally and efficiently in this new environment. The definition of competencies for health care professionals provides a clear guide on the level of knowledge, skills, and attitudes required to adequately carry out their professional practice. In this context, this acquisition of competencies by health care professionals can be defined as a dynamic and longitudinal process by which they use knowledge, skills, attitudes, and good judgment associated with their profession to develop it effectively in all situations corresponding to their field of practice. Objective: This report aims to define a proposal of essential knowledge domains and common competencies for all health care professionals, which are necessary to optimally develop their professional practice within the field of personalized precision medicine as a fundamental part of the medicine of the future. Methods: Based on a benchmark analysis and the input and expertise provided by a multidisciplinary group of experts through interviews and workshops, a new competency framework that would guarantee the optimal performance of health care professionals was defined. As a basis for the development of this report, the most relevant national and international competency frameworks and training programs were analyzed to identify aspects that are having an impact on the application of personalized precision medicine and will be considered when developing professional competencies in the future. Results: This report defines a framework made up of 58 competencies structured into 5 essential domains: determinants of health, biomedical informatics, practical applications, participatory health, and bioethics, along with a cross-cutting domain that impacts the overall performance of the competencies linked to each of the above domains. Likewise, 6 professional profiles to which this proposal of a competency framework is addressed were identified according to the area where they carry out their professional activity: health care, laboratory, digital health, community health, research, and management and planning. In addition, a classification is proposed by progressive levels of training that would be advisable to acquire for each competency according to the professional profile. Conclusions: This competency framework characterizes the knowledge, skills, and attitudes required by health care professionals for the practice of personalized precision medicine. Additionally, a classification by progressive levels of training is proposed for the 6 professional profiles identified according to their professional roles. UR - https://mededu.jmir.org/2023/1/e43656 UR - http://dx.doi.org/10.2196/43656 UR - http://www.ncbi.nlm.nih.gov/pubmed/36749626 ID - info:doi/10.2196/43656 ER - TY - JOUR AU - Nes, Gonçalves Andréa Aparecida AU - Zlamal, Jaroslav AU - Linnerud, Wang Silje Christin AU - Steindal, A. Simen AU - Solberg, Trygg Marianne PY - 2023/2/3 TI - A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype JO - JMIR Hum Factors SP - e44101 VL - 10 KW - clinical practice KW - guidance application model KW - nursing students KW - constructive alignment KW - metacognition KW - technological tool KW - nursing KW - nursing profession KW - application KW - mobile health, eHealth KW - educator KW - communication N2 - Background: The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students? clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice. Objective: We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice. Methods: This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing. Results: This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application?s name and logo, technical architecture, guidance and assessment module, and security and privacy. Conclusions: This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies. UR - https://humanfactors.jmir.org/2023/1/e44101 UR - http://dx.doi.org/10.2196/44101 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735289 ID - info:doi/10.2196/44101 ER - TY - JOUR AU - Fang, Heping AU - Lv, Yuxin AU - Chen, Lin AU - Zhang, Xuan AU - Hu, Yan PY - 2023/1/27 TI - The Current Knowledge, Attitudes, and Practices of the Neglected Methodology of Web-Based Questionnaires Among Chinese Health Workers: Web-Based Questionnaire Study JO - J Med Internet Res SP - e41591 VL - 25 KW - epidemiological survey KW - knowledge, attitudes, and practices (KAP) KW - medical education KW - methodology KW - web-based questionnaire (WBQ) N2 - Background: Web-based questionnaire (WBQ) surveys are popular, but the quality of reporting WBQ survey research is uneven and unsatisfactory worldwide. Education and training on WBQ methodology may be necessary. However, the current knowledge, attitudes, and practices (KAP) of its methodology remain unknown. Objective: We investigated the KAP of WBQ methodology among Chinese health workers for the first time to clarify the possible reasons for the unsatisfactory reporting quality of WBQ survey research from China?s experience, aiming to provide a basis for improvement. Methods: We developed a structured WBQ based on the current recommendations and knowledge and investigated 458 health workers from June 7 to July 6, 2022. A total of 381 valid questionnaires were analyzed after data processing. We defined 50% and 75% as ?qualified? and ?satisfactory? in knowledge and practice topics to describe the results and analyzed the basic characteristics of the participants who had difficulties in conducting WBQ survey research. Results: A total of 215 (56.4%) participants had used WBQs for investigation, mostly more than 2 times (88.3%), but only 95 (44.2%) of them had ever received methodological training. A total of 134 (62.3%) users believed that WBQs were practical, but 126 (58.6%) had doubts about the reliability of the results. Most of the knowledge and practice topics did not reach a satisfactory level, and some even did not reach a qualified level. A total of 95 (44.2%)-136 (63.3%) of the users had reported difficulties in conducting WBQ survey research, and different participants could have different difficulties according to their characteristics. In addition, 191 (88.8%) users believed training was necessary. Conclusions: We found that Chinese health workers seriously underestimated and neglected the importance of the WBQ methodology, which may be an important reason for the reduced reporting quality of WBQ survey research. Medical educators need to strengthen methodological training on WBQs, which may help to improve the quality of WBQ survey research. UR - https://www.jmir.org/2023/1/e41591 UR - http://dx.doi.org/10.2196/41591 UR - http://www.ncbi.nlm.nih.gov/pubmed/36533302 ID - info:doi/10.2196/41591 ER - TY - JOUR AU - Lie, Stangeland Silje AU - Helle, Nikolina AU - Sletteland, Vahl Nina AU - Vikman, Dubland Miriam AU - Bonsaksen, Tore PY - 2023/1/24 TI - Implementation of Virtual Reality in Health Professions Education: Scoping Review JO - JMIR Med Educ SP - e41589 VL - 9 KW - implementation KW - virtual reality KW - higher education KW - medical education KW - health professions education KW - continuing education KW - scoping review KW - health professional KW - technology N2 - Background: Virtual reality has been gaining ground in health professions education and may offer students a platform to experience and master situations without endangering patients or themselves. When implemented effectively, virtual reality technologies may enable highly engaging learning activities and interactive simulations. However, implementation processes present challenges, and the key to successful implementation is identifying barriers and facilitators as well as finding strategies to address them. Objective: This scoping review aimed to identify the literature on virtual reality implementation in health professions education, identify barriers to and facilitators of implementation, and highlight gaps in the literature in this area. Methods: The scoping review was conducted based on the Joanna Briggs Institute Evidence Synthesis methodologies. Electronic searches were conducted in the Academic Search Elite, Education Source, and CINAHL databases on January 5, 2022, in Google Scholar on February 2 and November 18, 2022, and in PubMed database on November 18, 2022. We conducted hand searches of key items, reference tracking, and citation tracking and searches on government webpages on February 2, 2022. At least 2 reviewers screened the identified literature. Eligible studies were considered based on predefined inclusion criteria. The results of the identified items were analyzed and synthesized using qualitative content analysis. Results: We included 7 papers and identified 7 categories related to facilitators of and barriers to implementation?collaborative participation, availability, expenses, guidelines, technology, careful design and evaluation, and training?and developed a model that links the categories to the 4 constructs from Carl May?s general theory of implementation. All the included reports provided recommendations for implementation, including recommendations for careful design and evaluation, training of faculty and students, and faculty presence during use. Conclusions: Virtual reality implementation in health professions education appears to be a new and underexplored research field. This scoping review has several limitations, including definitions and search words, language, and that we did not assess the included papers? quality. Important implications from our findings are that ensuring faculty?s and students? competence in using virtual reality technology is necessary for the implementation processes. Collaborative participation by including end users in the development process is another factor that may ensure successful implementation in higher education contexts. To ensure stakeholders? motivation and potential to use virtual reality, faculty and students could be invited to participate in the development process to ensure that the educational content is valued. Moreover, technological challenges and usability issues should be resolved before implementation to ensure that pedagogical content is the focus. This accentuates the importance of piloting, sufficient time resources, basic testing, and sharing of experiences before implementation. International Registered Report Identifier (IRRID): RR2-10.2196/37222 UR - https://mededu.jmir.org/2023/1/e41589 UR - http://dx.doi.org/10.2196/41589 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692934 ID - info:doi/10.2196/41589 ER - TY - JOUR AU - Grant, William AU - Adan, A. Matthew AU - Samurkas, A. Christina AU - Quigee, Daniela AU - Benitez, Jorge AU - Gray, Brett AU - Carnevale, Caroline AU - Gordon, J. Rachel AU - Castor, Delivette AU - Zucker, Jason AU - Sobieszczyk, E. Magdalena PY - 2023/1/24 TI - Effect of Participative Web-Based Educational Modules on HIV and Sexually Transmitted Infection Prevention Competency Among Medical Students: Single-Arm Interventional Study JO - JMIR Med Educ SP - e42197 VL - 9 KW - HIV prevention KW - medical education KW - sexual health education KW - pre-exposure prophylaxis KW - PrEP N2 - Background: The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers? practice habits are established. Objective: The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers. Methods: Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire. Results: Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2%) and postexposure prophylaxis (114/123, 92.7%). Before the training, 30.9% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91% (81/89) after the intervention. Conclusions: Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts. UR - https://mededu.jmir.org/2023/1/e42197 UR - http://dx.doi.org/10.2196/42197 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692921 ID - info:doi/10.2196/42197 ER - TY - JOUR AU - Ulbrich, Max AU - Van den Bosch, Vincent AU - Bönsch, Andrea AU - Gruber, Johannes Lennart AU - Ooms, Mark AU - Melchior, Claire AU - Motmaen, Ila AU - Wilpert, Caroline AU - Rashad, Ashkan AU - Kuhlen, Wolfgang Torsten AU - Hölzle, Frank AU - Puladi, Behrus PY - 2023/1/19 TI - Advantages of a Training Course for Surgical Planning in Virtual Reality for Oral and Maxillofacial Surgery: Crossover Study JO - JMIR Serious Games SP - e40541 VL - 11 KW - virtual surgical planning KW - virtual reality KW - Elucis KW - 3D Slicer KW - oral and maxillofacial surgery N2 - Background: As an integral part of computer-assisted surgery, virtual surgical planning (VSP) leads to significantly better surgery results, such as for oral and maxillofacial reconstruction with microvascular grafts of the fibula or iliac crest. It is performed on a 2D computer desktop screen (DS) based on preoperative medical imaging. However, in this environment, VSP is associated with shortcomings, such as a time-consuming planning process and the requirement of a learning process. Therefore, a virtual reality (VR)?based VSP application has great potential to reduce or even overcome these shortcomings due to the benefits of visuospatial vision, bimanual interaction, and full immersion. However, the efficacy of such a VR environment has not yet been investigated. Objective: This study aimed to demonstrate the possible advantages of a VR environment through a substep of VSP, specifically the segmentation of the fibula (calf bone) and os coxae (hip bone), by conducting a training course in both DS and VR environments and comparing the results. Methods: During the training course, 6 novices were taught how to use a software application in a DS environment (3D Slicer) and in a VR environment (Elucis) for the segmentation of the fibula and os coxae, and they were asked to carry out the maneuvers as accurately and quickly as possible. Overall, 13 fibula and 13 os coxae were segmented for each participant in both methods (VR and DS), resulting in 156 different models (78 fibula and 78 os coxae) per method (VR and DS) and 312 models in total. The individual learning processes in both environments were compared using objective criteria (time and segmentation performance) and self-reported questionnaires. The models resulting from the segmentation were compared mathematically (Hausdorff distance and Dice coefficient) and evaluated by 2 experienced radiologists in a blinded manner. Results: A much faster learning curve was observed for the VR environment than the DS environment (?=.86 vs ?=.25). This nearly doubled the segmentation speed (cm3/min) by the end of training, leading to a shorter time (P<.001) to reach a qualitative result. However, there was no qualitative difference between the models for VR and DS (P=.99). The VR environment was perceived by participants as more intuitive and less exhausting, and was favored over the DS environment. Conclusions: The more rapid learning process and the ability to work faster in the VR environment could save time and reduce the VSP workload, providing certain advantages over the DS environment. UR - https://games.jmir.org/2023/1/e40541 UR - http://dx.doi.org/10.2196/40541 UR - http://www.ncbi.nlm.nih.gov/pubmed/36656632 ID - info:doi/10.2196/40541 ER - TY - JOUR AU - Tran, Carrie AU - Toth-Pal, Eva AU - Ekblad, Solvig AU - Fors, Uno AU - Salminen, Helena PY - 2023/1/17 TI - Medical Students? Learning About Other Professions Using an Interprofessional Virtual Patient While Remotely Connected With a Study Group: Mixed Methods Study JO - JMIR Med Educ SP - e38599 VL - 9 KW - interprofessional learning KW - virtual patient KW - medical students KW - remote learning KW - distance learning KW - medical education N2 - Background: Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and virtual patients (VPs) may be useful additional methods to increase students? possibilities for interprofessional learning. Objective: This study had two aims. The first was to assess if an interprofessional VP case could facilitate medical students? learning about team collaboration in online groups. The second was to assess how students experienced learning with the VP when remotely connected with their group. Methods: A mixed methods design was used. The VP case was a 73-year-old man who needed help from different health professions in his home after a hip fracture. Questionnaires were answered by the students before and directly after each session. Qualitative group interviews were performed with each group of students directly after the VP sessions, and the interviews were analyzed using qualitative content analysis. Results: A total of 49 third-year medical students divided into 15 groups participated in the study. Each group had 2 to 5 students who worked together with the interprofessional VP without a teacher?s guidance. In the analysis of the group interviews, a single theme was identified: the interprofessional VP promoted student interaction and gave insight into team collaboration. Two categories were found: (1) the structure of the VP facilitated students? learning and (2) students perceived the collaboration in their remotely connected groups as functioning well and being effective. The results from the questionnaires showed that the students had gained insights into the roles and competencies of other health care professions. Conclusions: This study demonstrates that an interprofessional VP enabled insights into team collaboration and increased understanding of other professions among student groups comprising only medical students. The interprofessional VP seemed to benefit students? learning in an online, remote-learning context. Although our VP was not used as an interprofessional student activity according to the common definition of interprofessional education, the results imply that it still contributed to students? interprofessional learning. UR - https://mededu.jmir.org/2023/1/e38599 UR - http://dx.doi.org/10.2196/38599 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649071 ID - info:doi/10.2196/38599 ER - TY - JOUR AU - Hsieh, Pei-Lun AU - Wang, Yu-Rung AU - Huang, Tien-Chi PY - 2023/1/4 TI - Exploring Key Factors Influencing Nursing Students? Cognitive Load and Willingness to Serve Older Adults: Cross-sectional Descriptive Correlational Study JO - JMIR Serious Games SP - e43203 VL - 11 KW - immersive virtual reality learning KW - VR learning KW - mental effort KW - mental load KW - service willingness KW - older adult KW - virtual reality KW - nursing student KW - professional education KW - digital learning KW - older adult population N2 - Background: Virtual learning environments (VLEs) use a virtual environment to support learning activities. VLEs are commonly used to overcome the temporal and spatial restrictions of learning activities held in conventional face-to-face classrooms. In VLEs, students can participate in learning activities using the internet, and teachers can provide assistive learning tools during the process. Objective: The purpose of this study was to investigate the relationships among nursing students? mental load, cognitive load, and affective learning outcomes in terms of their willingness to serve older adults in an interaction-based educational virtual reality (VR) learning environment. Methods: This study used a cross-sectional method. A total of 130 students participated in interaction-based VR learning and completed related questionnaires. Descriptive and inferential statistics and stepwise regression for data analysis were used. Results: The research results revealed that in the dimension of willingness to use VR learning materials, perceived usefulness received the highest score (mean 4.42, SD 0.45). In the dimension of nursing ability, students scored the highest in information management and application ability to care for case patients (mean 4.35, SD 0.54). Correlation analysis revealed that cognitive load during learning and willingness to serve older adults were negatively correlated, whereas willingness to use VR learning materials was positively correlated with nursing ability and willingness to serve older adults. Analyzing the regression coefficients of predictor variables revealed that willingness to use VR learning materials (?=.23; t2=2.89, P=.005) and cognitive load during learning (?=?.35; t2=?.4.30, P<.001) were predictive factors of nursing students? willingness to serve older adults. Conclusions: This study demonstrated that students? willingness to use VR learning materials and their cognitive load during learning affected their willingness to care for older adults. Therefore, the components of mental or cognitive load generate inconsistent predictive effects on affective variables and willingness to serve older adults. UR - https://games.jmir.org/2023/1/e43203 UR - http://dx.doi.org/10.2196/43203 UR - http://www.ncbi.nlm.nih.gov/pubmed/36333104 ID - info:doi/10.2196/43203 ER - TY - JOUR AU - Barlow, Emma AU - Zahra, Wajiha AU - Hornsby, Jane AU - Wilkins, Alex AU - Davies, M. Benjamin AU - Burke, Joshua PY - 2022/12/21 TI - Defining a Role for Webinars in Surgical Training Beyond the COVID-19 Pandemic in the United Kingdom: Trainee Consensus Qualitative Study JO - JMIR Med Educ SP - e40106 VL - 8 IS - 4 KW - webinars KW - surgical training KW - trainee consensus KW - teaching KW - training KW - integration KW - trainee experience KW - user experience KW - perception KW - education KW - medical education KW - surgical skills N2 - Background: The COVID-19 pandemic posed several challenges for surgical training, including the suspension of many in-person teaching sessions in lieu of webinars. As restrictions have eased, both prepandemic and postpandemic training methods should be used. Objective: This study investigates trainees? experiences of webinars during the COVID-19 pandemic to develop recommendations for their effective integration into surgical training going forward. Methods: This project was led by the Association of Surgeons in Training and used an iterative process with mixed qualitative methods to consolidate arguments for and against webinars, and the drivers and barriers to their effective delivery, into recommendations. This involved 3 phases: (1) a web-based survey, (2) focus group interviews, and (3) a consensus session using a nominal group technique. Results: Trainees (N=281) from across specialties and grades confirmed that the COVID-19 pandemic led to an increase in webinars for surgical training. While there were concerns, particularly around the utility for practical training (80.9%), the majority agreed that webinars had a role in training following the COVID-19 pandemic (90.2%). The cited benefits included improved access or flexibility and potential standardization of training. The majority of limitations were technical. These perspectives were refined through focus group interviews (n=18) into 25 recommendations, 23 of which were ratified at a consensus meeting, which was held at the Association of Surgeons in Training 2021 conference. Conclusions: Webinars have a role in surgical training following the COVID-19 pandemic. The 23 recommendations encompass indications and technical considerations but also discuss important knowledge gaps. They should serve as an initial framework for ensuring that webinars add value and continue to evolve as a tool for training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055325; http://www.chictr.org.cn/showprojen.aspx?proj=142802 UR - https://mededu.jmir.org/2022/4/e40106 UR - http://dx.doi.org/10.2196/40106 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542431 ID - info:doi/10.2196/40106 ER - TY - JOUR AU - Stetten, Nichole AU - LeBeau, Kelsea AU - King, Lindsey AU - Pomeranz, Jamie PY - 2022/12/16 TI - Integrating a Video Game Recording Into a Qualitative Research Methods Course to Overcome COVID-19 Barriers to Teaching: Qualitative Analysis JO - JMIR Serious Games SP - e38417 VL - 10 IS - 4 KW - qualitative research KW - pedagogy KW - COVID-19 KW - video games KW - educational technology KW - web-based learning N2 - Background: Because of the COVID-19 pandemic, a doctoral-level public health qualitative research methods course was moved to a web-based format. One module originally required students to conduct in-person observations within the community, but the curriculum was adapted using a web-based video game exercise. Objective: This study sought to evaluate students? perceptions of this adaptation and determine whether the new pilot format successfully met the module?s original learning objectives. Methods: Recorded footage of a video game session was used for students to observe, take field notes, and compare the results. Qualitative methods were used to evaluate student feedback on the curriculum and determine whether the original learning objectives were met. Data were analyzed using a directed content analysis. Results: The findings demonstrate that all the learning objectives of this adapted qualitative observational research assignment using a web-based video game exercise were successfully met; namely, the students learned how to compare and contrast the observational notes of peers and to evaluate how personal bias and environmental factors can affect qualitative data collection. The assignment was also positively received by the students. Conclusions: The results align with the constructivist learning theory and other successful COVID-19 implementations. Our study demonstrates that the learning objectives of a qualitative observational assignment can be addressed given that there are proper forethought and delivery when the assignment is adapted to a web-based context using a video game exercise. UR - https://games.jmir.org/2022/4/e38417 UR - http://dx.doi.org/10.2196/38417 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322922 ID - info:doi/10.2196/38417 ER - TY - JOUR AU - Lim, Amanda Xiu Ming AU - Liao, Ariel Wenxin AU - Wang, Wenru AU - Seah, Betsy PY - 2022/12/15 TI - The Effectiveness of Technology-Based Cardiopulmonary Resuscitation Training on the Skills and Knowledge of Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e36423 VL - 24 IS - 12 KW - cardiac arrest KW - education KW - methods KW - first responders KW - resuscitation training KW - effectiveness KW - adolescents KW - schoolchildren N2 - Background: Cardiopulmonary resuscitation (CPR) training for adolescents is a prominent strategy to increase the number of community first responders who can recognize cardiac arrest and initiate CPR. More schools are adopting technology-based CPR training modalities to reduce class time and reliance on instructor availability and increase their capacity for wider training dissemination. However, it remains unclear whether these technology-based modalities are comparable with standard training. Objective: This study aimed to systematically review and perform meta-analyses to evaluate the effectiveness of technology-based CPR training on adolescents? CPR skills and knowledge. Methods: Searches were conducted in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL, PsycINFO, Education Resources Information Center, ProQuest Dissertations and Theses Global, and Scopus from inception to June 25, 2021. Eligible randomized controlled trials (RCTs) compared technology-based training with standard training for adolescents aged 12 to 18 years. Studies were appraised using the Cochrane risk-of-bias tool. Random-effects meta-analyses were performed using Review Manager (The Cochrane Collaboration). Subgroup analyses were conducted to explore sources of heterogeneity. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Seventeen RCTs involving 5578 adolescents were included. Most of the studies had unclear risks of selection bias (9/17, 53%) and high risks of performance bias (16/17, 94%). Interventions that included instructor guidance increased the likelihood of adolescents checking the responsiveness of the person experiencing cardiac arrest (risk ratio 1.39, 95% CI 1.19-1.63) and calling the emergency medical services (risk ratio 1.11, 95% CI 1.00-1.24). Self-directed technology-based CPR training without instructor guidance was associated with poorer overall skill performance (Cohen d=?0.74, 95% CI ?1.02 to ?0.45). Training without hands-on practice increased mean compression rates (mean difference 9.38, 95% CI 5.75-13.01), whereas real-time feedback potentially yielded slower compression rates. Instructor-guided training with hands-on practice (Cohen d=0.45, 95% CI 0.13-0.78) and the use of computer programs or mobile apps (Cohen d=0.62, 95% CI 0.37-0.86) improved knowledge scores. However, certainty of evidence was very low. Conclusions: Instructor-guided technology-based CPR training that includes hands-on practice and real-time feedback is noninferior to standard training in CPR skills and knowledge among adolescents. Our findings supported the use of technology-based components such as videos, computer programs, or mobile apps for self-directed theoretical instruction. However, instructor guidance, hands-on practice, and real-time feedback are still necessary components of training to achieve better learning outcomes for adolescents. Such a blended learning approach may reduce class time and reliance on instructor availability. Because of the high heterogeneity of the studies reviewed, the findings from this study should be interpreted with caution. More high-quality RCTs with large sample sizes and follow-up data are needed. Finally, technology-based training can be considered a routine refresher training modality in schools for future research. UR - https://www.jmir.org/2022/12/e36423 UR - http://dx.doi.org/10.2196/36423 UR - http://www.ncbi.nlm.nih.gov/pubmed/36520524 ID - info:doi/10.2196/36423 ER - TY - JOUR AU - King, Seth AU - Boyer, Joseph AU - Bell, Tyler AU - Estapa, Anne PY - 2022/12/8 TI - An Automated Virtual Reality Training System for Teacher-Student Interaction: A Randomized Controlled Trial JO - JMIR Serious Games SP - e41097 VL - 10 IS - 4 KW - virtual reality KW - artificial intelligence KW - behavioral skills training KW - education KW - professional development KW - staff training KW - mathematics N2 - Background: Shortages in qualified supervision and other resources prevent education personnel from rehearsing effective practices. Interactive simulations, although increasingly used in education, frequently require instructor management. Automated simulations rarely engage trainees in skills related to practice (eg, speech). Objective: We evaluated the capability of delivering behavioral skills training through an automated virtual reality (VR) simulation using artificial intelligence to improve the implementation of a nondirective mathematical questioning strategy. Methods: We recruited and randomly assigned 30 college-aged participants to equivalent treatment (ie, lecture, modeling, and VR; 15/30, 50%) and control groups (ie, lecture and modeling only; 15/30, 50%). The participants were blind to treatment conditions. Sessions and assessments were conducted face to face and involved the use of VR for assessment regardless of the condition. Lessons concerned the use of a nondirective mathematical questioning strategy in instances where a simulated student provided correct or incorrect answers to word problems. The measures included observed and automated assessments of participant performance and subjective assessments of participant confidence. The participants completed the pretest, posttest, and maintenance probes each week over the course of 3 weeks. Results: A mixed ANOVA revealed significant main effects of time (F2,27=124.154; P<.001; ?p2=0.816) and treatment (F1,28=19.281; P<.001; ?p2=0.408) as well as an interaction effect (F2,28=8.429; P<.001; ?p2=0.231) for the average percentage of steps in the questioning procedure. Posttest scores for the intervention group (mean 88%, SD 22.62%) exceeded those of the control group (mean 63.33%, SD 22.64%), with t28=3.653, P<.001, and Cohen d=1.334. Maintenance scores indicated a positive effect of the intervention (mean 83.33%, SD 24.40%) relative to the control (mean 54.67%, SD 15.98%), t28=3.807, P<.001, Cohen d=1.39. A Mann-Whitney U test indicated that the treatment groups? self-ratings of confidence (mean 2.41, SD 0.51) were higher than those of the control group (mean 2.04, SD 0.52), U=64, P=.04, r=0.137. Conclusions: The results demonstrate the potential of artificial intelligence-augmented VR to deliver effective, evidence-based training with limited instructor management. Additional work is needed to demonstrate the cascading effect of training on authentic practice and to encompass a wider range of skills. UR - https://games.jmir.org/2022/4/e41097 UR - http://dx.doi.org/10.2196/41097 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480248 ID - info:doi/10.2196/41097 ER - TY - JOUR AU - Tat, Sonny AU - Shaukat, Haroon AU - Zaveri, Pavan AU - Kou, Maybelle AU - Jarvis, Lenore PY - 2022/12/8 TI - Developing and Integrating Asynchronous Web-Based Cases for Discussing and Learning Clinical Reasoning: Repeated Cross-sectional Study JO - JMIR Med Educ SP - e38427 VL - 8 IS - 4 KW - asynchronous learning KW - clinical reasoning KW - emergency medicine KW - pediatrics KW - web-based learning tool N2 - Background: Trainees rely on clinical experience to learn clinical reasoning in pediatric emergency medicine (PEM). Outside of clinical experience, graduate medical education provides a handful of explicit activities focused on developing skills in clinical reasoning. Objective: In this paper, we describe the development, use, and changing perceptions of a web-based asynchronous tool to facilitate clinical reasoning discussion for PEM providers. Methods: We created a case-based web-based discussion tool for PEM clinicians and fellows to post and discuss cases. We examined website analytics for site use and collected user survey data over a 3-year period to assess the use and acceptability of the tool. Results: The learning tool had more than 30,000 site visits and 172 case comments for the 55 published cases over 3 years. Self-reported engagement with the learning tool varied inversely with clinical experience in PEM. The tool was relevant to clinical practice and useful for learning PEM for most respondents. The most experienced clinicians were more likely than fellows to report posting commentary, although absolute rate of commentary was low. Conclusions: An asynchronous method of case presentation and web-based commentary may present an acceptable way to supplement clinical experience and traditional education methods for sharing clinical reasoning. UR - https://mededu.jmir.org/2022/4/e38427 UR - http://dx.doi.org/10.2196/38427 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480271 ID - info:doi/10.2196/38427 ER - TY - JOUR AU - Du, Wenqiong AU - Zhong, Xin AU - Jia, Yijun AU - Jiang, Renqing AU - Yang, Haoyang AU - Ye, Zhao AU - Zong, Zhaowen PY - 2022/12/6 TI - A Novel Scenario-Based, Mixed-Reality Platform for Training Nontechnical Skills of Battlefield First Aid: Prospective Interventional Study JO - JMIR Serious Games SP - e40727 VL - 10 IS - 4 KW - mixed reality KW - decision-making KW - team work KW - battlefield first aid KW - nontechnical skills KW - training KW - next-generation modeling KW - virtual reality KW - medical education N2 - Background: Although battlefield first aid (BFA) training shares many common features with civilian training, such as the need to address technical skills and nontechnical skills (NTSs), it is more highly scenario-dependent. Studies into extended reality show clear benefits in medical training; however, the training effects of extended reality on NTSs, including teamwork and decision-making in BFA, have not been fully proven. Objective: The current study aimed to create and test a scenario-based, mixed-reality platform suitable for training NTSs in BFA. Methods: First, using next-generation modeling technology and an animation synchronization system, a 10-person offensive battle drill was established. Decision-making training software addressing basic principles of tactical combat casualty care was constructed and integrated into the scenarios with Unreal Engine 4 (Epic Games). Large-space teamwork and virtual interaction systems that made sense in the proposed platform were developed. Unreal Engine 4 and software engineering technology were used to combine modules to establish a mixed-reality BFA training platform. A total of 20 Grade 4 medical students were recruited to accept BFA training with the platform. Pretraining and posttraining tests were carried out in 2 forms to evaluate the training effectiveness: one was knowledge acquisition regarding the NTS and the other was a real-world, scenario-based test. In addition, the students were asked to rate their agreement with a series of survey items on a 5-point Likert scale. Results: A battlefield geographic environment, tactical scenarios, scenario-based decision software, large-space teamwork, and virtual interaction system modules were successfully developed and combined to establish the mixed-reality training platform for BFA. The posttraining score of the students? knowledge acquisition was significantly higher than that of pretraining (t=?12.114; P?.001). Furthermore, the NTS score and the total score that the students obtained in the real-world test were significantly higher than those before training (t=?17.756 and t=?21.354, respectively; P?.001). However, there was no significant difference between the scores of technical skills that the students obtained before and after training. A posttraining survey revealed that the students found the platform helpful in improving NTSs for BFA, and they were confident in applying BFA skills after training. However, most trainees thought that the platform was not helpful for improving the technical skills of BFA, and 45% (9/20) of the trainees were not satisfied with the simulation effect. Conclusions: A scenario-based, mixed-reality platform was constructed in this study. In this platform, interaction of the movement of multiple players in a large space and the interaction of decision-making by the trainees between the real world and the virtual world were accomplished. The platform could improve the NTSs of BFA. Future works, including improvement of the simulation effects and development of a training platform that could effectively improve both the technical skills and NTSs of BFA, will be carried out. UR - https://games.jmir.org/2022/4/e40727 UR - http://dx.doi.org/10.2196/40727 UR - http://www.ncbi.nlm.nih.gov/pubmed/36472903 ID - info:doi/10.2196/40727 ER - TY - JOUR AU - Zeng, Minrui AU - Cai, Yiyuan AU - Cao, Jin AU - He, Qianyu AU - Wang, Xiaohui AU - Lu, Yun AU - Liang, Huijuan AU - Xu, Dong AU - Liao, Jing PY - 2022/12/2 TI - The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China JO - J Med Internet Res SP - e40082 VL - 24 IS - 12 KW - virtual patient KW - unannounced standardized patient KW - primary health care KW - primary care KW - quality assessment KW - quality improvement KW - scenario KW - simulation KW - simulate KW - medical education KW - cross-sectional KW - digital health KW - eHealth N2 - Background: The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. Objective: This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Methods: Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted ? for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Results: Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, ?0.03 (95% CI ?0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted ? for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. Conclusions: There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the ?know-do? gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study. UR - https://www.jmir.org/2022/12/e40082 UR - http://dx.doi.org/10.2196/40082 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459416 ID - info:doi/10.2196/40082 ER - TY - JOUR AU - Domingueti, Daniel AU - Barbosa Feres Carvalho, Darlinton AU - Colombo Dias, Roberto Diego AU - Oliveira, Conceição Valéria PY - 2022/12/2 TI - Software-Based Simulation on a 3D Environment for Vaccination Teaching and Learning: Design Science Research JO - JMIR Med Educ SP - e35712 VL - 8 IS - 4 KW - software simulation KW - vaccination room KW - immunization KW - teaching KW - training KW - evaluation KW - virtual world KW - Unity3D KW - SUS KW - UTAUT2 N2 - Background: Student training requires specific laboratories for vaccination practice, which are usually limited, and even professionals? continuing education regularly lacks proper care. Thus, new methodologies, concepts, and technologies, such as software-based simulations, are in highly demand. Objective: This work aims to develop a 3D virtual environment to support teaching activities in the vaccination room. The software-based simulation must contribute positively to teaching considering a variable set of scenarios. Methods: We applied the design science research method to guide the work. First, the concepts and opportunities were raised, which we used to build the simulation (ie, the proposed technological artifact). The development was assisted by a specialist, in which we sought to create a vaccination room according to Brazilian standards. The artifact evaluation was achieved in 2 stages: (1) an evaluation to validate the design with experts through the Delphi method; and (2) a field evaluation with nursing students to validate aspects of usability (System Usability Scale [SUS]) and technology acceptance and use (Unified Theory of Acceptance and Use of Technology version 2). Results: We built the simulation software using the Unity game engine. An additional module was also developed to create simulation scenarios and view the students? performance reports. The design evaluation showed that the proposed solution is adequate. Students? evaluations confirm good usability (SUS score of 81.4), besides highlighting Performance Expectation as the most positively influential factor of Behavioral Intention. Effort Expectancy is positively affected by younger users. Both evaluation audiences cited the high relevance of the proposed artifact for teaching. Points for improvement are also reported. Conclusions: The research accomplished its goal of creating a software-based simulation to support teaching scenarios in the vaccination room. The evaluations still reveal desirable improvements and user behavior toward this kind of technological artifact. UR - https://mededu.jmir.org/2022/4/e35712 UR - http://dx.doi.org/10.2196/35712 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459390 ID - info:doi/10.2196/35712 ER - TY - JOUR AU - Beeman, M. Chase AU - Abrams, Ann Mary AU - Zajo, N. Kristin AU - Stanek, Joseph AU - O'Brien, H. Sarah AU - Chan, Peter AU - Shen, Yvette AU - McCorkle, Ben AU - Johnson, Latrice AU - Chisolm, Deena AU - Barnard-Kirk, Toyetta AU - Mahan, D. John AU - Martinez-Mendez, Alexandra AU - Phillips, L. Whitney AU - Creary, E. Susan PY - 2022/11/17 TI - Acceptability to and Engagement With a Virtual Sickle Cell Trait Education Program (SCTaware): Single-Center Prospective Study JO - JMIR Form Res SP - e38780 VL - 6 IS - 11 KW - virtual education KW - remote education KW - internet-based KW - health education KW - hematology KW - patient education KW - sickle cell KW - genetic KW - child KW - parenting KW - sickle cell trait KW - public health education KW - acceptability KW - Hemoglobin S-trait KW - screening KW - newborn KW - eHealth KW - digital health KW - telemedicine KW - telehealth N2 - Background: Public health programs are tasked with educating the community on health topics, but it is unclear whether these programs are acceptable to learners. Currently, these programs are delivered via a variety of platforms including in-person, virtually, and over the telephone. Sickle cell trait (SCT) education for parents of children with this trait is one of many education programs provided by the Ohio Department of Health. The novel SCTaware videoconference education program was developed by a research team after central Ohio?s standard program transitioned from in-person to telephone-only education during the COVID-19 pandemic. Objective: Our objectives were to investigate the acceptability of the format and engagement with the SCTaware education and assess parental worry about having a child with SCT before and after receiving SCTaware. Methods: This was a single-center, prospective study of English-speaking parents of children <3 years of age identified to have hemoglobin S trait by newborn screening. Parents who previously received SCT education by telephone, were able to be contacted, and had access to an electronic device capable of videoconferencing were eligible to complete surveys after receiving the virtual SCTaware education program. The SCTaware educator also completed a survey to assess participant engagement. Data were summarized descriptively and a McNemar test was used to compare parental worry before and after receiving SCTaware. Results: In total, 55 participants completed follow-up surveys after receiving standard SCT telephone education and then completing SCTaware. Most (n=51) participants reported that the SCTaware content and visuals were very easy to understand (n=47) and facilitated conversation with the educator (n=42). All of them said the visuals were respectful and trustworthy, helped them understand content better, and that their questions were addressed. Nearly two-thirds (62%, n=34) reported that the pictures appeared very personal and applied to them. The educator noted most participants (n=45) were engaged and asked questions despite having to manage distractions during their education sessions. Many participants (n=33) reported some level of worry following telephone-only education; this was significantly reduced after receiving SCTaware (P<.001). Conclusions: Our results suggest that SCTaware is acceptable and engaging to parents. While telephone education may make SCT education more accessible, these findings suggest that many parents experience significant worry about their child with SCT after these sessions. A study to evaluate SCTaware?s effectiveness at closing parents? SCT knowledge gaps is ongoing. UR - https://formative.jmir.org/2022/11/e38780 UR - http://dx.doi.org/10.2196/38780 UR - http://www.ncbi.nlm.nih.gov/pubmed/36394943 ID - info:doi/10.2196/38780 ER - TY - JOUR AU - Marzouk, Sammer AU - He, Shuhan AU - Lee, Jarone PY - 2022/11/11 TI - Emoji Education: How Students Can Help Increase Health Awareness by Making Emojis JO - JMIR Med Educ SP - e39059 VL - 8 IS - 4 KW - emoji KW - medical education KW - technology, education KW - medical students KW - creativity KW - student KW - health awareness KW - health KW - awareness KW - medical KW - society KW - innovation KW - communication KW - medical communication KW - electronic KW - artistic KW - representation UR - https://mededu.jmir.org/2022/4/e39059 UR - http://dx.doi.org/10.2196/39059 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367758 ID - info:doi/10.2196/39059 ER - TY - JOUR AU - Al-Shammari, A. Moustafa AU - Yasir, Amean AU - Aldoori, Nuhad AU - Mohammad, Hussein PY - 2022/11/11 TI - Using Normalization Process Theory to Evaluate an End-of-Life Pediatric Palliative Care Web-Based Training Program for Nurses: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e23783 VL - 11 IS - 11 KW - End-of-Life Nursing Education Consortium for pediatric palliative care KW - implementation KW - Iraq KW - life-limiting illness KW - pediatric palliative care KW - pragmatic trial KW - web-based training N2 - Background: Palliative care (PC) is a new concept in Iraq, and there is no training for health care specialists or the public. The lack of education and training programs is the most important barrier for PC. Intermediate training is needed for nurses who regularly manage patients with life-threatening diseases. The End-of-Life Nursing Education Consortium for pediatric palliative care (PPC) program is intended for nurses who are interested in providing care to children with life-limiting diseases or providing support in the event of an accident or unexpected death. Objective: Our trial aims to evaluate the effect of a web-based training course, using the Normalization Process Theory. It focuses on how complex interventions become routinely embedded in practice and on training of a sample of academic nurses in the application of PPC in routine daily practice. It hypothesizes that nurses will be able to provide PC for the pediatric population after completing the training. Methods: This is a multicenter, parallel, pragmatic trial in 5 health care settings spread across a single city in Babylon Province, Iraq. Participants will be recruited and stratified into 2 categories (critical care units and noncritical care units). In the experimental condition, 86 nurses will be trained in the application of PPC for 2 weeks through a web-based training course powered by the Relais Platform. The nurses will be invited to participate via email or instant messaging (WhatsApp, Telegram, or Viber). They will provide end-of-life care in addition to usual care to children and adolescents with life-limiting conditions. In the control condition, 86 nurses will continue usual care. The program?s effectiveness will be assessed at the level of nurses only. We will compare baseline findings (before the intervention) with postintervention findings (after completing the training course). A further assessment will be performed 3 months after the course. As numerous unidentified factors can influence the effect of the training, we will perform a progressive evaluation to assess sample selection, application, and intervention value, as well as implementation difficulties. The nursing staff will not be blinded to the intervention, but will be blinded to the results. Results: The study trial recruitment opened in July 2020. The first outcomes became available in December 2020. Conclusions: The trial attempts to clarify the delivery of PC at the end of life through the implementation of a web-based training course among Iraqi nurses in the pediatric field. The study strengths include the usual practice setting, staff training, readiness of staff to participate in the study, and random allocation to the intervention. However, participants may drop out after being transferred to another department during the study period. Trial Registration: ClinicalTrials.gov NCT04461561; https://clinicaltrials.gov/ct2/show/NCT04461561 International Registered Report Identifier (IRRID): PRR1-10.2196/23783 UR - https://www.researchprotocols.org/2022/11/e23783 UR - http://dx.doi.org/10.2196/23783 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367759 ID - info:doi/10.2196/23783 ER - TY - JOUR AU - Khalaf, Zahra AU - Khan, Shaheer PY - 2022/11/9 TI - Education During Ward Rounds: Systematic Review JO - Interact J Med Res SP - e40580 VL - 11 IS - 2 KW - education KW - learning KW - rounds KW - trainee KW - ward rounds KW - medical education KW - simulation-based learning KW - digital health KW - digital learning KW - education intervention N2 - Background: Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds. Objective: This systematic review examines perceptions of education in ward rounds, educational activities in ward rounds, barriers to learning, and perceptions of simulation-based ward rounds. Methods: The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MEDLINE (EBSCO), Cochrane, and Scopus were searched on May 29, 2022, for studies assessing learning during ward rounds. The search terms included ?ward rounds,? ?education,? and ?trainees.? Then, the selected articles were reference searched. In total, 354 articles were retrieved. The articles were assessed for eligibility by 2 independent reviewers who screened titles, abstracts, and full-length texts. Articles addressing trainees? education in all ward rounds were included. Articles were excluded if they were specific to certain disciplines, were reviews, were not published in scholarly journals, were published before 2015, were published in languages other than English, or did not concern human participants. Following the removal of 63 duplicates, a total of 268 articles were excluded. The risk of bias within the selected articles was also assessed via the Critical Appraisal Skills Programme checklist for qualitative research. Qualitative data were used to describe results in a narrative synthesis and in tables. Results: A total of 23 articles were included. Perceptions of teaching in rounds were addressed by 6 studies, of which 3 showed negative perceptions among participants, 2 reported ambivalent perceptions, and 1 showed positive perceptions. Perceived barriers to teaching during rounds were assessed by 7 studies. The reported barriers included time constraints, workloads, schedules, interruptions, the service-oriented nature of rounds, the lack of feedback, hierarchies, the lack of opportunities to ask questions and be engaged in patient management, and divergent learner needs. Further, 8 studies identified types of educational activities, including observation, patient-specific teaching, and discussion. Perceptions of learning through simulated ward rounds were assessed by 8 studies, and a consensus of satisfaction was noted among learners. The interventions that were explored to improve education included using teaching frameworks, involving clinical librarians, and changing the setting of ward rounds. Conclusions: The main limitations of this review are the predominant use of qualitative data in the included articles and the lack of standardization for the educational compositions of ward rounds among articles, which made the articles hard to compare. In conclusion, learning opportunities in ward rounds are often missed, and trainees perceive rounds to have low educational value. It is important to recognize the barriers to education during ward rounds and address them to maximize the benefits of ward rounds. Finally, there is a need to develop plans that incorporate teaching regularly during ward rounds in the inpatient setting. Trial Registration: PROSPERO CRD42022337736; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337736 UR - https://www.i-jmr.org/2022/2/e40580 UR - http://dx.doi.org/10.2196/40580 UR - http://www.ncbi.nlm.nih.gov/pubmed/36285742 ID - info:doi/10.2196/40580 ER - TY - JOUR AU - Gavarkovs, Adam AU - Kusurkar, A. Rashmi AU - Kulasegaram, Kulamakan AU - Crukley, Jeff AU - Miller, Erin AU - Anderson, Melanie AU - Brydges, Ryan PY - 2022/11/9 TI - Motivational Design for Web-Based Instruction in Health Professions Education: Protocol for a Systematic Review and Directed Content Analysis JO - JMIR Res Protoc SP - e42681 VL - 11 IS - 11 KW - medical education KW - nursing education KW - e-learning KW - serious games KW - instructional design KW - motivation KW - health care KW - health professional KW - professional education KW - digital learning KW - web-based learning N2 - Background: Web-based instruction plays an essential role in health professions education (HPE) by facilitating learners? interactions with educational content, teachers, peers, and patients when they would not be feasible in person. Within the unsupervised settings where web-based instruction is often delivered, learners must effectively self-regulate their learning to be successful. Effective self-regulation places heavy demands on learners? motivation, so effective web-based instruction must be designed to instigate and maintain learners? motivation to learn. Models of motivational design integrate theories of motivation with design strategies intended to create the conditions for motivated engagement. Teachers can use such models to develop their procedural and conceptual knowledge in ways that help them design motivating instruction in messy real-world contexts. Studies such as randomized controlled trials (RCTs) and other quasi-experimental designs that compare different motivational design strategies play a critical role in advancing models of motivational design. Synthesizing the evidence from those studies can identify effective strategies and help teachers and researchers understand the mechanisms governing why strategies work, for whom, and under what circumstances. Objective: The planned review aims to analyze how studies comparing motivational design strategies for web-based instruction in HPE support and advance models of motivational design by (1) controlling for established risks to internal validity, (2) leveraging authentic educational contexts to afford ecological validity, (3) drawing on established theories of motivation, (4) investigating a wide breadth of motivational constructs, and (5) analyzing mediators and moderators of strategy effects. Methods: The planned review will use database searching, registry searching, and hand searching to identify studies comparing motivational design strategies for web-based instruction, delivered to learners in HPE. Studies will be considered from 1990 onward. Two team members will independently screen studies and extract data from the included studies. During extraction, we will record information on the design characteristics of the studies, the theories of motivation they are informed by, the motivational constructs they target, and the mediators and moderators they consider. Results: We have executed our database and registry searches and have begun screening titles and abstracts. Conclusions: By appraising the characteristics of studies that have focused on the motivational design of web-based instruction in HPE, the planned review will produce recommendations that will ensure impactful programs of future research in this crucial educational space. Trial Registration: PROSPERO CRD42022359521; https://tinyurl.com/57chuzf6 International Registered Report Identifier (IRRID): DERR1-10.2196/42681 UR - https://www.researchprotocols.org/2022/11/e42681 UR - http://dx.doi.org/10.2196/42681 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350706 ID - info:doi/10.2196/42681 ER - TY - JOUR AU - Lin, Michelle AU - Phipps, Mina AU - Yilmaz, Yusuf AU - Nash, J. Christopher AU - Gisondi, A. Michael AU - Chan, M. Teresa PY - 2022/10/28 TI - A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study JO - JMIR Med Educ SP - e39946 VL - 8 IS - 4 KW - open educational resource KW - free open-access meducation KW - FOAM KW - meducation KW - open-access KW - internet based KW - web based KW - website KW - social media KW - medical education KW - disruptive innovation KW - blog KW - podcast KW - emergency KW - critical care N2 - Background: Free open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown. Objective: This study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework. Methods: The authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework. Results: The authors identified 109 emergency medicine and critical care websites, which comprised 45.9% (n=50) blogs, 22.9% (n=25) podcasts, and 31.2% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5% (n=30) sold products, 18.3% (n=20) used advertisements, 44.0% (n=48) had institutional funding, and 27.5% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9%) to ?5 (n=60, 55%) individuals. Conclusions: There was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education. UR - https://mededu.jmir.org/2022/4/e39946 UR - http://dx.doi.org/10.2196/39946 UR - http://www.ncbi.nlm.nih.gov/pubmed/36306167 ID - info:doi/10.2196/39946 ER - TY - JOUR AU - Salman, Hira AU - Powell, Leigh AU - Alsuwaidi, Laila AU - Nair, Bhavana AU - Tegginmani, Ahmed Shakeel AU - Mohamadeya, Jalal AU - Zary, Nabil PY - 2022/10/28 TI - Profiling of Learners in Medical Schools as a Move Toward Precision Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e41828 VL - 11 IS - 10 KW - learners KW - medical students KW - medical undergraduates KW - medical graduates KW - profiling of learner KW - learner profile KW - medical education KW - medical universities KW - precision education KW - student record KW - graduate education KW - data extraction tool N2 - Background: Academic experiences seek to get the best out of learners, maximizing performance and developing the skills and competencies needed to foster lifelong learning. The more personalized and tailored the academic experience among learners, the better the outcome. Precision education is a novel approach to research and practice, which is concerned with identifying and tailoring education to the precise needs of the learner. An emerging area of precision education is using data to develop learner profiles for a better understanding of individual learners relative to the characteristics and competencies of lifelong learners. Objective: This scoping review aims to identify literature that reports on profiling learners within medical schools. Our review, as described in this paper, will describe the characteristics being measured, the methods and data sources used to generate profiles, and the resulting profiles that emerge. This review aims to provide guidance to those supporting medical school learners on the current state of learner profiling. Methods: This scoping review will use the Population, Concept, and Context framework, published by Joanna Briggs Institute, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The search strategy was developed in collaboration with a library specialist. An initial search was conducted in PubMed, ERIC, Google Scholar, Cochrane, CINAHL, and SCOPUS. Data will be extracted, and 2 authors will undertake the screening procedure using the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews checklist. Results: The database searches yielded 166 results, and title and abstract screening of 135 extracted articles is currently underway after eliminating 31 duplicates. We anticipate the scoping review to be completed in the first week of October 2022. The final scoping review will present the findings in a narrative and pictorial fashion. Conclusions: This review will help guide scholars looking to understand the current state of learner profiling within medical schools. International Registered Report Identifier (IRRID): PRR1-10.2196/41828 UR - https://www.researchprotocols.org/2022/10/e41828 UR - http://dx.doi.org/10.2196/41828 UR - http://www.ncbi.nlm.nih.gov/pubmed/36209414 ID - info:doi/10.2196/41828 ER - TY - JOUR AU - Pallavicini, Federica AU - Pepe, Alessandro AU - Clerici, Massimo AU - Mantovani, Fabrizia PY - 2022/10/25 TI - Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review JO - JMIR Serious Games SP - e35000 VL - 10 IS - 4 KW - virtual reality KW - medicine KW - mental health KW - physical health KW - education KW - training KW - COVID-19 N2 - Background: Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. Objective: This systematic review aimed to describe the literature on health care?targeted virtual reality applications during the COVID-19 crisis. Methods: We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: ?[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].? Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. Results: Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. Conclusions: Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/ UR - https://games.jmir.org/2022/4/e35000 UR - http://dx.doi.org/10.2196/35000 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282554 ID - info:doi/10.2196/35000 ER - TY - JOUR AU - Kenjrawi, Yazan AU - Dashash, Mayssoon PY - 2022/10/25 TI - The First Asynchronous Online Evidence-Based Medicine Course for Syrian Health Workforce: Effectiveness and Feasibility Pilot Study JO - JMIR Form Res SP - e36782 VL - 6 IS - 10 KW - evidence-based medicine KW - continuous medical education KW - web-based learning KW - Syria KW - medical graduates KW - medical education KW - web-based course N2 - Background: Evidence-based medicine (EBM) is critical for providing the best scientifically proven patient health care, and it is implemented worldwide in order to improve the quality of the delivered health care. However, not all Syrian health professionals are knowledgeable about the importance, methodology, and implementation of EBM. Providing web-based learning courses on EBM might be effective in improving the EBM knowledge of health care professionals. Objective: This study was performed to test the effectiveness and the feasibility of an asynchronous web-based course on EBM in improving the competencies of Syrian health care professionals in terms of EBM. Methods: A web-based course on EBM was developed in Arabic and uploaded onto the Syrian Virtual University platform. An electronic registration form was designed and distributed to medical groups on social media for registration to this web-based course. Both the pretest and posttest had the same 3 sections to measure the impact of this web-based EBM program on the knowledge, skills, and attitudes of the Syrian health care professionals. The posttest had an additional section for measuring the efficacy and ease of use of this program. Student paired 1-tailed t test was used to analyze the differences in the different assessment sections among the participants. Results: Nineteen participants filled the electronic registration form, but 8 participants did not meet the inclusion criteria. Therefore, the pretest was sent to the remaining 11 participants (7 men and 4 women) who graduated from Syrian universities. Ten of them completed the pretest, while 7 of them completed the posttest. The web-based course was found to be effective in improving the participants? EBM knowledge, skills, and attitudes at P>.05. Further, the web-based EBM course was feasible and easy-to-use. Conclusions: In order for EBM to be implemented in Syria, continuous medical education training programs should be designed for clinical practitioners. Our study shows that asynchronous web-based medical education is an effective and a feasible means for introducing the concept of EBM, improving practitioners? skills, and promoting the positive attitudes of Syrian clinical practitioners toward EBM. UR - https://formative.jmir.org/2022/10/e36782 UR - http://dx.doi.org/10.2196/36782 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282556 ID - info:doi/10.2196/36782 ER - TY - JOUR AU - Liu, Shalom David AU - Sawyer, Jake AU - Luna, Alexander AU - Aoun, Jihad AU - Wang, Janet AU - Boachie, Lord AU - Halabi, Safwan AU - Joe, Bina PY - 2022/10/21 TI - Perceptions of US Medical Students on Artificial Intelligence in Medicine: Mixed Methods Survey Study JO - JMIR Med Educ SP - e38325 VL - 8 IS - 4 KW - artificial intelligence KW - eHealth KW - digital health KW - integration KW - medical education KW - medical curriculum KW - education KW - medical student KW - medical school KW - elective course N2 - Background: Given the rapidity with which artificial intelligence is gaining momentum in clinical medicine, current physician leaders have called for more incorporation of artificial intelligence topics into undergraduate medical education. This is to prepare future physicians to better work together with artificial intelligence technology. However, the first step in curriculum development is to survey the needs of end users. There has not been a study to determine which media and which topics are most preferred by US medical students to learn about the topic of artificial intelligence in medicine. Objective: We aimed to survey US medical students on the need to incorporate artificial intelligence in undergraduate medical education and their preferred means to do so to assist with future education initiatives. Methods: A mixed methods survey comprising both specific questions and a write-in response section was sent through Qualtrics to US medical students in May 2021. Likert scale questions were used to first assess various perceptions of artificial intelligence in medicine. Specific questions were posed regarding learning format and topics in artificial intelligence. Results: We surveyed 390 US medical students with an average age of 26 (SD 3) years from 17 different medical programs (the estimated response rate was 3.5%). A majority (355/388, 91.5%) of respondents agreed that training in artificial intelligence concepts during medical school would be useful for their future. While 79.4% (308/388) were excited to use artificial intelligence technologies, 91.2% (353/387) either reported that their medical schools did not offer resources or were unsure if they did so. Short lectures (264/378, 69.8%), formal electives (180/378, 47.6%), and Q and A panels (167/378, 44.2%) were identified as preferred formats, while fundamental concepts of artificial intelligence (247/379, 65.2%), when to use artificial intelligence in medicine (227/379, 59.9%), and pros and cons of using artificial intelligence (224/379, 59.1%) were the most preferred topics for enhancing their training. Conclusions: The results of this study indicate that current US medical students recognize the importance of artificial intelligence in medicine and acknowledge that current formal education and resources to study artificial intelligence?related topics are limited in most US medical schools. Respondents also indicated that a hybrid formal/flexible format would be most appropriate for incorporating artificial intelligence as a topic in US medical schools. Based on these data, we conclude that there is a definitive knowledge gap in artificial intelligence education within current medical education in the US. Further, the results suggest there is a disparity in opinions on the specific format and topics to be introduced. UR - https://mededu.jmir.org/2022/4/e38325 UR - http://dx.doi.org/10.2196/38325 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269641 ID - info:doi/10.2196/38325 ER - TY - JOUR AU - Harris, B. Stewart AU - Idzik, Shannon AU - Boasso, Adriano AU - Neunie, Quasheba Sola AU - Noble, Daniel Alexander AU - Such, Elaine Helen AU - Van, Joanna PY - 2022/10/14 TI - The Educational Impact of Web-Based, Faculty-Led Continuing Medical Education Programs in Type 2 Diabetes: A Survey Study to Analyze Changes in Knowledge, Competence, and Performance of Health Care Professionals JO - JMIR Med Educ SP - e40520 VL - 8 IS - 4 KW - clinical case KW - competence KW - continuing medical education KW - knowledge KW - multidisciplinary team KW - web-based education KW - performance KW - type 2 diabetes N2 - Background: The treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited. Objective: This study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence, and performance following short, case-based, multidisciplinary web-based CME activities; and identify the remaining educational gaps. Methods: Two faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5). Results: Each activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P<.001), with the proportion of learners answering at least six of 7 questions correctly, increasing from 22% (11/50) to 60% (30/50). A nonsignificant improvement in knowledge and competence was observed following participation in touch MultiDisciplinary Team (mean score, SD 4.36, 1.24 vs 4.58, 1.07; P=.35); however, baseline knowledge and competence were relatively high, where 80% of the respondents (40/50) answered at least four of 6 questions correctly. A significant improvement in HCP self-reported performance was observed in a combined analysis of both activities (mean score, SD 2.65, 1.32 vs 3.15, 1.26; P=.03), with the proportion of learners selecting the answer representing the best clinical option for all 4 questions increasing from 32% (11/34) to 59% (20/34) after the activity. Several unmet educational needs were self-reported or identified from the analysis of incorrectly answered questions, including setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. Conclusions: Short, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. UR - https://mededu.jmir.org/2022/4/e40520 UR - http://dx.doi.org/10.2196/40520 UR - http://www.ncbi.nlm.nih.gov/pubmed/36102282 ID - info:doi/10.2196/40520 ER - TY - JOUR AU - White, A. Andrew AU - King, M. Ann AU - D?Addario, E. Angelo AU - Brigham, Berg Karen AU - Dintzis, Suzanne AU - Fay, E. Emily AU - Gallagher, H. Thomas AU - Mazor, M. Kathleen PY - 2022/10/3 TI - Effects of Practicing With and Obtaining Crowdsourced Feedback From the Video-Based Communication Assessment App on Resident Physicians? Adverse Event Communication Skills: Pre-post Trial JO - JMIR Med Educ SP - e40758 VL - 8 IS - 4 KW - medical error disclosure KW - simulation studies KW - communication assessment KW - graduate medical education KW - crowdsourcing KW - patient-centered care KW - medical education KW - virtual education KW - virtual communication KW - physician communication KW - resident KW - virtual learning KW - digital learning KW - video communication KW - medical error KW - digital response N2 - Background: US residents require practice and feedback to meet Accreditation Council for Graduate Medical Education mandates and patient expectations for effective communication after harmful errors. Current instructional approaches rely heavily on lectures, rarely provide individualized feedback to residents about communication skills, and may not assure that residents acquire the skills desired by patients. The Video-based Communication Assessment (VCA) app is a novel tool for simulating communication scenarios for practice and obtaining crowdsourced assessments and feedback on physicians? communication skills. We previously established that crowdsourced laypeople can reliably assess residents? error disclosure skills with the VCA app. However, its efficacy for error disclosure training has not been tested. Objective: We aimed to evaluate the efficacy of using VCA practice and feedback as a stand-alone intervention for the development of residents? error disclosure skills. Methods: We conducted a pre-post study in 2020 with pathology, obstetrics and gynecology, and internal medicine residents at an academic medical center in the United States. At baseline, residents each completed 2 specialty-specific VCA cases depicting medical errors. Audio responses were rated by at least 8 crowdsourced laypeople using 6 items on a 5-point scale. At 4 weeks, residents received numerical and written feedback derived from layperson ratings and then completed 2 additional cases. Residents were randomly assigned cases at baseline and after feedback assessments to avoid ordinal effects. Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2×3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings. Results: In total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents? communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents? communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6%). Conclusions: Residents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum. UR - https://mededu.jmir.org/2022/4/e40758 UR - http://dx.doi.org/10.2196/40758 UR - http://www.ncbi.nlm.nih.gov/pubmed/36190751 ID - info:doi/10.2196/40758 ER - TY - JOUR AU - Si, Mingyu AU - Su, Xiaoyou AU - Jiang, Yu AU - Wang, Wenjun AU - Zhang, Xi AU - Gu, Xiaofen AU - Ma, Li AU - Li, Jing AU - Zhang, Shaokai AU - Ren, Zefang AU - Liu, Yuanli AU - Qiao, Youlin PY - 2022/9/30 TI - An Internet-Based Education Program for Human Papillomavirus Vaccination Among Female College Students in Mainland China: Application of the Information-Motivation-Behavioral Skills Model in a Cluster Randomized Trial JO - J Med Internet Res SP - e37848 VL - 24 IS - 9 KW - human papillomavirus vaccination KW - internet-based education KW - information-motivation-behavioral skills model KW - female college students KW - China N2 - Background: Patients diagnosed with cervical cancer in the last 2 decades were mainly young females. Human papillomavirus (HPV) vaccination is the most radical way to prevent HPV infection and cervical cancer. However, most female college students in mainland China have not yet been vaccinated, and their relevant knowledge is limited. Theory-based education delivered via the internet is a potentially accessible and useful way to promote HPV vaccination among this population. Objective: This 3-month follow-up study intended to identify the feasibility and efficacy of an information-motivation-behavioral skills (IMB) model?based online intervention for promoting awareness and willingness regarding HPV vaccination among female college students. Methods: A 7-day online HPV education program for female college students in mainland China was developed using a cluster randomized trial design. Recruitment and questionnaire surveys were performed online without face-to-face contact. SPSS 23.0 was used for statistical analysis. The chi-square test and t test were used to compare differences in qualitative and continuous variables between intervention and control groups. The generalized estimating equation was used to test the effectiveness of the intervention with a consideration of the time factor. Results: Among 3867 participants, 102 had been vaccinated against HPV before the study (vaccination rate of 2.6%). A total of 3484 participants were followed up after the baseline survey, with no statistical difference in the loss rate between the intervention and control groups during the intervention and follow-up periods. At different follow-up time points, HPV-related knowledge, and the motivation, behavioral skills, and willingness regarding HPV vaccination were higher in the intervention group than in the control group. HPV-related knowledge was statistically different between the 2 groups, while the motivation, behavioral skills, and willingness regarding HPV vaccination only showed statistical differences right after the intervention, reaching a peak right after the intervention and then gradually reducing over time. Furthermore, there was no statistical difference in the HPV vaccination rate between the 2 groups. Conclusions: IMB model?based online education could be a promising way to increase the HPV vaccination rate and reduce the burden of HPV infection and cervical cancer among high-risk female college students in China. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025476; http://www.chictr.org.cn/showprojen.aspx? proj=42672 International Registered Report Identifier (IRRID): RR2-DOI:10.1186/s12889-019-7903-x UR - https://www.jmir.org/2022/9/e37848 UR - http://dx.doi.org/10.2196/37848 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178723 ID - info:doi/10.2196/37848 ER - TY - JOUR AU - Newcomer, Valerie AU - Metzinger, Megan AU - Vick, Sydney AU - Robertson, Caroline AU - Lawrence, Taylor AU - Glass, Amanda AU - Elliott, Lauren AU - Williams, Ansleigh PY - 2022/9/30 TI - A Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners: Usability Study JO - JMIR Med Educ SP - e35637 VL - 8 IS - 3 KW - knowledge translation KW - task-oriented training KW - stroke assessments KW - telerehabilitation KW - occupational therapy KW - students KW - practitioners KW - educational program N2 - Background: There are gaps in knowledge translation (KT) of current evidence-based practices regarding stroke assessment and rehabilitation delivered through teletherapy. A lack of this knowledge can prevent occupational therapy (OT) students and practitioners from implementing current research findings. Objective: The aim of this pilot study was to create an educational program to translate knowledge into practice regarding the remote delivery of stroke assessment and rehabilitation to OT students and practitioners. Four areas of focus were addressed in the educational program, including KT, task-oriented training, stroke assessments, and telerehabilitation. Methods: Two pilot studies were conducted to assess the knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale and general feedback questionnaire. Participants in study 1 were 5 OT practitioners and 1 OT assistant. Participants in study 2 were 9 current OT students. Four 1-hour modules were emailed weekly to participants over the course of 4 weeks, with each module covering a different topic (KT, task-oriented training, stroke assessments, and telerehabilitation). Preliminary results were reviewed using descriptive statistics. Results: Statistically significant results were found with increased scores of knowledge for both students and practitioners. Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants. Conclusions: Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice. UR - https://mededu.jmir.org/2022/3/e35637 UR - http://dx.doi.org/10.2196/35637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178717 ID - info:doi/10.2196/35637 ER - TY - JOUR AU - Soon, Siang Marcus Khai AU - Martinengo, Laura AU - Lu, Junde AU - Car, Tudor Lorainne AU - Chia, Khng Clement Luck PY - 2022/9/27 TI - The Use of Telegram in Surgical Education: Exploratory Study JO - JMIR Med Educ SP - e35983 VL - 8 IS - 3 KW - COVID-19 KW - undergraduate medical education KW - distance education KW - social media KW - Telegram KW - general surgery KW - messaging apps N2 - Background: The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram?s role in medical education remains relatively unexplored. Objective: This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. Methods: A Telegram channel ?Telegram Education for Surgery Learning and Application (TESLA)? was created to supplement medical students? learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. Results: Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. Conclusions: The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy. UR - https://mededu.jmir.org/2022/3/e35983 UR - http://dx.doi.org/10.2196/35983 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099020 ID - info:doi/10.2196/35983 ER - TY - JOUR AU - Høybakk, Berit Jofrid AU - Nes, Gonçalves Andréa Aparecida AU - Kvande, Evelyn Monica AU - Solberg, Trygg Marianne PY - 2022/9/15 TI - Exploring the Impact of Virtual Reflection Groups on Advanced Practice Nurse Students During the COVID-19 Pandemic: Focus Group Study With Master?s Students JO - JMIR Nursing SP - e40418 VL - 5 IS - 1 KW - advanced practice nurse KW - competence KW - COVID-19 KW - professional discussions KW - qualitative study KW - virtual reflection groups KW - interviews KW - learning KW - development N2 - Background: In the master?s program of advanced practice nursing at a Norwegian university college, the learning activity reflection groups were converted into virtual reflection group (VRG) meetings during the COVID-19 pandemic. Regardless of the students? clinical practices in different hospitals, they could participate in the same VRG meeting on the web together with the educator from the university college, and the clinical supervisors were invited to participate. The students were in the process of developing the core competence required in their role as advanced practice nurses (APNs), and they had increased responsibility in the implementation of the VRG meetings. Objective: In this study, we aimed to explore how master?s students of advanced practice nursing experienced VRG meetings during the COVID-19 pandemic. Methods: A qualitative exploratory design was adopted using focus group interviews. A group of students in the master?s program of advanced practice nursing participated in an interview that lasted for 60 minutes. They had experienced participating in the VRG meetings following a rigorous guide during their clinical practice. The data from the focus group were analyzed using qualitative content analysis. Results: The main findings of this study highlighted the importance of structure in VRG meetings, the role of increased responsibility in students? learning processes, the development of APN students? competencies, and increased professional collaboration with clinical supervisors. The APN students and clinical supervisors also continued their discussions in the clinical setting afterward, which strengthened the collaboration between students? education in the master?s program and their clinical practice. Conclusions: VRG meetings gave the students the opportunity to lead professional discussions while reflecting thoroughly on the chosen patient cases from clinical practice. They experienced receiving feedback from fellow students, supervisors, and educators as stimulating their critical thinking development. UR - https://nursing.jmir.org/2022/1/e40418 UR - http://dx.doi.org/10.2196/40418 UR - http://www.ncbi.nlm.nih.gov/pubmed/36107492 ID - info:doi/10.2196/40418 ER - TY - JOUR AU - Pang, Mengwei AU - Zhao, Xiaohan AU - Lu, Daiyu AU - Dong, Yihan AU - Jiang, Lin AU - Li, Jie AU - Ji, Ping PY - 2022/9/12 TI - Preliminary User Evaluation of a New Dental Technology Virtual Simulation System: Development and Validation Study JO - JMIR Serious Games SP - e36079 VL - 10 IS - 3 KW - virtual simulation KW - dental technology KW - OSCE KW - virtual reality KW - dentistry KW - dental technician KW - framework KW - certified dental technician KW - development KW - validation KW - serious game KW - dental KW - technology N2 - Background: With the advancements in the dental health care industry, the demand for dental technicians has increased. Dental technicians should be thoroughly assessed and trained in practical skills and pass professional certification examinations to ensure that they are competent to work closely with dentists. Unfortunately, such training courses and tests are in short supply worldwide. The use of virtual simulation technology can help solve these problems. Objective: This study presents a new strategic framework design for a certified dental technician practical examination called as the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT), which is based on the Objective Structured Clinical Examination (OSCE). We present the development and validation of the OMEDT system, a new virtual simulated training system, to meet the demands of the OMEDT framework. The combination of OMEDT and the OMEDT system can solve the complex problems encountered in the certified dental technician practical examination with excellent efficiency, high quality, and low cost. Methods: The OMEDT framework design was constructed according to the OSCE guide and the Chinese vocational skill standards for dental technicians. To develop the OMEDT system, we organized a new framework based on the virtual learning network platform, the haptic feedback system, and the real-time dental training and evaluation system. The effectiveness evaluation of the OMEDT system was divided into 2 phases: in the first phase, 36 students were recruited to use the test module to finish the task and their performance data were collected and analyzed; and in the second phase, a questionnaire was administered to 30 students who used the system for their studies and graduation exams. Results: The OMEDT and the corresponding skill training virtual simulation OMEDT system were developed, and preliminary user evaluation was performed to assess their effectiveness and usefulness. The OMEDT system was found to improve students? practical skills by training with the evaluation results. In addition, several key research topics were explored, including the effects of positive feedback of the knowledge of results on the improvement of the students? skill level and the common sense transformation of educators in the virtual simulation technology environment. Conclusions: The development of OMEDT and the OMEDT system has been completed and their effectiveness has been verified. UR - https://games.jmir.org/2022/3/e36079 UR - http://dx.doi.org/10.2196/36079 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094803 ID - info:doi/10.2196/36079 ER - TY - JOUR AU - Kennedy, Blair Ann AU - Riyad, Youssef Cindy Nessim AU - Ellis, Ryan AU - Fleming, R. Perry AU - Gainey, Mallorie AU - Templeton, Kara AU - Nourse, Anna AU - Hardaway, Virginia AU - Brown, April AU - Evans, Pam AU - Natafgi, Nabil PY - 2022/8/30 TI - Evaluating a Global Assessment Measure Created by Standardized Patients for the Multiple Mini Interview in Medical School Admissions: Mixed Methods Study JO - J Particip Med SP - e38209 VL - 14 IS - 1 KW - co-design KW - participatory design KW - medical schools KW - exploratory sequential mixed methods design KW - school admission criteria KW - medical students KW - communication KW - multiple mini interviews KW - interview KW - patient KW - student KW - medical school KW - acceptance KW - study design N2 - Background: Standardized patients (SPs) are essential stakeholders in the multiple mini interviews (MMIs) that are increasingly used to assess medical school applicants? interpersonal skills. However, there is little evidence for their inclusion in the development of instruments. Objective: This study aimed to describe the process and evaluate the impact of having SPs co-design and cocreate a global measurement question that assesses medical school applicants? readiness for medical school and acceptance status. Methods: This study used an exploratory, sequential, and mixed methods study design. First, we evaluated the initial MMI program and determined the next quality improvement steps. Second, we held a collaborative workshop with SPs to codevelop the assessment question and response options. Third, we evaluated the created question and the additional MMI rubric items through statistical tests based on 1084 applicants? data from 3 cohorts of applicants starting in the 2018-2019 academic year. The internal reliability of the MMI was measured using a Cronbach ? test, and its prediction of admission status was tested using a forward stepwise binary logistic regression. Results: Program evaluation indicated the need for an additional quantitative question to assess applicant readiness for medical school. In total, 3 simulation specialists, 2 researchers, and 21 SPs participated in a workshop leading to a final global assessment question and responses. The Cronbach ??s were >0.8 overall and in each cohort year. The final stepwise logistic model for all cohorts combined was statistically significant (P<.001), explained 9.2% (R2) of the variance in acceptance status, and correctly classified 65.5% (637/972) of cases. The final model consisted of 3 variables: empathy, rank of readiness, and opening the encounter. Conclusions: The collaborative nature of this project between stakeholders, including nonacademics and researchers, was vital for the success of this project. The SP-created question had a significant impact on the final model predicting acceptance to medical school. This finding indicates that SPs bring a critical perspective that can improve the process of evaluating medical school applicants. UR - https://jopm.jmir.org/2022/1/e38209 UR - http://dx.doi.org/10.2196/38209 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040776 ID - info:doi/10.2196/38209 ER - TY - JOUR AU - Krnic Martinic, Marina AU - ?ivljak, Marta AU - Maru?i?, Ana AU - Sapunar, Damir AU - Poklepovi? Peri?i?, Tina AU - Buljan, Ivan AU - Tokali?, Ru?ica AU - Mali?a, Snje?ana AU - Neuberg, Marijana AU - Ivani?evi?, Kata AU - Aranza, Diana AU - Skitareli?, Nata?a AU - Zorani?, Sanja AU - Mik?i?, ?tefica AU - ?avi?, Dalibor AU - Puljak, Livia PY - 2022/8/25 TI - Web-Based Educational Intervention to Improve Knowledge of Systematic Reviews Among Health Science Professionals: Randomized Controlled Trial JO - J Med Internet Res SP - e37000 VL - 24 IS - 8 KW - educational intervention KW - systematic review KW - health science professionals KW - knowledge KW - randomized controlled trial N2 - Background: Lack of knowledge of systematic reviews (SRs) could prevent individual health care professionals from using SRs as a source of information in their clinical practice or discourage them from participating in such research. Objective: In this randomized controlled trial, we evaluated the effect of a short web-based educational intervention on short-term knowledge of SRs. Methods: Eligible participants were 871 Master?s students of university health sciences studies in Croatia; 589 (67.6%) students who agreed to participate in the trial were randomized using a computer program into 2 groups. Intervention group A (294/589, 49.9%) received a short web-based educational intervention about SR methodology, and intervention group B (295/589, 50.1%) was presented with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. The participants? knowledge of SRs was assessed before and after the intervention. The participants could not be blinded because of the nature of the intervention. The primary outcome was the difference in the percentage of correct answers about SR methodology per participant between the groups after the intervention, expressed as relative risk and 95% CI. Results: Results from 162 and 165 participants in the educational intervention and PRISMA checklist groups, respectively, were available for analysis. Most of them (educational intervention group: 130/162, 80.2%; PRISMA checklist group: 131/165, 79.4%) were employed as health care professionals in addition to being health sciences students. After the intervention, the educational intervention group had 23% (relative risk percentage) more correct answers in the postintervention questionnaire than the PRISMA checklist group (relative risk=1.23, 95% CI 1.17-1.29). Conclusions: A short web-based educational intervention about SRs is an effective tool for short-term improvement of knowledge of SRs among health care studies students, most of whom were also employed as health care professionals. Further studies are needed to explore the long-term effects of the tested education. Trial Registration: OSF Registries 10.17605/OSF.IO/RYMVC; https://osf.io/rymvc UR - https://www.jmir.org/2022/8/e37000 UR - http://dx.doi.org/10.2196/37000 UR - http://www.ncbi.nlm.nih.gov/pubmed/36006686 ID - info:doi/10.2196/37000 ER - TY - JOUR AU - Khan, Nagina AU - van Mook, Walther AU - Dave, Subodh AU - Ha, Sohyun AU - Sagisi, Joshua AU - Davi, Nicole AU - Aftab, Chantel AU - Tiwari, Sucheta AU - Hickman, Marie AU - Gilliar, Wolfgang PY - 2022/8/25 TI - Learners? Perspectives of Professionalism: Protocol for a Mixed Methods Systematic Review JO - JMIR Res Protoc SP - e37473 VL - 11 IS - 8 KW - professionalism KW - undergraduate medical education KW - medical school KW - medical education KW - medical curriculum KW - teaching methods KW - teaching KW - medical students KW - student KW - undergraduate KW - convergent integrated synthesis KW - integrated synthesis KW - curriculum KW - recommendation KW - learner KW - perspective KW - review N2 - Background: Professionalism has come to be associated with competence in medical education, with the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. Recent studies indicate students should have the opportunity to observe the application of knowledge and skills by their mentors to improve patient health and safety. A noticeable detail that needs implementation into the curriculum is the inclusion of student perspectives. This review will explore students? understanding and experience of professionalism in undergraduate medical education (UME). Objective: This paper presents the protocol for a review that aims to develop an integrated synthesis of qualitative and quantitative studies resulting in recommendations for medical school curricula to incorporate the learners? perspectives in teaching professionalism in UME. Methods: We will take an integrated approach to synthesis. Data will be extracted from the included studies, and quantitative data will be ?qualitized.? PubMed (Medline), Embase, PsycInfo, and ERIC (Education Resources Information Center) will be searched for studies published in English from 2010 to 2021. Studies will be screened and critically appraised for methodological quality using the Mixed Methods Appraisal Tool by 2 researchers, with disagreements resolved by a third researcher. Qualitative, quantitative, and mixed methods studies will be considered. Our population of interest is undergraduate medical students; hence, studies on medical residents and graduate medical students will be excluded. We will consider studies that explore how concepts of professionalism are understood, experienced, and taught in undergraduate medicine and on how medical students understand and develop the identified constructs of professionalism. Results: This study is in the screening phase; therefore, no results are available at this time. However, we had initiated the searches, screening, and are currently in the critical appraisal stage. We will commence preparation to clean and convert the data for coding in July 2022, and analysis will be ongoing from the end of July 2022 until submission for publication in November 2022. Conclusions: This research will contribute to the student perspectives on professionalism in medical education literature. The findings will aid in the creation of a checklist to guide the development of a curriculum on professionalism in UME. International Registered Report Identifier (IRRID): PRR1-10.2196/37473 UR - https://www.researchprotocols.org/2022/8/e37473 UR - http://dx.doi.org/10.2196/37473 UR - http://www.ncbi.nlm.nih.gov/pubmed/36006688 ID - info:doi/10.2196/37473 ER - TY - JOUR AU - Mazur, M. Lukasz AU - Khasawneh, Amro AU - Fenison, Christi AU - Buchanan, Shawna AU - Kratzke, M. Ian AU - Adapa, Karthik AU - An, J. Selena AU - Butler, Logan AU - Zebrowski, Ashlyn AU - Chakravarthula, Praneeth AU - Ra, H. Jin PY - 2022/8/24 TI - A Novel Theory-Based Virtual Reality Training to Improve Patient Safety Culture in the Department of Surgery of a Large Academic Medical Center: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e40445 VL - 11 IS - 8 KW - virtual reality training KW - patient safety culture KW - patient safety events KW - sensemaking KW - high reliability organizations N2 - Background: Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health care system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality (VR) training to promote understanding and sensemaking toward the holistic view of the culture of patient safety and high reliability. Objective: We aim to assess the effect of VR training on health care workers? (HCWs?) understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high reliability organization principles in the laboratory environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. Methods: This mixed methods study uses a pre-VR versus post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and frontline HCWs in the operation rooms at an academic medical center. HCWs? understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the data frame theory framework, supported by a semistructured interview guide to capture the sensemaking process of patient safety culture and principles of high reliability organizations. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality surveys on patient safety culture. TeamSTEPPS behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool. Patient safety events reported in the voluntary institutional reporting system will be compared before the training versus those after the training. We will compare the Agency for Healthcare Research and Quality patient safety culture scores and patient safety events reporting before the training versus those after the training by using descriptive statistics and a within-subject 2-tailed, 2-sample t test with the significance level set at .05. Results: Ethics approval was obtained in May 2021 from the institutional review board of the University of North Carolina at Chapel Hill (22-1150). The enrollment of participants for this study will start in fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. Conclusions: Our findings will help assess the effectiveness of VR training in improving HCWs? understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and principles and behaviors of high reliability organizations. These findings will contribute to developing VR training to improve patient safety culture in other specialties. UR - https://www.researchprotocols.org/2022/8/e40445 UR - http://dx.doi.org/10.2196/40445 UR - http://www.ncbi.nlm.nih.gov/pubmed/36001370 ID - info:doi/10.2196/40445 ER - TY - JOUR AU - Guterud, Mona AU - Bugge, Fagerheim Helge AU - Røislien, Jo AU - Larsen, Karianne AU - Eriksen, Erik AU - Ingebretsen, Håkon Svein AU - Mikkelsen, Lerstang Martin AU - Kramer-Johansen, Jo AU - Bache, G. Kristi AU - Sandset, Charlotte Else AU - Hov, Ranhoff Maren PY - 2022/8/11 TI - Interrater Agreement on National Institutes of Health Stroke Scale Between Paramedics and Stroke Physicians: Validation Study for the Digital Training Model in the Paramedic Norwegian Acute Stroke Prehospital Project JO - JMIR Neurotech SP - e39444 VL - 1 IS - 1 KW - paramedic KW - stroke KW - ambulance KW - National Institutes of Health Stroke Scale KW - NIHSS KW - training KW - digital KW - interrater KW - agreement KW - Norway KW - acute KW - treatment KW - hospital KW - time KW - communication KW - mobile application KW - clinical trial KW - physician KW - simulation N2 - Background: Time spent in the prehospital phase of acute stroke care is multifactorial and has an effect on the possibilities for acute treatment. Communication between paramedics and the in-hospital stroke team directly affects time to treatment. A mutual stroke scale such as the National Institutes of Health Stroke Scale (NIHSS) may improve communication quality. The Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) was a stepped-wedge, randomized trial of stroke screening using NIHSS in the ambulance where the intervention was training paramedics in stroke and the NIHSS, with the use of NIHSS made into a mobile app to guide the examination and facilitate communication with the in-hospital stroke team. Objective: The aim of this study was to validate the digital training model from the ParaNASPP clinical trial. Methods: In total, 24 paramedics were recruited from Oslo University Hospital in Norway to complete the ParaNASPP training model; 20 exclusive videos with predefined NIHSS scores were recorded; and 4 stroke physicians from Oslo University Hospital were included for reference. Bland-Altman plots with 95% limits of agreement (LoA) were calculated?first comparing paramedics and stroke physicians to the predefined scores and then with each other. The predefined LoA were set to 3 points. To align with clinical practice, NIHSS scores were also dichotomized into 2 categories: from 0-5 (minor stroke) or ?6 (moderate and major stroke), and agreement was calculated using Cohen ?. Results: The videos (n=20) had a median (range) NIHSS score of 7 (0-31). The paramedics? scores were slightly higher than the predefined scores with a mean difference of ?0.38 and the LoA ranging from ?4.04 to 3.29. The paramedics scored higher than the stroke physicians with a mean difference of ?0.39, with the LoA ranging from ?4.58 to 3.80. When the NIHSS scores were dichotomized, Cohen ? was 0.89 between the predefined scores and paramedics, 0.92 between the predefined scores and stroke physicians, and 0.81 between the paramedics and stroke physicians, all indicating very good agreement. Conclusions: The paramedics scored higher than both the predefined scores and stroke physicians? scores, hence the predefined LoA were not met. However, the width of the LoA was smaller than seen when experienced neurologists are compared. When the NIHSS scores were dichotomized, the paramedics achieved very good agreement with both the predefined scores and stroke physicians? scores. This study demonstrates the possibilities for the transfer of clinical competence in digital simulation training. UR - https://neuro.jmir.org/2022/1/e39444 UR - http://dx.doi.org/10.2196/39444 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/39444 ER - TY - JOUR AU - Yin, Leena AU - Ng, Fiona AU - Rutherford-Rojas, Mateo AU - Williams, Mia AU - Cornes, Susannah AU - Fernandez, Alicia AU - Garcia, E. Maria AU - Khoong, C. Elaine PY - 2022/8/11 TI - Assessing Medical Student Readiness to Navigate Language Barriers in Telehealth: Cross-sectional Survey Study JO - JMIR Med Educ SP - e36096 VL - 8 IS - 3 KW - interpreters KW - language barriers KW - medical students KW - medical education KW - limited English proficiency KW - telehealth KW - telemedicine KW - online education KW - clinician KW - health care professional N2 - Background: The COVID-19 pandemic has greatly increased telehealth usage in the United States. Patients with limited English proficiency (LEP) face barriers to health care, which may be mitigated when providers work with professional interpreters. However, telehealth may exacerbate disparities if clinicians are not trained to work with interpreters in that setting. Although medical students are now involved in telehealth on an unprecedented scale, no educational innovations have been published that focus on digital care across language barriers. Objective: The aim of this study is to investigate advanced medical students? confidence in caring for patients with LEP during telehealth encounters. Methods: We administered a written survey to medical students on clinical clerkships at one US institution in August and September 2020. We assessed students? overall confidence in working with interpreters; confidence in performing 8 clinical tasks during in-person versus telehealth encounters; and frequency of performing 5 different clinical tasks with patients with LEP compared to English-speaking patients during in-person versus telehealth encounters. Wilcoxon signed-rank tests and chi-square tests were used to compare confidence and task performance frequency, respectively, for patients with LEP versus English-speaking patients during telehealth encounters. Students were also asked to identify barriers to care for patients with LEP. The free-response questions were qualitatively analyzed using open coding to identify key themes. Results: Of 300 medical students surveyed, 121 responded. Furthermore, 72 students answered >50% of questions and were included in the analyses. Compared to caring for patients with LEP during in-person encounters, respondents were less confident in working with interpreters (P<.001), developing trust (P<.001), identifying agenda (P=.005), eliciting preferences for diabetes management (P=.01), and empowering patients in lifestyle modifications (P=.04) during telehealth encounters. During both in-person and telehealth encounters, approximately half of students (40%-78%) reported engaging less frequently in every clinical task with patients with LEP and this was as low as 22% (13/59) for some tasks. Students identified these key barriers to care for patients with LEP: time pressure, interpretation quality and access, technical difficulties, cultural differences, and difficulty with rapport building. Conclusions: Advanced medical students were significantly less confident caring for patients with LEP via telehealth than in person. Broader implementation of training around navigating language barriers is necessary for telehealth care, which has rapidly expanded in the United States. Our study identified potential key areas for curricular focus, including creating patient-centered agendas and management plans within the constraints of virtual settings. These developments must take place simultaneously with systems-level improvements in interpreter infrastructure to ensure high-quality care for linguistically diverse patients. UR - https://mededu.jmir.org/2022/3/e36096 UR - http://dx.doi.org/10.2196/36096 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969421 ID - info:doi/10.2196/36096 ER - TY - JOUR AU - Abdelwahab, Rewan AU - Abdou, Maya AU - Newman, Catherine PY - 2022/8/11 TI - Piloting a Community Education Skin Cancer Program Coordinated by Medical Students JO - JMIR Dermatol SP - e36793 VL - 5 IS - 3 KW - skin cancer KW - skin KW - cancer KW - oncology KW - dermatology KW - community education KW - health education KW - pediatric KW - paediatric KW - skin of color KW - sun exposure KW - tanning KW - service KW - child KW - school age KW - school KW - student KW - medical student KW - health literacy KW - telehealth KW - teledermatology KW - telemedicine KW - online education KW - distance education KW - internet-based KW - digital health KW - melanoma KW - patient education KW - prevention UR - https://derma.jmir.org/2022/3/e36793 UR - http://dx.doi.org/10.2196/36793 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632889 ID - info:doi/10.2196/36793 ER - TY - JOUR AU - Lobchuk, Michelle AU - Bathi, Reddy Prachotan AU - Ademeyo, Adedotun AU - Livingston, Aislinn PY - 2022/8/3 TI - Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis JO - JMIR Form Res SP - e35319 VL - 6 IS - 8 KW - web browser KW - user-centered design KW - qualitative research KW - internet KW - empathy N2 - Background: COVID-19 restrictions severely curtailed empirical endeavors that involved in-person interaction, such as usability testing sessions for technology development. Researchers and developers found themselves using web-based moderation for usability testing. Skilled remote moderators and observers are fundamental in this approach. However, to date, more empirical work is needed that captures the perceptions and support needs of moderators and observers in testing situations. Objective: The aim of this paper was to identify remote moderator and observer participant experiences and their use of certain tools to capture feedback of users as they interact with the web browser application. Methods: This research is part of a broader study on an educational web browser application for nursing students to learn perspective taking and enhance their perceptual understanding of a dialogue partner?s thoughts and feelings. The broader study used a quantitative and think-aloud qualitative problem-discovery usability study design. This case study explored written accounts of the remote moderator and observer participants regarding their roles, experiences, and reactions to the testing protocol and their suggestions for improved techniques and strategies for conducting remote usability testing. Content analysis was used to analyze participants? experiences in the usability testing sessions. Results: We collected data from 1 remote moderator and 2 remote observers. Five themes were identified: dealing with personal stressors, dealing with user anxiety, maintaining social presence, ethical response to the study protocol, and communication during sessions. The participants offered recommendations for the design of future remote testing activities as well as evidence-informed training materials for usability project personnel. Conclusions: This study?s findings contribute to a growing body of endeavors to understand human-computer interaction and its impact on remote moderator and observer roles. As technology rapidly advances, more remote usability testing will occur where the knowledge gleaned in this study can have an impact. Recommendations based on moderator and observer participant perspectives identify the need for more evidence-informed training materials for their roles that focus on web-based interpersonal communication skills, execution of user testing protocols, troubleshooting technology and test user issues, proficiency in web conferencing platforms, behavior analysis and feedback technologies, and time management. UR - https://formative.jmir.org/2022/8/e35319 UR - http://dx.doi.org/10.2196/35319 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921138 ID - info:doi/10.2196/35319 ER - TY - JOUR AU - Srikesavan, Cynthia AU - Davey, Zoe AU - Cipriani, Andrea AU - Henshall, Catherine PY - 2022/8/3 TI - Resilience Enhancement Online Training for Nurses (REsOluTioN): Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e37015 VL - 11 IS - 8 KW - online training KW - nurses KW - resilience KW - mental well-being KW - pilot trial KW - COVID-19 KW - nursing KW - mental health KW - health care staff KW - psychological health KW - online health KW - resilience training KW - health care setting N2 - Background: Globally, nurses are facing increased pressure to provide high-quality complex patient care within environments with scarce resources in terms of staffing, infrastructure, or financial reward. The strain and demand on the psychological health and well-being of nurses during COVID-19 has been substantial, with many experiencing burnout; as such, interventions to enhance resilience within the workplace are required. A face-to-face resilience enhancement training program for nurses that was effective in improving resilience levels was translated into a 4-week online training program, Resilience Enhancement Online Training for Nurses (REsOluTioN), to enable greater accessibility for nurses. Objective: This study aims to compare levels of resilience, psychological health, and well-being in nurses before and after the online resilience training compared to a wait list control group. It will also explore participants? engagement with the trial and their acceptability of the online training. Methods: This is a two-arm, parallel, randomized controlled trial with a 6-week follow-up period. Up to 100 registered nonagency nurses working at a National Health Service hospital trust in South England will be recruited. Four cohorts will run, and participants will be randomized into a wait list control group or to REsOluTioN. Pre- and postonline surveys will collect study outcome measure data. In the REsOluTioN arm, data will be collected on the perceived usefulness of the online training via an online survey. Institutional and health research authority approvals have been obtained. Results: REsOluTioN will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training will be interactive with input from mentors, health care leaders, and peers to promote engagement and enhanced communication, and will create a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them. This can increase self-knowledge and learning around workplace resilience coping strategies and provide a safe space to validate feelings through mentorship and peer support. Findings will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial is now finished and was conducted between August 2021 and May 2022. Conclusions: The REsOluTioN trial will enable preliminary data to be gathered to indicate the online training?s effectiveness in enhancing nurses? resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): DERR1-10.2196/37015 UR - https://www.researchprotocols.org/2022/8/e37015 UR - http://dx.doi.org/10.2196/37015 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862692 ID - info:doi/10.2196/37015 ER - TY - JOUR AU - Kiesewetter, Jan AU - Hege, Inga AU - Sailer, Michael AU - Bauer, Elisabeth AU - Schulz, Claudia AU - Platz, Manfred AU - Adler, Martin PY - 2022/7/28 TI - Implementing Remote Collaboration in a Virtual Patient Platform: Usability Study JO - JMIR Med Educ SP - e24306 VL - 8 IS - 3 KW - collaborative learning KW - clinical reasoning KW - webRTC KW - collaboration KW - collaborative KW - decision making N2 - Background: Learning with virtual patients is highly popular for fostering clinical reasoning in medical education. However, little learning with virtual patients is done collaboratively, despite the potential learning benefits of collaborative versus individual learning. Objective: This paper describes the implementation of student collaboration in a virtual patient platform. Our aim was to allow pairs of students to communicate remotely with each other during virtual patient learning sessions. We hypothesized that we could provide a collaborative tool that did not impair the usability of the system compared to individual learning and that this would lead to better diagnostic accuracy for the pairs of students. Methods: Implementing the collaboration tool had five steps: (1) searching for a suitable software library, (2) implementing the application programming interface, (3) performing technical adaptations to ensure high-quality connections for the users, (4) designing and developing the user interface, and (5) testing the usability of the tool in 270 virtual patient sessions. We compared dyad to individual diagnostic accuracy and usability with the 10-item System Usability Scale. Results: We recruited 137 students who worked on 6 virtual patients. Out of 270 virtual patient sessions per group (45 dyads times 6 virtual patients, and 47 students working individually times 6 virtual patients minus 2 randomly selected deleted sessions) the students made successful diagnoses in 143/270 sessions (53%, SD 26%) when working alone and 192/270 sessions (71%, SD 20%) when collaborating (P=.04, ?2=0.12). A usability questionnaire given to the students who used the collaboration tool showed a usability score of 82.16 (SD 1.31), representing a B+ grade. Conclusions: The collaboration tool provides a generic approach for collaboration that can be used with most virtual patient systems. The collaboration tool helped students diagnose virtual patients and had good overall usability. More broadly, the collaboration tool will provide an array of new possibilities for researchers and medical educators alike to design courses for collaborative learning with virtual patients. UR - https://mededu.jmir.org/2022/3/e24306 UR - http://dx.doi.org/10.2196/24306 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900827 ID - info:doi/10.2196/24306 ER - TY - JOUR AU - Heo, Sejin AU - Moon, Suhyeon AU - Kim, Minha AU - Park, Minsu AU - Cha, Chul Won AU - Son, Hi Meong PY - 2022/7/22 TI - An Augmented Reality?Based Guide for Mechanical Ventilator Setup: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e38433 VL - 10 IS - 3 KW - augmented reality KW - mechanical ventilation education KW - medical education KW - critical care KW - medical training KW - virtual reality KW - virtual education KW - nurse KW - nursing education KW - nursing KW - health care professional KW - learning platform KW - digital learning KW - digital health N2 - Background: Recently, the demand for mechanical ventilation (MV) has increased with the COVID-19 pandemic; however, the conventional approaches to MV training are resource intensive and require on-site training. Consequently, the need for independent learning platforms with remote assistance in institutions without resources has surged. Objective: This study aimed to determine the feasibility and effectiveness of an augmented reality (AR)?based self-learning platform for novices to set up a ventilator without on-site assistance. Methods: This prospective randomized controlled pilot study was conducted at Samsung Medical Center, Korea, from January to February 2022. Nurses with no prior experience of MV or AR were enrolled. We randomized the participants into 2 groups: manual and AR groups. Participants in the manual group used a printed manual and made a phone call for assistance, whereas participants in the AR group were guided by AR-based instructions and requested assistance with the head-mounted display. We compared the overall score of the procedure, required level of assistance, and user experience between the groups. Results: In total, 30 participants completed the entire procedure with or without remote assistance. Fewer participants requested assistance in the AR group compared to the manual group (7/15, 47.7% vs 14/15, 93.3%; P=.02). The number of steps that required assistance was also lower in the AR group compared to the manual group (n=13 vs n=33; P=.004). The AR group had a higher rating in predeveloped questions for confidence (median 3, IQR 2.50-4.00 vs median 2, IQR 2.00-3.00; P=.01), suitability of method (median 4, IQR 4.00-5.00 vs median 3, IQR 3.00-3.50; P=.01), and whether they intended to recommend AR systems to others (median 4, IQR 3.00-5.00 vs median 3, IQR 2.00-3.00; P=.002). Conclusions: AR-based instructions to set up a mechanical ventilator were feasible for novices who had no prior experience with MV or AR. Additionally, participants in the AR group required less assistance compared with those in the manual group, resulting in higher confidence after training. Trial Registration: ClinicalTrials.gov NCT05446896; https://beta.clinicaltrials.gov/study/NCT05446896 UR - https://games.jmir.org/2022/3/e38433 UR - http://dx.doi.org/10.2196/38433 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867382 ID - info:doi/10.2196/38433 ER - TY - JOUR AU - Wong, Yuen-Ha Janet AU - Ko, Joanna AU - Nam, Sujin AU - Kwok, Tyrone AU - Lam, Sheila AU - Cheuk, Jessica AU - Chan, Maggie AU - Lam, Veronica AU - Wong, C. Gordon T. AU - Ng, H. Zoe L. AU - Wai, Ka-Chung Abraham PY - 2022/7/14 TI - Virtual ER, a Serious Game for Interprofessional Education to Enhance Teamwork in Medical and Nursing Undergraduates: Development and Evaluation Study JO - JMIR Serious Games SP - e35269 VL - 10 IS - 3 KW - game KW - interprofessional education KW - teamwork KW - learning style KW - emergency medicine KW - emergency nursing N2 - Background: Engaging students in interprofessional education for higher order thinking and collaborative problem-solving skills is challenging. This study reports the development of Virtual ER, a serious game played on a virtual platform, and how it can be an innovative way for delivering interprofessional education to medical and nursing undergraduates. Objective: We report the development of a serious online game, Virtual ER, and evaluate its effect on teamwork enhancement and clinical competence. We also explore if Virtual ER can be an effective pedagogical tool to engage medical and nursing students with different learning styles. Methods: Virtual ER is a custom-made, learning outcome?driven, case-based web app. We developed a game performance scoring system with specific mechanisms to enhance serious gaming elements. Sixty-two students were recruited from our medical and nursing programs. They played the games in teams of 4 or 5, followed by an instructor-led debriefing for concept consolidation. Teamwork attitudes, as measured by the Human Factors Attitude Survey, were compared before and after the game. Learning style was measured with a modified Honey and Mumford learning style questionnaire. Results: Students were satisfied with Virtual ER (mean satisfaction score 5.44, SD 0.95, of a possible 7). Overall, Virtual ER enhanced teamwork attitude by 3.02 points (95% CI 1.15-4.88, P=.002). Students with higher scores as activists (estimate 9.09, 95% CI 5.17-13.02, P<.001) and pragmatists (estimate 5.69, 95% CI 1.18-10.20, P=.01) had a significantly higher degree of teamwork attitude enhancement, while students with higher scores as theorists and reflectors did not demonstrate significant changes. However, there was no difference in game performance scores between students with different learning styles. Conclusions: There was considerable teamwork enhancement after playing Virtual ER for interprofessional education, in particular for students who had activist or pragmatist learning styles. Serious online games have potential in interprofessional education for the development of 21st century life skills. Our findings also suggest that Virtual ER for interprofessional education delivery could be expanded locally and globally. UR - https://games.jmir.org/2022/3/e35269 UR - http://dx.doi.org/10.2196/35269 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834309 ID - info:doi/10.2196/35269 ER - TY - JOUR AU - Lie, Stangeland Silje AU - Helle, Nikolina AU - Sletteland, Vahl Nina AU - Vikman, Dubland Miriam AU - Bonsaksen, Tore PY - 2022/7/5 TI - Implementation of Virtual Reality in Health Professional Higher Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e37222 VL - 11 IS - 7 KW - virtual reality KW - higher education KW - medical education KW - health care professional education KW - continuing education KW - implementation KW - technology KW - scoping review KW - Google Scholar KW - health professional N2 - Background: The use of virtual reality in higher education show great potential to promote novel and innovative learning experiences. Until recently, virtual reality has mostly been used in technical higher education, but lately medical education programs have begun using virtual reality. Virtual reality for health professional education improves the knowledge and skills of health professionals compared with traditional or other digital education initiatives. However, the implementation of technology in higher education is slow because of barriers to technology use and innovative and successful practices are not shared. It is, therefore, of great interest to explore how virtual reality is implemented in higher health professional and continuing education. Objective: The aim of this scoping review is to identify studies that reported implementation of virtual reality in higher health professional education, to identify barriers and facilitators for implementation, and to highlight research gaps in this area. Methods: The scoping review will be conducted according to JBI Evidence Synthesis methodologies. CINAHL, the Academic Search Elite and Education Source electronic databases, and Google Scholar will be searched for studies published between 2017 and 2022. In addition, manual searching of key items, reference tracking, and citation tracking will be performed. Searches for white papers will also be manually conducted. All authors will independently extract data from full-text papers. We will use qualitative content analysis to abstract the findings. Results: The literature searches were conducted in January and February 2022. The review is expected to be completed by fall 2022, after which time it will be submitted for publication. Conclusions: We anticipate that, from the review, we will be able to coordinate recommendations for and present the challenges of virtual reality initiatives in health professional education programs. We will present recommendations for future research. International Registered Report Identifier (IRRID): DERR1-10.2196/37222 UR - https://www.researchprotocols.org/2022/7/e37222 UR - http://dx.doi.org/10.2196/37222 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787531 ID - info:doi/10.2196/37222 ER - TY - JOUR AU - Aggarwal, Anuj AU - Hess, Olivia AU - Lockman, L. Justin AU - Smith, Lauren AU - Stevens, Mitchell AU - Bruce, Janine AU - Caruso, Thomas PY - 2022/6/30 TI - Anesthesiologists With Advanced Degrees in Education: Qualitative Study of a Changing Paradigm JO - JMIR Med Educ SP - e38050 VL - 8 IS - 2 KW - academic medical centers KW - trends KW - medical education KW - medical KW - faculty KW - anesthesiologists KW - medical professionals KW - learning KW - institute KW - clinician KW - educator KW - experience KW - decision-making KW - training N2 - Background: Anesthesiology education has undergone profound changes over the past century, from a pure clinical apprenticeship to novel comprehensive curricula based on andragogic learning theories. Combined with institutional and regulatory requirements, these new curricula have propagated professionalization of the clinician-educator role. A significant number of clinician-educator anesthesiologists, often with support from department chairs, pursue formal health professions education (HPE) training, yet there are no published data demonstrating the benefits or costs of these degrees to educational leaders. Objective: This study aims to collect the experiences of anesthesiologists who have pursued HPE degrees to understand the advantages and costs of HPE degrees to anesthesiologists. Methods: Investigators performed a qualitative study of anesthesiologists with HPE degrees working at academic medical centers. Interviews were thematically analyzed via an iterative process. They were coded using a team-based approach, and representative themes and exemplary quotations were identified. Results: Seven anesthesiologists were interviewed, representing diverse geographic regions, subspecialties, and medical institutions. Analyses of interview transcripts resulted in the following 6 core themes: outcomes, extrinsic motivators, intrinsic motivators, investment, experience, and recommendations. The interviewees noted the advantages of HPE training for those wishing to pursue leadership or scholarship in medical education; however, they also noted the costs and investment of time in addition to preexisting commitments. The interviewees also highlighted the issues faculty and chairs might consider for the optimal timing of HPE training. Conclusions: There are numerous professional and personal benefits to pursuing HPE degrees for faculty interested in education leadership or scholarship. Making an informed decision to pursue HPE training can be challenging when considering the competing pressures of clinical work and personal obligations. The experiences of the interviewed anesthesiologists offer direction to future anesthesiologists and chairs in their decision-making process of whether and when to pursue HPE training. UR - https://mededu.jmir.org/2022/2/e38050 UR - http://dx.doi.org/10.2196/38050 UR - http://www.ncbi.nlm.nih.gov/pubmed/35771619 ID - info:doi/10.2196/38050 ER - TY - JOUR AU - Kiyozumi, Tetsuro AU - Ishigami, Norio AU - Tatsushima, Daisuke AU - Araki, Yoshiyuki AU - Yoshimura, Yuya AU - Saitoh, Daizoh PY - 2022/6/29 TI - Instructor Development Workshops for Advanced Life Support Training Courses Held in a Fully Virtual Space: Observational Study JO - JMIR Serious Games SP - e38952 VL - 10 IS - 2 KW - virtual reality KW - virtual space KW - instructor development workshop KW - resuscitation training course KW - advanced life support KW - resuscitation training KW - digital training KW - virtual learning KW - digital education KW - medical education N2 - Background: Various face-to-face training opportunities have been lost due to the COVID-19 pandemic. Instructor development workshops for advanced resuscitation (ie, advanced life support) training courses are no exception. Virtual reality (VR) is an attractive strategy for remote training. However, to our knowledge, there are no reports of resuscitation instructor training programs being held in a virtual space. Objective: This study aimed to investigate the learning effects of an instructor development workshop that was conducted in a virtual space. Methods: In this observational study, we created a virtual workshop space by using NEUTRANS (Synamon Inc)?a commercial VR collaboration service. The instructor development workshop for the advanced life support training course was held in a virtual space (ie, termed the VR course) as a certified workshop by the Japanese Association of Acute Medicine. We asked 13 instructor candidates (students) who participated in the VR course to provide a workshop report (VR group). Reports from a previously held face-to-face workshop (ie, the face-to-face course and group) were likewise prepared for comparison. A total of 5 certified instructor trainers viewed and scored the reports on a 5-point Likert scale. Results: All students completed the VR course without any problems and received certificates of completion. The scores for the VR group and the face-to-face group did not differ at the level of statistical significance (median 3.8, IQR 3.8-4.0 and median 4.2, IQR 3.9-4.2, respectively; P=.41). Conclusions: We successfully conducted an instructor development workshop in a virtual space. The degree of learning in the virtual workshop was the same as that in the face-to-face workshop. UR - https://games.jmir.org/2022/2/e38952 UR - http://dx.doi.org/10.2196/38952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767318 ID - info:doi/10.2196/38952 ER - TY - JOUR AU - Johnson, Grødem Susanne AU - Potrebny, Thomas AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2022/6/29 TI - Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Scoping Review JO - JMIR Med Educ SP - e38259 VL - 8 IS - 2 KW - user-computer interface KW - mobile apps KW - online learning KW - health education KW - students N2 - Background: Mobile devices can provide extendable learning environments in higher education and motivate students to engage in adaptive and collaborative learning. Developers must design mobile apps that are practical, effective, and easy to use, and usability testing is essential for understanding how mobile apps meet users? needs. No previous reviews have investigated the usability of mobile apps developed for health care education. Objective: The aim of this scoping review is to identify usability methods and attributes in usability studies of mobile apps for health care education. Methods: A comprehensive search was carried out in 10 databases, reference lists, and gray literature. Studies were included if they dealt with health care students and usability of mobile apps for learning. Frequencies and percentages were used to present the nominal data, together with tables and graphical illustrations. Examples include a figure of the study selection process, an illustration of the frequency of inquiry usability evaluation and data collection methods, and an overview of the distribution of the identified usability attributes. We followed the Arksey and O?Malley framework for scoping reviews. Results: Our scoping review collated 88 articles involving 98 studies, mainly related to medical and nursing students. The studies were conducted from 22 countries and were published between 2008 and 2021. Field testing was the main usability experiment used, and the usability evaluation methods were either inquiry-based or based on user testing. Inquiry methods were predominantly used: 1-group design (46/98, 47%), control group design (12/98, 12%), randomized controlled trials (12/98, 12%), mixed methods (12/98, 12%), and qualitative methods (11/98, 11%). User testing methods applied were all think aloud (5/98, 5%). A total of 17 usability attributes were identified; of these, satisfaction, usefulness, ease of use, learning performance, and learnability were reported most frequently. The most frequently used data collection method was questionnaires (83/98, 85%), but only 19% (19/98) of studies used a psychometrically tested usability questionnaire. Other data collection methods included focus group interviews, knowledge and task performance testing, and user data collected from apps, interviews, written qualitative reflections, and observations. Most of the included studies used more than one data collection method. Conclusions: Experimental designs were the most commonly used methods for evaluating usability, and most studies used field testing. Questionnaires were frequently used for data collection, although few studies used psychometrically tested questionnaires. The usability attributes identified most often were satisfaction, usefulness, and ease of use. The results indicate that combining different usability evaluation methods, incorporating both subjective and objective usability measures, and specifying which usability attributes to test seem advantageous. The results can support the planning and conduct of future usability studies for the advancement of mobile learning apps in health care education. International Registered Report Identifier (IRRID): RR2-10.2196/19072 UR - https://mededu.jmir.org/2022/2/e38259 UR - http://dx.doi.org/10.2196/38259 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767323 ID - info:doi/10.2196/38259 ER - TY - JOUR AU - Gosselin Boucher, Vincent AU - Bacon, Simon AU - Voisard, Brigitte AU - Dragomir, I. Anda AU - Gemme, Claudia AU - Larue, Florent AU - Labbé, Sara AU - Szczepanik, Geneviève AU - Corace, Kimberly AU - Campbell, Tavis AU - Vallis, Michael AU - Garber, Gary AU - Rouleau, Codie AU - Diodati, G. Jean AU - Rabi, Doreen AU - Sultan, Serge AU - Lavoie, Kim AU - PY - 2022/6/24 TI - Assessing Physician?s Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test JO - JMIR Med Educ SP - e31489 VL - 8 IS - 2 KW - assessment KW - motivational communication KW - tool development KW - physicians KW - health promotion N2 - Background: Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. Objective: The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC?the Motivational Communication Competency Assessment Test (MC-CAT). Methods: Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. Results: The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (?=.78). Conclusions: The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases. UR - https://mededu.jmir.org/2022/2/e31489 UR - http://dx.doi.org/10.2196/31489 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749167 ID - info:doi/10.2196/31489 ER - TY - JOUR AU - Button, Brenton AU - Cook, Clare AU - Goertzen, James AU - Cameron, Erin PY - 2022/6/13 TI - A Novel, Combined Student and Preceptor Professional Development Session for Optimizing Feedback: Protocol for a Multimethod, Multisite, and Multiyear Intervention JO - JMIR Res Protoc SP - e32829 VL - 11 IS - 6 KW - feedback KW - professional development KW - undergraduate KW - medical education KW - intervention KW - preceptors KW - students KW - medical students KW - longitudinal integrated clerkship N2 - Background: Providing feedback to medical learners is a critical educational activity. Despite the recognition of its importance, most research has focused on training preceptors to give feedback, which neglects the role of learners in receiving feedback. Delivering a combined professional development session for both preceptors and students may facilitate more effective feedback communication and improve both the quality and quantity of feedback. Objective: The objective of our research project is to examine the impact of a relational feedback intervention on both preceptors and students during a longitudinal integrated clerkship. Methods: Students and preceptors will attend a 2.5-hour combined professional development session, wherein they will be provided with educational tools for giving and receiving feedback within a coaching relationship and practice feedback giving and receiving skills together. Before the combined professional development session, students will be asked to participate in a 1-hour preparation session that will provide an orientation on their role in receiving feedback and their participation in the combined professional development session. Students and preceptors will be asked to complete a precombined professional development session survey and an immediate postcombined professional development session survey. Preceptors will be asked to complete a follow-up assessment survey, and students will be asked to participate in a follow-up, student-only focus group. Anonymized clinical faculty teaching evaluations and longitudinal integrated clerkship program evaluations will also be used to assess the impact of the intervention. Results: As of March 1, 2022, a total of 66 preceptors and 29 students have completed the baseline and follow-up measures. Data collection is expected to conclude in December 2023. Conclusions: Our study is designed to contribute to the literature on the feedback process between preceptors and students within a clinical setting. Including both the preceptors and the students in the same session will improve on the work that has already been conducted in this area, as the students and preceptors can further develop their relationships and coconstruct feedback conversations. We will use social learning theory to interpret the results of our study, which will help us explain the results and potentially make the work generalizable to other fields. International Registered Report Identifier (IRRID): DERR1-10.2196/32829 UR - https://www.researchprotocols.org/2022/6/e32829 UR - http://dx.doi.org/10.2196/32829 UR - http://www.ncbi.nlm.nih.gov/pubmed/35583554 ID - info:doi/10.2196/32829 ER - TY - JOUR AU - Guillaume, Dominique AU - Troncoso, Erica AU - Duroseau, Brenice AU - Bluestone, Julia AU - Fullerton, Judith PY - 2022/6/7 TI - Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review JO - JMIR Med Educ SP - e32614 VL - 8 IS - 2 KW - digital learning KW - continuing medical education KW - mHealth KW - peer learning KW - mentorship KW - health systems KW - global health KW - mobile phone N2 - Background: Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. Objective: The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. Methods: A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. Results: A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. Conclusions: The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital. UR - https://mededu.jmir.org/2022/2/e32614 UR - http://dx.doi.org/10.2196/32614 UR - http://www.ncbi.nlm.nih.gov/pubmed/35671080 ID - info:doi/10.2196/32614 ER - TY - JOUR AU - Bergeron, Lysa AU - Décary, Simon AU - Djade, Djignefa Codjo AU - Daniel, J. Sam AU - Tremblay, Martin AU - Rivest, Louis-Paul AU - Légaré, France PY - 2022/6/2 TI - Factors Associated With Specialists? Intention to Adopt New Behaviors After Taking Web-Based Continuing Professional Development Courses: Cross-sectional Study JO - JMIR Med Educ SP - e34299 VL - 8 IS - 2 KW - continuing professional development KW - CPD-Reaction KW - behavioral intention KW - medical specialists KW - web-based training KW - medical education KW - education KW - physician KW - psychosocial KW - online course N2 - Background: Web-based continuing professional development (CPD) is a convenient and low-cost way for physicians to update their knowledge. However, little is known about the factors that influence their intention to put this new knowledge into practice. Objective: We aimed to identify sociocognitive factors associated with physicians? intention to adopt new behaviors as well as indications of Bloom?s learning levels following their participation in 5 web-based CPD courses. Methods: We performed a cross-sectional study of specialist physicians who had completed 1 of 5 web-based CPD courses offered by the Federation of Medical Specialists of Quebec. The participants then completed CPD-Reaction, a questionnaire based on Godin?s integrated model for health professional behavior change and with evidence of validity that measures behavioral intention (dependent variable) and psychosocial factors influencing intention (n=4). We also assessed variables related to sociodemographics (n=5), course content (n=9), and course format (eg, graphic features and duration) (n=8). Content variables were derived from CanMEDS competencies, Bloom?s learning levels, and Godin?s integrated model. We conducted ANOVA single-factor analysis, calculated the intraclass correlation coefficient (ICC), and performed bivariate and multivariate analyses. Results: A total of 400 physicians participated in the courses (range: 38-135 physicians per course). Average age was 50 (SD 12) years; 56% (n=223) were female, and 44% (n=177) were male. Among the 259 who completed CPD-Reaction, behavioral intention scores ranged from 5.37 (SD 1.17) to 6.60 (SD 0.88) out of 7 and differed significantly from one course to another (P<.001). The ICC indicated that 17% of the total variation in the outcome of interest, the behavioral intention of physicians, could be explained at the level of the CPD course (ICC=0.17). In bivariate analyses, social influences (P<.001), beliefs about capabilities (P<.001), moral norm (P<.001), beliefs about consequences (P<.001), and psychomotor learning (P=.04) were significantly correlated with physicians? intention to adopt new behaviors. Multivariate analysis showed the same factors, except for social influences and psychomotor learning, as significantly correlated with intention. Conclusions: We observed average to high behavioral intention scores after all 5 web-based courses, with some variations by course taken. Factors affecting physicians? intention were beliefs about their capabilities and about the consequences of adopting new clinical behaviors, as well as doubts about whether the new behavior aligned with their moral values. Our results will inform design of future web-based CPD courses to ensure they contribute to clinical behavior change. UR - https://mededu.jmir.org/2022/2/e34299 UR - http://dx.doi.org/10.2196/34299 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476039 ID - info:doi/10.2196/34299 ER - TY - JOUR AU - Brijnath, Bianca AU - Baruah, Upasana AU - Antoniades, Josefine AU - Varghese, Mathew AU - Cooper, Claudia AU - Dow, Briony AU - Kent, Mike AU - Loganathan, Santosh PY - 2022/6/2 TI - Using Digital Media to Improve Dementia Care in India: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e38456 VL - 11 IS - 6 KW - dementia KW - care KW - India KW - digital health KW - film N2 - Background: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. Objective: The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. Methods: This study employs a mixed methods design and is divided into 4 phases: (1) video interviews with Indian caregivers and health professionals; (2) coproduction of resources; (3) pilot randomized controlled trial (RCT); and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. Results: This study received funding from the Alzheimer?s Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India (proposal ID 2020-10137); the Curtin University Human Research Ethics Committee (approval number HRE2020-0735); and the NARI Research Governance Office (site-specific approval dated March 17, 2021). Conclusions: This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Trial Registration: Clinical Trials Registry-India CTRI/2021/01/030403; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=50794 International Registered Report Identifier (IRRID): DERR1-10.2196/38456 UR - https://www.researchprotocols.org/2022/6/e38456 UR - http://dx.doi.org/10.2196/38456 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653168 ID - info:doi/10.2196/38456 ER - TY - JOUR AU - Chidambaram, Swathi AU - Palumbo, Chiara Maria AU - Stifano, Vito AU - McKenna, John AU - Redaelli, Alberto AU - Olivi, Alessandro AU - Apuzzo, Michael AU - Pannullo, Susan PY - 2022/6/1 TI - The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study JO - JMIR Neurotech SP - e36960 VL - 1 IS - 1 KW - mixed reality KW - augmented reality KW - extended reality KW - HoloLens KW - interdisciplinary teams KW - virtual reality KW - brain tumour KW - tumor KW - radiosurgery KW - surgery N2 - Background: Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement. Objective: We describe a novel visualization application, titled ?NeuroVis? by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient?s neuroanatomy in stereotactic surgery (SRS) case planning discussions. Methods: We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs. Results: The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs. Conclusions: The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care. UR - https://neuro.jmir.org/2022/1/e36960 UR - http://dx.doi.org/10.2196/36960 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/36960 ER - TY - JOUR AU - Røynesdal, Øystein AU - Magnus, H. Jeanette AU - Moen, Anne PY - 2022/5/30 TI - Pedagogical Approaches and Learning Activities, Content, and Resources Used in the Design of Massive Open Online Courses (MOOCs) in the Health Sciences: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e35878 VL - 11 IS - 5 KW - MOOC KW - scoping review KW - collaborative learning KW - PhD KW - postgraduate KW - education KW - health sciences KW - massive open online course N2 - Background: Developing online, widely accessible educational courses, such as Massive Open Online Courses (MOOCs), offer novel opportunities to advancing academic research and the educational system in resource-constrained countries. Despite much literature on the use of design-related features and principles of different pedagogical approaches when developing MOOCs, there are reports of inconsistency between the pedagogical approach and the learning activities, content, or resources in MOOCs. Objective: We present a protocol for a scoping review aiming to systematically identify and synthesize literature on the pedagogical approaches used, and the learning activities, content, and resources used to facilitate social interaction and collaboration among postgraduate learners in MOOCs across the health sciences. Methods: We will follow a 6-step procedure for scoping reviews to conduct a search of published and gray literature in the following databases: Medline via Ovid, ERIC, SCOPUS, Web of Science, and PsychINFO. Two reviewers will screen titles, abstracts, and relevant full texts independently to determine eligibility for inclusion. The team will extract data using a predefined charting form and synthesize results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Results: The scoping review is currently ongoing. As of March 2022, we have performed initial data searches and screened titles and abstracts of the studies we found but revised the search string owing to inaccurate results. We aim to start analyzing the data in June 2022 and expect to complete the scoping review by February 2023. Conclusions: With the results of this review, we hope to report on the use of pedagogical approaches and what learning activities, content, and resources foster social and collaborative learning processes, and to further elucidate how practitioners and academics can harvest our findings to bridge the gap between pedagogics and learning activities in the instructional design of MOOCs for postgraduate students in the health sciences. International Registered Report Identifier (IRRID): DERR1-10.2196/35878 UR - https://www.researchprotocols.org/2022/5/e35878 UR - http://dx.doi.org/10.2196/35878 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635750 ID - info:doi/10.2196/35878 ER - TY - JOUR AU - Yilmaz, Yusuf AU - Jurado Nunez, Alma AU - Ariaeinejad, Ali AU - Lee, Mark AU - Sherbino, Jonathan AU - Chan, M. Teresa PY - 2022/5/27 TI - Harnessing Natural Language Processing to Support Decisions Around Workplace-Based Assessment: Machine Learning Study of Competency-Based Medical Education JO - JMIR Med Educ SP - e30537 VL - 8 IS - 2 KW - natural language processing KW - machine learning algorithms KW - competency-based medical education KW - assessment KW - medical education KW - medical residents KW - machine learning KW - work performance KW - prediction models N2 - Background: Residents receive a numeric performance rating (eg, 1-7 scoring scale) along with a narrative (ie, qualitative) feedback based on their performance in each workplace-based assessment (WBA). Aggregated qualitative data from WBA can be overwhelming to process and fairly adjudicate as part of a global decision about learner competence. Current approaches with qualitative data require a human rater to maintain attention and appropriately weigh various data inputs within the constraints of working memory before rendering a global judgment of performance. Objective: This study explores natural language processing (NLP) and machine learning (ML) applications for identifying trainees at risk using a large WBA narrative comment data set associated with numerical ratings. Methods: NLP was performed retrospectively on a complete data set of narrative comments (ie, text-based feedback to residents based on their performance on a task) derived from WBAs completed by faculty members from multiple hospitals associated with a single, large, residency program at McMaster University, Canada. Narrative comments were vectorized to quantitative ratings using the bag-of-n-grams technique with 3 input types: unigram, bigrams, and trigrams. Supervised ML models using linear regression were trained with the quantitative ratings, performed binary classification, and output a prediction of whether a resident fell into the category of at risk or not at risk. Sensitivity, specificity, and accuracy metrics are reported. Results: The database comprised 7199 unique direct observation assessments, containing both narrative comments and a rating between 3 and 7 in imbalanced distribution (scores 3-5: 726 ratings; and scores 6-7: 4871 ratings). A total of 141 unique raters from 5 different hospitals and 45 unique residents participated over the course of 5 academic years. When comparing the 3 different input types for diagnosing if a trainee would be rated low (ie, 1-5) or high (ie, 6 or 7), our accuracy for trigrams was 87%, bigrams 86%, and unigrams 82%. We also found that all 3 input types had better prediction accuracy when using a bimodal cut (eg, lower or higher) compared with predicting performance along the full 7-point rating scale (50%-52%). Conclusions: The ML models can accurately identify underperforming residents via narrative comments provided for WBAs. The words generated in WBAs can be a worthy data set to augment human decisions for educators tasked with processing large volumes of narrative assessments. UR - https://mededu.jmir.org/2022/2/e30537 UR - http://dx.doi.org/10.2196/30537 UR - http://www.ncbi.nlm.nih.gov/pubmed/35622398 ID - info:doi/10.2196/30537 ER - TY - JOUR AU - Shah, Savan PY - 2022/5/26 TI - Evaluation of Online Near-Peer Teaching for Penultimate-Year Objective Structured Clinical Examinations in the COVID-19 Era: Longitudinal Study JO - JMIR Med Educ SP - e37872 VL - 8 IS - 2 KW - near-peer teaching KW - peer-assisted learning KW - Objective Structured Clinical Examination KW - OSCE KW - online teaching KW - COVID-19 KW - medical education KW - learning KW - medical school KW - near-peer teacher KW - NPT KW - near-peer learner KW - NPL N2 - Background: The benefits of near-peer learning are well established in several aspects of undergraduate medical education including preparing students for Objective Structured Clinical Examinations (OSCEs). The COVID-19 pandemic has resulted in a paradigm shift to predominantly online teaching. Objective: This study aims to demonstrate the feasibility and benefits of an exclusively online near-peer OSCE teaching program in a time of significant face-to-face and senior-led teaching shortage. Methods: A teaching program was delivered to penultimate-year students by final-year students at Manchester Medical School. Program development involved compiling a list of salient topics and seeking senior faculty approval. Teachers and students were recruited on Facebook. In total, 22 sessions and 42 talks were attended by 72 students and taught by 13 teachers over a 3-month period. Data collection involved anonymous weekly questionnaires and 2 separate anonymous student and teacher postcourse questionnaires including both quantitative and qualitative components. Results: On a scale of 1-10, students rated the quality of the program highly (mean 9.30, SD 1.15) and felt the sessions were highly useful in guiding their revision (mean 8.95, SD 0.94). There was a significant increase in perceived confidence ratings after delivery of the program (P<.001). Teachers felt the program helped them better understand and retain the subject material taught (mean 9.36, SD 0.81) and develop skills to become effective clinical teachers (mean 9.27, SD 0.79). Conclusions: This is the first study demonstrating the efficacy of a near-peer OSCE teaching program delivered exclusively online. This provides an exemplary framework for how similar programs should be encouraged given their efficacy and logistical viability in supplementing the undergraduate curriculum. UR - https://mededu.jmir.org/2022/2/e37872 UR - http://dx.doi.org/10.2196/37872 UR - http://www.ncbi.nlm.nih.gov/pubmed/35617013 ID - info:doi/10.2196/37872 ER - TY - JOUR AU - Taramarcaz, Victor AU - Herren, Tara AU - Golay, Eric AU - Regard, Simon AU - Martin-Achard, Sébastien AU - Mach, Francois AU - Schnetzler, Nicolas AU - Ricci, Gaëtan AU - Zamberg, Ido AU - Larribau, Robert AU - Niquille, Marc AU - Suppan, Mélanie AU - Schiffer, Eduardo AU - Suppan, Laurent PY - 2022/5/18 TI - A Short Intervention and an Interactive e-Learning Module to Motivate Medical and Dental Students to Enlist as First Responders: Implementation Study JO - J Med Internet Res SP - e38508 VL - 24 IS - 5 KW - basic life support KW - cardiopulmonary resuscitation KW - first responder KW - undergraduate medical education KW - out-of-hospital cardiac arrest KW - medical education KW - e-learning KW - digital education KW - medical student KW - blended learning N2 - Background: Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students. Objective: Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders. Methods: A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders. Results: Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9%) initially agreed to participate. Moreover, 102 (19.3%) attended the practice sessions, and 48 (9.1%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56). Conclusions: This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders. International Registered Report Identifier (IRRID): RR2-10.2196/24664 UR - https://www.jmir.org/2022/5/e38508 UR - http://dx.doi.org/10.2196/38508 UR - http://www.ncbi.nlm.nih.gov/pubmed/35583927 ID - info:doi/10.2196/38508 ER - TY - JOUR AU - Sivananthan, Arun AU - Gueroult, Aurelien AU - Zijlstra, Geiske AU - Martin, Guy AU - Baheerathan, Aravindhan AU - Pratt, Philip AU - Darzi, Ara AU - Patel, Nisha AU - Kinross, James PY - 2022/5/17 TI - Using Mixed Reality Headsets to Deliver Remote Bedside Teaching During the COVID-19 Pandemic: Feasibility Trial of HoloLens 2 JO - JMIR Form Res SP - e35674 VL - 6 IS - 5 KW - mixed reality KW - remote learning KW - HoloLens KW - bedside teaching KW - COVID-19 KW - personal protective equipment KW - digital education KW - medical education KW - e-learning KW - protection KW - feasibility KW - medical student KW - virtual reality N2 - Background: COVID-19 has had a catastrophic impact in terms of human lives lost. Medical education has also been impacted as appropriately stringent infection control policies precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. Objective: This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching. Methods: Two MR sessions were led by senior doctors wearing the HoloLens headset. The trainers selected patients requiring their specialist input. The headset allowed bidirectional audiovisual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of the COVID-19 pandemic on bedside teaching, and the MR sessions were evaluated using pre- and postround questionnaires, using Likert scales. Data related to clinician exposure to at-risk patients and use of personal protective equipment (PPE) were collected. Results: Prequestionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (median 7, IQR 6-7). Postsession questionnaires showed that, overall, users subjectively agreed the MR session was helpful to their learning (median 6, IQR 5.25-7) and that it was worthwhile (median 6, IQR 5.25-7). Mixed reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. Conclusions: This study is proof of principle that HoloLens can be used effectively to deliver clinical bedside teaching. This novel format confers significant advantages in terms of minimizing exposure of trainees to COVID-19, reducing PPE use, enabling larger attendance, and delivering convenient and accessible real-time clinical training. UR - https://formative.jmir.org/2022/5/e35674 UR - http://dx.doi.org/10.2196/35674 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389347 ID - info:doi/10.2196/35674 ER - TY - JOUR AU - König, Lars AU - Marbach-Breitrück, Eugenia AU - Engler, Anne AU - Suhr, Ralf PY - 2022/5/16 TI - The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study JO - J Med Internet Res SP - e37523 VL - 24 IS - 5 KW - digital education KW - digital health literacy KW - digital literacy KW - e-learning KW - health education KW - health information KW - health literacy KW - learning material KW - school KW - school-age children N2 - Background: Experts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). Objective: The goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants? health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants? subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course. Methods: The pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement). Results: To test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]?0=676,000; ?=?0.316), practical knowledge (BF?0=92,300; ?=?0.294), critical thinking (BF?0=7.42e+13; ?=?0.482), self-awareness (BF?0=11,500,000; ?=?0.345), and citizenship (BF?0=266,000; ?=?0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF?0=2.339; ?=?0.135), evaluating reliability (BF?0=2.03e+11; ?=?0.434), and determining relevance (BF?0=316,000; ?=?0.308). Moreover, participants demonstrated higher subjective (BF?0=3.58e+82; ?=?1.515) and objective knowledge (BF?0=3.82e+97; ?=?1.758) in the domain of (digital) health literacy. Conclusions: The newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). UR - https://www.jmir.org/2022/5/e37523 UR - http://dx.doi.org/10.2196/37523 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576572 ID - info:doi/10.2196/37523 ER - TY - JOUR AU - Archer, Jessica AU - Robinson, Luke AU - Brown, Ted PY - 2022/5/13 TI - The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e36448 VL - 11 IS - 5 KW - allied health KW - healthcare funding KW - interprofessional collaboration KW - integrated healthcare KW - primary health KW - primary care N2 - Background: Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding?related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic. Objective: The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels. Methods: A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures. Results: Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022. Conclusions: The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability. International Registered Report Identifier (IRRID): DERR1-10.2196/36448 UR - https://www.researchprotocols.org/2022/5/e36448 UR - http://dx.doi.org/10.2196/36448 UR - http://www.ncbi.nlm.nih.gov/pubmed/35559853 ID - info:doi/10.2196/36448 ER - TY - JOUR AU - Landis-Lewis, Zach AU - Flynn, Allen AU - Janda, Allison AU - Shah, Nirav PY - 2022/5/10 TI - A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34990 VL - 11 IS - 5 KW - learning health system KW - audit and feedback KW - anesthesiology KW - knowledge-based system KW - human-centered design N2 - Background: Health care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric?s level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A&F. From an informatics perspective, precision A&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels. Objective: This study aims to implement and evaluate a demonstration system for precision A&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium. Methods: We propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes. Results: The proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024. Conclusions: The proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective. International Registered Report Identifier (IRRID): PRR1-10.2196/34990 UR - https://www.researchprotocols.org/2022/5/e34990 UR - http://dx.doi.org/10.2196/34990 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536637 ID - info:doi/10.2196/34990 ER - TY - JOUR AU - Ajab, Shereen AU - Pearson, Emma AU - Dumont, Steven AU - Mitchell, Alicia AU - Kastelik, Jack AU - Balaji, Packianathaswamy AU - Hepburn, David PY - 2022/5/9 TI - An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study JO - JMIR Med Educ SP - e33565 VL - 8 IS - 2 KW - simulation KW - high fidelity KW - low fidelity KW - COVID-19 KW - bedside teaching KW - undergraduate medical education KW - fidelity KW - medical education KW - medical student KW - review KW - innovation KW - risk KW - design KW - implementation N2 - Background: Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students? confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods. Objective: To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19?safe environment using SimMan 3G. Methods: Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session. Results: In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature. Conclusions: Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally. UR - https://mededu.jmir.org/2022/2/e33565 UR - http://dx.doi.org/10.2196/33565 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404828 ID - info:doi/10.2196/33565 ER - TY - JOUR AU - Dunn, Sheila AU - Munro, Sarah AU - Devane, Courtney AU - Guilbert, Edith AU - Jeong, Dahn AU - Stroulia, Eleni AU - Soon, A. Judith AU - Norman, V. Wendy PY - 2022/5/5 TI - A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study JO - J Med Internet Res SP - e34302 VL - 24 IS - 5 KW - mifepristone KW - abortion KW - community of practice KW - virtual community of practice KW - diffusion of innovation KW - learning community N2 - Background: Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective: The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l?avortement (CAPS-CPCA) VCoP and explore physicians? experience with CAPS-CPCA and their views on its value in supporting implementation. Methods: This was a mixed methods intrinsic case study of Canadian health care providers? use and physicians? perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians? characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians? experiences and perceptions of the VCoP. Results: From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6%) completed a baseline survey. Of these 222 respondents, 156 (70.3%) were family physicians, 170 (80.2%) were women, and 78 (35.1%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project?s knowledge translation activities with policy makers to mitigate these barriers. Conclusions: A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028443 UR - https://www.jmir.org/2022/5/e34302 UR - http://dx.doi.org/10.2196/34302 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511226 ID - info:doi/10.2196/34302 ER - TY - JOUR AU - Beverly, Elizabeth AU - Rigot, Brooke AU - Love, Carrie AU - Love, Matt PY - 2022/4/29 TI - Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals JO - JMIR Med Educ SP - e32657 VL - 8 IS - 2 KW - virtual reality KW - qualitative KW - medical education KW - health care KW - digital learning KW - learning platform KW - health care providers N2 - Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals? experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67%, women; n=22, 92%, White; and n=4, 17%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character?s frustrations and disappointments; perceived ease of use of cine-VR: 96% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. UR - https://mededu.jmir.org/2022/2/e32657 UR - http://dx.doi.org/10.2196/32657 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486427 ID - info:doi/10.2196/32657 ER - TY - JOUR AU - White, A. Andrew AU - King, M. Ann AU - D?Addario, E. Angelo AU - Brigham, Berg Karen AU - Dintzis, Suzanne AU - Fay, E. Emily AU - Gallagher, H. Thomas AU - Mazor, M. Kathleen PY - 2022/4/29 TI - Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory JO - JMIR Med Educ SP - e30988 VL - 8 IS - 2 KW - medical error disclosure KW - simulation studies KW - communication assessment KW - graduate medical education KW - crowdsourcing KW - patient-centered care KW - generalizability theory KW - medical education KW - medical error KW - communication N2 - Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents? error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates? and crowdsourced laypeople?s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. UR - https://mededu.jmir.org/2022/2/e30988 UR - http://dx.doi.org/10.2196/30988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486423 ID - info:doi/10.2196/30988 ER - TY - JOUR AU - Suen, Tung Michelle Man AU - Lai, Kwan Agnes Yuen AU - Wang, Ping Man AU - Ho, Yin Daniel Sai AU - Lam, Hing Tai PY - 2022/4/28 TI - Development and Evaluation of an Innovative Web-Based Training, Learning, and Sharing Platform for Social Workers (Hong Kong Jockey Club SMART Family-Link Project): Mixed Methods Evaluation Study JO - JMIR Form Res SP - e32894 VL - 6 IS - 4 KW - web-based KW - learning platform KW - capacity building KW - social work practice KW - ICT KW - social work KW - professional development KW - information and communication technology KW - Google Analytics KW - family services KW - mobile phone N2 - Background: Information and communication technology (ICT) use may enhance social work practice and continuous professional development. Under the Hong Kong Jockey Club SMART Family-Link Project, we developed an innovative web-based training, learning, and sharing platform (i-TLS) to support not only ICT and other learning needs of Hong Kong social workers but also their practice. Objective: We developed i-TLS with 3 major components (i-Training, i-Learning, and i-Sharing) and assessed its acceptability and impact on facilitating ICT use in family services. Methods: We described the i-TLS development based on a 4-phase model and evaluated i-TLS using the platform database, Google Analytics, a self-administered survey, and individual phone interviews 1 year after launching. Results: i-TLS was launched in 12 nongovernmental organizations on July 1, 2019. The COVID-19 outbreak in December 2019 limited face-to-face services, which galvanized digital transformation in social work practice. By July 31, 2020, 313 social workers had registered with i-TLS. Approximately 79.6% (249/313) of users accessed i-TLS at least once in the past 28 days, averaging 3.2 (SD 1.35) platform visits per day and viewing 4.8 (SD 1.42) pages per visit. i-Training provided 41 mini-modules on applying ICT to family services, with 730 enrollments. Approximately 70% (511/730) of users completed the mini-modules and obtained digital mini-certificates. i-Learning provided 112 items of learning resources centered on ICT use in family services, with nearly 4000 page views. i-Sharing had 25 discussion threads with 59 posts. Approximately 53.7% (168/313) of users completed the 1-year evaluation survey, including 7.1% (12/168) who were phone interviewed. The mean i-TLS satisfaction score (out of 10) increased from light (4.99, SD 1.54) to occasional (6.15, SD 1.34) and frequent (6.31, SD 2.29) users. Frequent users showed higher scores (out of 10) than light users for an increase in knowledge (5.84, SD 1.34 vs 4.09, SD 1.74; P<.001), self-efficacy (5.23, SD 1.92 vs 3.96, SD 1.77; P=.02), and knowledge application (6.46, SD 1.33 vs 1.91, SD 1.40; P<.001). Interviewees reported increased ICT use in services and considered i-TLS an acceptable and supportive tool for learning and practice, especially during the pandemic. Conclusions: i-TLS is acceptable to social workers and enhances their learning and use of ICT in family services. This was achieved through access to self-directed and collaborative learning and sharing of experiences within their practice. Further research on enhancing web-based platforms is needed to expand participation and capacity building among social workers and other health and social care professionals. UR - https://formative.jmir.org/2022/4/e32894 UR - http://dx.doi.org/10.2196/32894 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482365 ID - info:doi/10.2196/32894 ER - TY - JOUR AU - Lin, Yuchen AU - Lemos, Martin AU - Neuschaefer-Rube, Christiane PY - 2022/4/27 TI - Digital Health and Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Survey Study for Designing a Digital Learning Toolbox App JO - JMIR Med Educ SP - e34042 VL - 8 IS - 2 KW - digital learning KW - mLearning KW - mHealth KW - speech-language pathology KW - phoniatrics KW - otolaryngology KW - communication disorders KW - mobile phone N2 - Background: The digital age has introduced opportunities and challenges for clinical education and practice caused by infinite incoming information and novel technologies for health. In the interdisciplinary field of communication sciences and disorders (CSD), engagement with digital topics has emerged slower than in other health fields, and effective strategies for accessing, managing, and focusing on digital resources are greatly needed. Objective: We aimed to conceptualize and investigate preferences of stakeholders regarding a digital learning toolbox, an app containing a library of current resources for CSD. This cross-sectional survey study conducted in German-speaking countries investigated professional and student perceptions and preferences regarding such an app?s features, functions, content, and associated concerns. Methods: An open web-based survey was disseminated to professionals and students in the field of CSD, including speech-language pathologists (SLPs; German: Logopäd*innen), speech-language pathology students, phoniatricians, otolaryngologists, and medical students. Insights into preferences and perceptions across professions, generations, and years of experience regarding a proposed app were investigated. Results: Of the 164 participants, an overwhelming majority (n=162, 98.8%) indicated readiness to use such an app, and most participants (n=159, 96.9%) perceived the proposed app to be helpful. Participants positively rated app functions that would increase utility (eg, tutorial, quality rating function, filters based on content or topic, and digital format); however, they had varied opinions regarding an app community feature. Regarding app settings, most participants rated the option to share digital resources through social media links (144/164, 87.8%), receive and manage push notifications (130/164, 79.3%), and report technical issues (160/164, 97.6%) positively. However, significant variance was noted across professions (H3=8.006; P=.046) and generations (H3=9.309; P=.03) regarding a username-password function, with SLPs indicating greater perceived usefulness in comparison to speech-language pathology students (P=.045), as was demonstrated by Generation X versus Generation Z (P=.04). Participants perceived a range of clinical topics to be important; however, significant variance was observed across professions, between physicians and SLPs regarding the topic of diagnostics (H3=9.098; P=.03) and therapy (H3=21.236; P<.001). Concerns included technical challenges, data protection, quality of the included resources, and sustainability of the proposed app. Conclusions: This investigation demonstrated that professionals and students show initial readiness to engage in the co-design and use of an interdisciplinary digital learning toolbox app. Specifically, this app could support effective access, sharing, evaluation, and knowledge management in a digital age of rapid change. Formalized digital skills education in the field of CSD is just a part of the solution. It will be crucial to explore flexible, adaptive strategies collaboratively for managing digital resources and tools to optimize targeted selection and use of relevant, high-quality evidence in a world of bewildering data. UR - https://mededu.jmir.org/2022/2/e34042 UR - http://dx.doi.org/10.2196/34042 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475980 ID - info:doi/10.2196/34042 ER - TY - JOUR AU - Peng, XinYun AU - Wang-Trexler, Nicole AU - Magagna, William AU - Land, Susan AU - Peck, Kyle PY - 2022/4/26 TI - Learning Agility of Learning and Development Professionals in the Life Sciences Field During the COVID-19 Pandemic: Empirical Study JO - Interact J Med Res SP - e33360 VL - 11 IS - 1 KW - COVID-19 KW - learning agility KW - learning and development professionals KW - life sciences professionals KW - training and development KW - mixed methods N2 - Background: The COVID-19 pandemic has impacted the life sciences field worldwide. Life sciences organizations (eg, pharmaceutical and med-tech companies) faced a rapidly increasing need for vital medical products, patient support, and vaccine development. Learning and development (L&D) departments play a crucial role in life sciences organizations as they apply learning initiatives to organizational strategy within a constantly evolving sector. During the COVID-19 pandemic, the work of L&D professionals in life sciences organizations changed profoundly during the abrupt shift to remote work, since learning and training normally occur in a face-to-face environment. Given the complex and dynamic situation of the pandemic, both individuals and organizations needed to learn quickly and apply what they learned to solve new, unprecedented problems. This situation presents an opportunity to study how characteristics of learning agility were evidenced by life sciences organizations and individual employees in the remote working mode. Objective: In collaboration with Life Sciences Trainers & Educators Networks (LTEN), this study investigated the responses and learning agility of L&D professionals and their organizational leadership within the life sciences sector to the work changes due to the pandemic. The study answered the following questions: (1) How did L&D professionals in the life sciences sector respond to the changes in their work environment during the COVID-19 pandemic? (2) How did L&D professionals in the life sciences sector demonstrate learning agility during remote working? Methods: We adopted a mixed methods approach that included a semistructured interview and a survey. Participants who were life sciences or health care L&D practitioners and in relevant positions were recruited via email through the LTEN and its partner pharmaceutical, biotech, or medical devices organizations. Interviews with 12 L&D professionals were conducted between June and August 2020 through phone or online conferencing, covering 22 open-ended questions to stimulate ideas that could be explored further in the survey. The semistructured interview questions were grounded in theory on learning agility. In total, 4 themes were developed from the interviews, which formed the basis for developing the survey items. The subsequent survey regarding 4 specific themes was conducted from August to October 2020 using Qualtrics. Both interview and survey data were analyzed based on a learning agility framework. Results: Findings revealed generally positive organizational and individual responses toward the changes brought about by the pandemic. Results also indicated that a disruptive crisis, such as the shift from working in the office to working from home (WFH), required professionals? learning agility to both self-initiate their own learning and to support the learning agility of others in the organization. Conclusions: This study was designed to better understand education and training in the life sciences field, particularly during the unique circumstances of the global COVID-19 pandemic. We put forward several directions for future research on the learning agility of L&D professionals in life sciences organizations. UR - https://www.i-jmr.org/2022/1/e33360 UR - http://dx.doi.org/10.2196/33360 UR - http://www.ncbi.nlm.nih.gov/pubmed/35417403 ID - info:doi/10.2196/33360 ER - TY - JOUR AU - Nozawa, Kyosuke AU - Ishii, Ayaka AU - Asaoka, Hiroki AU - Iwanaga, Mai AU - Kumakura, Yousuke AU - Oyabu, Yuri AU - Shinozaki, Tomohiro AU - Imamura, Kotaro AU - Kawakami, Norito AU - Miyamoto, Yuki PY - 2022/4/26 TI - Effectiveness of an Online Peer Gatekeeper Training Program for Postsecondary Students on Suicide Prevention in Japan: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34832 VL - 11 IS - 4 KW - gatekeeper KW - suicide prevention KW - mental health KW - youth KW - school KW - student KW - peer support KW - depression KW - self-efficacy KW - suicide KW - prevention KW - online training KW - online program KW - protocol KW - RCT KW - control trial N2 - Background: Postsecondary student suicide is one of Japan?s most severe public health problems. Gatekeeper training (GKT) programs are a generally recommended suicide prevention intervention in Japan. For suicide countermeasures, an online program tailored to students may enhance self-efficacy as a gatekeeper. Objective: This study aims to describe a research protocol to investigate the effect of a newly developed internet-delivered online peer GKT program to improve postsecondary student self-efficacy as gatekeepers for suicide countermeasures in Japan. Methods: This study is a 2-arm, parallel, randomized controlled trial with a 1:1 (intervention: waiting list) allocation. Participants (n=320) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or waiting list control group. An approximately 85-minute, 6-section, internet-based gatekeeper program for postsecondary students has been developed that includes videos to help participants acquire skills as gatekeepers. The intervention group will complete the program within 10 days. The primary outcome, self-efficacy as a gatekeeper, is measured using the Gatekeeper Self-Efficacy Scale at baseline, immediately after taking the program, and 2 months after the survey after completing the program follow-up. To compare the primary outcomes, a t test, where the significance level is 5% (2-sided), will be used to test the intervention effect on an intention-to-treat basis. Results: The study was at the stage of data collection at the time of submission. We recruited participants for this study during August and September 2021, and data collection will continue until December 2021. The data analysis related to the primary outcome will start in December 2021, and we hope to publish the results in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of an online GKT program for postsecondary students to improve self-efficacy as a gatekeeper using a randomized controlled trial design. The study will explore the potential of an online peer gatekeeper program for postsecondary students that can be disseminated online to a large number of students with minimal cost. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000045325; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051685 International Registered Report Identifier (IRRID): DERR1-10.2196/34832 UR - https://www.researchprotocols.org/2022/4/e34832 UR - http://dx.doi.org/10.2196/34832 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471412 ID - info:doi/10.2196/34832 ER - TY - JOUR AU - Cercel, Ovidiu Mihai PY - 2022/4/25 TI - Gamification in Diplomacy Studies as an Effective Tool for Knowledge Transfer: Questionnaire Study JO - JMIR Serious Games SP - e32996 VL - 10 IS - 2 KW - modern diplomacy KW - international relations KW - innovations in learning experience KW - gamification KW - serious games KW - role play design KW - knowledge transfer KW - competency development N2 - Background: Graduate education in modern diplomacy poses several challenges, as it requires several competencies to be developed before diplomatic service is joined. Incorporation of simulation games can have a positive impact on the design of international relations and diplomacy learning process. We have designed a novel role play game (MAEDRI) to simulate part of the activities of a typical Ministry of Foreign Affairs. Objective: This study aims to evaluate the effectiveness of MAEDRI in transferring knowledge in international relations education programs at the National University of Political Studies and Public Administration, Bucharest, Romania, across a 4-year period. Methods: The game enrolled master?s level graduate students. The data were collected through a voluntary and anonymous questionnaire between 2017 and 2020. At the end of each of the 4 editions we organized debriefing sessions that gave students the opportunity to provide feedback on their experience with this exercise, level of collaboration within the team, lessons learned, and to make suggestions for improvements. Using an online questionnaire, we measured the participants? perception regarding the level of effectiveness in increasing knowledge transfer, motivation, and engagement. Questionnaire data were consolidated in percentages for each item. Results: A total of 49 participants completed the study. A total of 24 skills (13 professional and 11 social skills) were assessed. We identified a strong positive correlation between stress management and conflict management (r=.86; P<.001) as well as significantly positive correlations between building relations within the team and the ability to dialog and be persuasive (r=.7; P<.001), between procedure compliance and planning and organizing the work (r=.69; P<.001), and between analysis capacity and decision based on data received (r=.68; P<.001). Among social skills, self-control, confidence, and flexibility were the most substantially improved. Conclusions: We describe several benefits of a novel game, used as an education tool to enhance a series of competencies necessary in international relations studies. Our results demonstrate a significant level of student engagement and motivation while playing MAEDRI, improvement of several essential skills, and enhanced knowledge transfer to real-life situations. While the data are encouraging, further research is needed to evaluate the full impact of role play as an effective experiential learning method. UR - https://games.jmir.org/2022/2/e32996 UR - http://dx.doi.org/10.2196/32996 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468081 ID - info:doi/10.2196/32996 ER - TY - JOUR AU - Kunkes, Taylor AU - Makled, Basiel AU - Norfleet, Jack AU - Schwaitzberg, Steven AU - Cavuoto, Lora PY - 2022/4/21 TI - Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis JO - JMIR Perioper Med SP - e34522 VL - 5 IS - 1 KW - knowledge elicitation KW - knowledge acquisition KW - medical simulation KW - medical training KW - medical assessment KW - critical care KW - cognitive task analysis KW - qualitative methods KW - qualitative KW - endotracheal intubation KW - preoperative KW - training KW - health care professional KW - medical education KW - cognitive skill N2 - Background: Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. Objective: This study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties. Methods: A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task. Results: The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment. Conclusions: Although the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices. UR - https://periop.jmir.org/2022/1/e34522 UR - http://dx.doi.org/10.2196/34522 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451970 ID - info:doi/10.2196/34522 ER - TY - JOUR AU - Chua, Ling Wei AU - Ooi, Leng Sim AU - Chan, Han Gene Wai AU - Lau, Ching Tang AU - Liaw, Ying Sok PY - 2022/4/18 TI - The Effect of a Sepsis Interprofessional Education Using Virtual Patient Telesimulation on Sepsis Team Care in Clinical Practice: Mixed Methods Study JO - J Med Internet Res SP - e35058 VL - 24 IS - 4 KW - sepsis KW - interprofessional education KW - team training KW - nurse-physician communication KW - simulation KW - telesimulation N2 - Background: Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning. Objective: This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students? sepsis knowledge, team communication skills, and skill use in clinical practice. Methods: A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants? sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants? sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice. Results: Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other?s roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education?particularly the use of virtual telesimulation?fostered participants? understanding and appreciation of each other?s interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice. Conclusions: Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance. UR - https://www.jmir.org/2022/4/e35058 UR - http://dx.doi.org/10.2196/35058 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436237 ID - info:doi/10.2196/35058 ER - TY - JOUR AU - Metcalf, Mary AU - Rossie, Karen AU - Stokes, Katie AU - Tanner, Bradley PY - 2022/4/11 TI - Health Care Professionals? Clinical Skills to Address Vaping and e-Cigarette Use by Patients: Needs and Interest Questionnaire Study JO - JMIR Form Res SP - e32242 VL - 6 IS - 4 KW - clinical skills KW - vaping KW - e-cigarettes KW - nicotine KW - brief interventions KW - addiction treatment KW - health care professionals KW - continuing education N2 - Background: Widespread vaping and e-cigarette use is a relatively new phenomenon. Youth vaping peaked in 2019, with over 25% of high school students currently vaping. e-Cigarettes are used where smoking is not permitted or as an alternative smoking cessation treatment instead of Food and Drug Administration?approved options. Vaping and e-cigarette use has the potential to harm health, including causing adverse respiratory effects and nicotine addiction. Health care professionals need skills training to help their patients with this relatively new and evolving health problem. Objective: The aim of this study is to understand health care professionals? training needs in this subject area to determine the focus for web-based continuing education training. Methods: We reviewed the literature on clinical aspects of vaping and e-cigarette use. Using the results and our experience in substance use continuing education, we created a list of key clinical skills and surveyed health care professionals about their training needs. We also asked about their interest in a list of related topics. We recruited individuals who completed our web-based courses on substance use, members of health care professional?related groups, and experts who had published an article on the subject. Half of the 31 health care professionals who completed the survey were physicians and the remainder were primarily nurses, social workers, and counselors. Participants self-identified as nonexperts (n=25) and experts (n=6) on vaping. Results: Participants who were nonexperts on average agreed or strongly agreed that they needed training in each of 8 clinical skills (n=25; range 3.7-4.4 agreement out of 5). The top two skills were recommending treatments for patients (4.4 out of 5, SD 0.49) and evaluating and treating the health effects of vaping and e-cigarette use (4.4 out of 5, SD 0.50). Experts agreed on the importance of training for health care professionals in all skills but rated the need for training higher than nonexperts for each topic. Over half of the participating health care professionals (44%-80%) were interested in nearly all (9/10, 90%) vaping-related topics on a checklist. The topics participants were most interested in were the pros and cons of vaping versus smoking and the health effects of second- and third-hand vaping. Primary care physicians showed more interest in vaping-related topics than nonprimary care physicians (t13=2.17; P=.02). Conclusions: This study confirmed gaps in health care professionals? vaping-related clinical skills identified in the literature by identifying a perceived need for training in related skills and health care professionals? interest in key topics related to vaping prevention and cessation. This study provides specific guidance on which clinical skills training is most needed and which topics are most interesting to health care professionals. UR - https://formative.jmir.org/2022/4/e32242 UR - http://dx.doi.org/10.2196/32242 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404264 ID - info:doi/10.2196/32242 ER - TY - JOUR AU - Hamoen, C. Esther AU - De Jong, M. Peter G. AU - Van Blankenstein, M. Floris AU - Reinders, J. Marlies E. PY - 2022/4/7 TI - Design and First Impressions of a Small Private Online Course in Clinical Workplace Learning: Questionnaire and Interview Study JO - JMIR Med Educ SP - e29624 VL - 8 IS - 2 KW - blended learning KW - design-based research KW - web-based learning KW - workplace learning KW - medical education KW - clinical internship N2 - Background: Clinical workplace learning takes place in a dynamic and complex learning environment that is designated as a site for patient care and education. Challenges in clinical training can be overcome by implementing blended learning, as it offers flexible learning programs suitable for student-centered learning, web-based collaboration, and peer learning. Objective: The aim of this study is to evaluate the Small Private Online Course (SPOC) by interns? first impressions and satisfaction measures (N=20) on using the SPOC. This study describes the design process of a SPOC from a theoretical and practical perspective and how it has been integrated into a clinical internship in internal medicine. Methods: The design of the SPOC was based on general theoretical principles that learning should be constructive, contextual, collaborative, and self-regulated, and the self-determination theory to stimulate intrinsic motivation. Interns? impressions and level of satisfaction were evaluated with a web-based questionnaire and group interview. Results: Interns thought the web-based learning environment to be a useful and accessible alternative to improve knowledge and skills. Peer learning and web-based collaboration through peer interaction was perceived as less effective, as student feedback was felt inferior to teacher feedback. The interns would prefer more flexibility within the course, which could improve self-regulated learning and autonomy. Conclusions: The evaluation shows that the SPOC is a useful and accessible addition to the clinical learning environment, providing an alternative opportunity to improve knowledge and skills. Further research is needed to improve web-based collaboration and interaction in our course. UR - https://mededu.jmir.org/2022/2/e29624 UR - http://dx.doi.org/10.2196/29624 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389362 ID - info:doi/10.2196/29624 ER - TY - JOUR AU - Stenseth, Vistven Hege AU - Steindal, Alexander Simen AU - Solberg, Trygg Marianne AU - Ølnes, Alexandra Mia AU - Mohallem, Andrea AU - Sørensen, Lene Anne AU - Strandell-Laine, Camilla AU - Olaussen, Camilla AU - Aure, Farsjø Caroline AU - Riegel, Fernando AU - Pedersen, Ingunn AU - Zlamal, Jaroslav AU - Martini, Gue Jussara AU - Bresolin, Paula AU - Linnerud, Wang Silje Christin AU - Nes, Gonçalves Andréa Aparecida PY - 2022/4/4 TI - Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e36725 VL - 11 IS - 4 KW - simulation-based learning KW - technological supported simulation-based learning KW - critical thinking KW - nursing students KW - nursing education, educational approach KW - education KW - nursing N2 - Background: Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students. Objective: The proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students. Methods: The proposed scoping review will use the framework established by Arksey and O?Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized. Results: The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023. Conclusions: The results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students? reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students? firsthand experiences and further development of successful teaching strategies in nursing education. International Registered Report Identifier (IRRID): DERR1-10.2196/36725 UR - https://www.researchprotocols.org/2022/4/e36725 UR - http://dx.doi.org/10.2196/36725 UR - http://www.ncbi.nlm.nih.gov/pubmed/35373777 ID - info:doi/10.2196/36725 ER - TY - JOUR AU - Sanavro, M. Sanne AU - van der Worp, Henk AU - Jansen, Danielle AU - Koning, Paul AU - Blanker, H. Marco AU - PY - 2022/4/1 TI - Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study JO - JMIR Hum Factors SP - e33630 VL - 9 IS - 2 KW - primary care KW - digital consultation KW - interdisciplinary KW - specialist care N2 - Background: Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective: This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods: We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results: In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions: Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking. UR - https://humanfactors.jmir.org/2022/2/e33630 UR - http://dx.doi.org/10.2196/33630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363155 ID - info:doi/10.2196/33630 ER - TY - JOUR AU - Wang, Jiaqi Judy AU - Singh, K. Rishabh AU - Miselis, Hough Heather AU - Stapleton, Nicole Stephanie PY - 2022/3/31 TI - Technology Literacy in Undergraduate Medical Education: Review and Survey of the US Medical School Innovation and Technology Programs JO - JMIR Med Educ SP - e32183 VL - 8 IS - 1 KW - curricular development KW - medical innovation KW - medical technology KW - student engagement N2 - Background: Modern innovations, like machine learning, genomics, and digital health, are being integrated into medical practice at a rapid pace. Physicians in training receive little exposure to the implications, drawbacks, and methodologies of upcoming technologies prior to their deployment. As a result, there is an increasing need for the incorporation of innovation and technology (I&T) training, starting in medical school. Objective: We aimed to identify and describe curricular and extracurricular opportunities for innovation in medical technology in US undergraduate medical education to highlight challenges and develop insights for future directions of program development. Methods: A review of publicly available I&T program information on the official websites of US allopathic medical schools was conducted in June 2020. Programs were categorized by structure and implementation. The geographic distribution of these categories across US regions was analyzed. A survey was administered to school-affiliated student organizations with a focus on I&T and publicly available contact information. The data collected included the founding year, thematic focus, target audience, activities offered, and participant turnout rate. Results: A total of 103 I&T opportunities at 69 distinct Liaison Committee on Medical Education?accredited medical schools were identified and characterized into the following six categories: (1) integrative 4-year curricula, (2) facilitated doctor of medicine/master of science dual degree programs in a related field, (3) interdisciplinary collaborations, (4) areas of concentration, (5) preclinical electives, and (6) student-run clubs. The presence of interdisciplinary collaboration is significantly associated with the presence of student-led initiatives (P=.001). ?Starting and running a business in healthcare? and ?medical devices? were the most popular thematic focuses of student-led I&T groups, representing 87% (13/15) and 80% (12/15) of respondents, respectively. ?Career pathways exploration for students? was the only type of activity that was significantly associated with a high event turnout rate of >26 students per event (P=.03). Conclusions: Existing school-led and student-driven opportunities in medical I&T indicate growing national interest and reflect challenges in implementation. The greater visibility of opportunities, collaboration among schools, and development of a centralized network can be considered to better prepare students for the changing landscape of medical practice. UR - https://mededu.jmir.org/2022/1/e32183 UR - http://dx.doi.org/10.2196/32183 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357319 ID - info:doi/10.2196/32183 ER - TY - JOUR AU - Nozari, Ala AU - Mukerji, Shivali AU - Lok, Ling-Ling AU - Gu, Qingrou AU - Buhl, Lauren AU - Jain, Sanjay AU - Ortega, Rafael PY - 2022/3/31 TI - Perception of Web-Based Didactic Activities During the COVID-19 Pandemic Among Anesthesia Residents: Pilot Questionnaire Study JO - JMIR Med Educ SP - e31080 VL - 8 IS - 1 KW - resident education KW - COVID-19 KW - barriers to education KW - didactic KW - medical education KW - online education KW - web-based education KW - virtual training KW - anesthesiology residents KW - medical residents KW - pandemic KW - virtual didactics N2 - Background: Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. Objective: In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineate the perceived barriers to the successful implementation of web-based medical education. Methods: A 19-item survey was compiled and distributed electronically using Qualtrics. This anonymous survey included information on the training level of each resident, their participation in formal didactics before and during the pandemic, and their perception of the ease and limitations of virtual didactics. The resident?s opinions on specific educational resources were assessed, and the effectiveness of new delivery methods on resident engagement and learning was examined. Results: Thirty anesthesiology residents were surveyed, 19 of whom agreed to participate in the pilot study. One participant with incomplete responses was excluded, yielding a final cohort of 18 respondents. Most residents (56%, 10/18) reported that the COVID-19 pandemic negatively affected their residency training. The time spent on didactic training and independent studies was, nevertheless, not affected by the pandemic for 90% (16/18) of respondents. Nonetheless, 72% (13/18) of residents were less engaged during virtual lectures in comparison to in-person didactics. Important limitations included distraction from the physical environment (67%, 12/18), internet instability (67%, 12/18), less obligation to participate (44%, 8/18), technical difficulty and unmuted microphones (33%, 6/18, each), and people speaking over each other (28%, 5/18). Despite these limitations, most residents stated that they would like to keep a combination of virtual didactics including live Zoom lectures (56%, 10/18), prerecorded web didactics (56%, 10/18), and virtual ground rounds via Zoom (50%, 9/18) as the ?new normal.? Conclusions: Despite important limitations listed in this report, anesthesia residents would like to keep a combination of virtual lectures and presentations as the new normal after the COVID-19 pandemic. UR - https://mededu.jmir.org/2022/1/e31080 UR - http://dx.doi.org/10.2196/31080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275840 ID - info:doi/10.2196/31080 ER - TY - JOUR AU - Sukhera, Javeed AU - Ahmed, Hasan PY - 2022/3/30 TI - Leveraging Machine Learning to Understand How Emotions Influence Equity Related Education: Quasi-Experimental Study JO - JMIR Med Educ SP - e33934 VL - 8 IS - 1 KW - bias KW - equity KW - sentiment analysis KW - medical education KW - emotion KW - education N2 - Background: Teaching and learning about topics such as bias are challenging due to the emotional nature of bias-related discourse. However, emotions can be challenging to study in health professions education for numerous reasons. With the emergence of machine learning and natural language processing, sentiment analysis (SA) has the potential to bridge the gap. Objective: To improve our understanding of the role of emotions in bias-related discourse, we developed and conducted a SA of bias-related discourse among health professionals. Methods: We conducted a 2-stage quasi-experimental study. First, we developed a SA (algorithm) within an existing archive of interviews with health professionals about bias. SA refers to a mechanism of analysis that evaluates the sentiment of textual data by assigning scores to textual components and calculating and assigning a sentiment value to the text. Next, we applied our SA algorithm to an archive of social media discourse on Twitter that contained equity-related hashtags to compare sentiment among health professionals and the general population. Results: When tested on the initial archive, our SA algorithm was highly accurate compared to human scoring of sentiment. An analysis of bias-related social media discourse demonstrated that health professional tweets (n=555) were less neutral than the general population (n=6680) when discussing social issues on professionally associated accounts (?2 [2, n=555)]=35.455; P<.001), suggesting that health professionals attach more sentiment to their posts on Twitter than seen in the general population. Conclusions: The finding that health professionals are more likely to show and convey emotions regarding equity-related issues on social media has implications for teaching and learning about sensitive topics related to health professions education. Such emotions must therefore be considered in the design, delivery, and evaluation of equity and bias-related education. UR - https://mededu.jmir.org/2022/1/e33934 UR - http://dx.doi.org/10.2196/33934 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353048 ID - info:doi/10.2196/33934 ER - TY - JOUR AU - Son, Hyojin AU - Ross, Alyson AU - Mendoza-Tirado, Elizabeth AU - Lee, Jumin Lena PY - 2022/3/16 TI - Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing JO - JMIR Nursing SP - e34036 VL - 5 IS - 1 KW - virtual reality KW - health care KW - application KW - nursing UR - https://nursing.jmir.org/2022/1/e34036 UR - http://dx.doi.org/10.2196/34036 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293870 ID - info:doi/10.2196/34036 ER - TY - JOUR AU - Balaji, Aanika AU - Clever, Lou Sarah PY - 2022/3/11 TI - Authors? Reply to: Techniques to Teach Students Effectively Using Telemedicine. Comment on ?Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial? JO - JMIR Med Educ SP - e37401 VL - 8 IS - 1 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 KW - teaching KW - telemedicine KW - clerkships UR - https://mededu.jmir.org/2022/1/e37401 UR - http://dx.doi.org/10.2196/37401 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191840 ID - info:doi/10.2196/37401 ER - TY - JOUR AU - Kandola, Hardeep AU - Minhas, Sonica PY - 2022/3/11 TI - Techniques to Teach Students Effectively Using Telemedicine. Comment on ?Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial? JO - JMIR Med Educ SP - e30703 VL - 8 IS - 1 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 KW - teaching KW - telemedicine KW - clerkships UR - https://mededu.jmir.org/2022/1/e30703 UR - http://dx.doi.org/10.2196/30703 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191846 ID - info:doi/10.2196/30703 ER - TY - JOUR AU - Ozkara, Berksu Burak AU - Karabacak, Mert AU - Alpaydin, Demet Duygu PY - 2022/3/7 TI - Student-Run Online Journal Club Initiative During a Time of Crisis: Survey Study JO - JMIR Med Educ SP - e33612 VL - 8 IS - 1 KW - online journal club KW - medical student KW - distance learning KW - COVID-19 KW - undergraduate education KW - student journal club KW - online education KW - establishment KW - initiative KW - literature KW - research KW - publishing KW - education N2 - Background: Since the closure of university campuses due to COVID-19 in spring 2020 necessitated a quick transition to online courses, medical students were isolated from hospitals and universities, negatively impacting their education. During this time, medical students had no opportunity to participate in academic discussions and were also socially isolated. Furthermore, medical doctors and professors of medical schools were given additional responsibilities during the pandemic because they were the frontliners in the fight against COVID-19. As a result, they did not have enough time to contribute effectively to medical student education. Objective: This paper describes the establishment of the Cerrahpasa Neuroscience Society Journal Clubs, a group of entirely student-run online journal clubs at Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa. Methods: The website, mass emailing, and social media accounts were used to announce the online journal clubs. Only medical students were eligible to apply. Journal clubs included psychiatry, neuroradiology, neurosurgery, neurology, and neuroscience. Following the last journal club meeting, a questionnaire created by the society?s board was distributed to the participants. SPSS Statistics (version 26) was used for statistical analysis. Results: Since March 15, 2021, synchronous online journal club meetings have been held every 2 weeks on a weekday using Google Meet, Microsoft Teams, or Zoom. Meetings of each journal club lasted approximately 1 hour on average. Interstudent interaction across multiple institutions was achieved since a total of 45 students from 11 different universities attended the meetings on a regular basis. Students on the society?s board served as academic mentors for the clubs. The clubs received excellent feedback from participants, with an overall contentment score of 4.32 out of 5. Conclusions: By establishing these clubs, we have created a venue for academic discussions, which helps to reduce the negative impact of the pandemic on education. In addition, we believe it greatly aided students in staying in touch with their peers, thereby reducing the sense of isolation. We realize that traditional journal clubs are run by faculty; however, we believe that this experience demonstrated that medical students could run a journal club on their own since the feedback from participants was excellent. Additionally, as a medical student, being a journal club academic mentor is a challenging responsibility; however, having this responsibility significantly improved our academic mentors? leadership abilities. UR - https://mededu.jmir.org/2022/1/e33612 UR - http://dx.doi.org/10.2196/33612 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148270 ID - info:doi/10.2196/33612 ER - TY - JOUR AU - Kernan, D. William AU - Basch, H. Corey PY - 2022/3/4 TI - Adaptation of an In-Person Internship to a Virtual Format for Public Health Undergraduates JO - JMIR Public Health Surveill SP - e35252 VL - 8 IS - 3 KW - internship KW - remote learning KW - high-impact practice KW - COVID-19 KW - public health education KW - learning outcomes KW - virtual learning KW - virtual internship KW - public health KW - health education KW - undergraduate education KW - virtual education UR - https://publichealth.jmir.org/2022/3/e35252 UR - http://dx.doi.org/10.2196/35252 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089869 ID - info:doi/10.2196/35252 ER - TY - JOUR AU - Sadeghi, H. Amir AU - Peek, J. Jette AU - Max, A. Samuel AU - Smit, L. Liselot AU - Martina, G. Bryan AU - Rosalia, A. Rodney AU - Bakhuis, Wouter AU - Bogers, JJC Ad AU - Mahtab, AF Edris PY - 2022/3/2 TI - Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study JO - JMIR Serious Games SP - e30456 VL - 10 IS - 1 KW - cardiac surgery KW - cardiopulmonary resuscitation KW - emergency resternotomy KW - virtual reality KW - simulation training KW - serious games KW - virtual reality simulation KW - digital health KW - medical training KW - virtual training N2 - Background: Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim. Objective: We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery. Methods: Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator?s usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. Results: Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87%) felt actively involved in the simulation, and 23 (77%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80%) and thought that the software responded adequately (n=21, 70%). All 15 (100%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87%) of the expert participants would recommend VR training to other colleagues, and 14 (93%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post?cardiac surgery emergencies requiring CPR. Additionally, 10 (91%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario. Conclusions: We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform. UR - https://games.jmir.org/2022/1/e30456 UR - http://dx.doi.org/10.2196/30456 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234652 ID - info:doi/10.2196/30456 ER - TY - JOUR AU - Schnieders, Elena AU - Röhr, Freda AU - Mbewe, Misho AU - Shanzi, Aubrey AU - Berner-Rodoreda, Astrid AU - Barteit, Sandra AU - Louis, R. Valérie AU - Andreadis, Petros AU - Syakantu, Gardner AU - Neuhann, Florian PY - 2022/2/24 TI - Real-life Evaluation of an Interactive Versus Noninteractive e-Learning Module on Chronic Obstructive Pulmonary Disease for Medical Licentiate Students in Zambia: Web-Based, Mixed Methods Randomized Controlled Trial JO - JMIR Med Educ SP - e34751 VL - 8 IS - 1 KW - distance education KW - randomized controlled trial KW - personal satisfaction KW - knowledge KW - user-centered design KW - chronic obstructive pulmonary disease KW - interactive KW - noninteractive KW - low- and middle-income country KW - LMIC KW - mobile phone N2 - Background: e-Learning for health professionals in many low- and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive (user-influenceable content) and noninteractive (static material) e-learning. Studies conducted in high-income countries suggest that interactive e-learning is more effective than noninteractive e-learning in increasing learner satisfaction and knowledge; however, there is a gap in our understanding of whether this also holds true in LMICs. Objective: This study aims to validate the hypothesis above in a resource-constrained and real-life setting to understand e-learning quality and delivery by comparing interactive and noninteractive e-learning user satisfaction, usability, and knowledge gain in a new medical university in Zambia. Methods: We conducted a web-based, mixed methods randomized controlled trial at the Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited medical licentiate students (second, third, and fourth study years) via email. Participants were randomized to undergo asynchronous e-learning with an interactive or noninteractive module for chronic obstructive pulmonary disease and informally blinded to their group allocation. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the noninteractive module consisted of PowerPoint slides. Both modules covered the same content scope. The primary outcome was learner satisfaction. The secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights into quantitative findings, which were evaluated through web-based questionnaires. Results: Initially, 94 participants were enrolled in the study, of whom 41 (44%; 18 intervention participants and 23 control participants) remained in the study and were analyzed. There were no significant differences in satisfaction (intervention: median 33.5, first quartile 31.3, second quartile 35; control: median 33, first quartile 30, second quartile 37.5; P=.66), usability, or knowledge gain between the intervention and control groups. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested that the content of the interactive module was more challenging to access because of technical difficulties and individual factors (eg, limited experience with interactive e-learning). Conclusions: We did not observe an increase in user satisfaction with interactive e-learning. However, this finding may not be generalizable to other low-resource settings because the post hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, technical and individual barriers to accessing e-learning may have affected the results, mainly because the interactive module was considered more difficult to access and use. Nevertheless, qualitative data showed high motivation and interest in e-learning. Future studies should minimize technical barriers to e-learning to further evaluate interactive e-learning in LMICs. UR - https://mededu.jmir.org/2022/1/e34751 UR - http://dx.doi.org/10.2196/34751 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200149 ID - info:doi/10.2196/34751 ER - TY - JOUR AU - Jarratt, LynnMarie AU - Situ, Jenny AU - King, D. Rachel AU - Montanez Ramos, Estefania AU - Groves, Hannah AU - Ormesher, Ryen AU - Cossé, Melissa AU - Raboff, Alyse AU - Mahajan, Avanika AU - Thompson, Jennifer AU - Ko, F. Randy AU - Paltrow-Krulwich, Samantha AU - Price, Allison AU - Hurwitz, May-Ling Ariel AU - CampBell, Timothy AU - Epler, T. Lauren AU - Nguyen, Fiona AU - Wolinsky, Emma AU - Edwards-Fligner, Morgan AU - Lobo, Jolene AU - Rivera, Danielle AU - Langsjoen, Jens AU - Sloane, Lori AU - Hendrix, Ingrid AU - Munde, O. Elly AU - Onyango, O. Clinton AU - Olewe, K. Perez AU - Anyona, B. Samuel AU - Yingling, V. Alexandra AU - Lauve, R. Nicolas AU - Kumar, Praveen AU - Stoicu, Shawn AU - Nestsiarovich, Anastasiya AU - Bologa, G. Cristian AU - Oprea, I. Tudor AU - Tollestrup, Kristine AU - Myers, B. Orrin AU - Anixter, Mari AU - Perkins, J. Douglas AU - Lambert, Gerard Christophe PY - 2022/2/23 TI - A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study JO - JMIR Med Educ SP - e23845 VL - 8 IS - 1 KW - COVID-19 KW - pandemic KW - daily report KW - policy KW - epidemics KW - global health KW - SARS-CoV-2 KW - New Mexico KW - medical education N2 - Background: On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico?s pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the ?UNM Global Health COVID-19 Intelligence Briefing.? Objective: In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. Methods: Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. Results: An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. Conclusions: The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty. UR - https://mededu.jmir.org/2022/1/e23845 UR - http://dx.doi.org/10.2196/23845 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142625 ID - info:doi/10.2196/23845 ER - TY - JOUR AU - Lima, Araujo Isabela Dantas de AU - Ponce de Leon, Martins Casandra Genoveva Rosales AU - Ribeiro, Medeiros Laiane AU - Silva, da Izabel Cristina Rodrigues AU - Vilela, Monteiro Danielle AU - Fonseca, Monti Luciana Mara AU - Góes, de Fernanda dos Santos Nogueira AU - Funghetto, Schwerz Silvana PY - 2022/2/18 TI - A Serious Game (Immunitates) About Immunization: Development and Validation Study JO - JMIR Serious Games SP - e30738 VL - 10 IS - 1 KW - educational technology KW - immunization KW - nursing education KW - validation KW - methodological study KW - vaccination KW - public health KW - nursing students KW - teaching KW - education KW - support tool KW - continuing education N2 - Background: Vaccination is a fundamental part of all levels?local to worldwide?of public health, and it can be considered one of humanity's greatest achievements in the control and elimination of infectious diseases. Teaching immunization and vaccination can be monotonous and tiring. It is necessary to develop new approaches for teaching these themes in nursing school. Objective: We aimed to develop and validate a serious game about immunization and vaccination for Brazilian nursing students. Methods: We developed a quiz-type game, Immunitates, using design and educational theoretical models and Brazilian National Health Guidelines. The game?s heuristics and content were evaluated with 2 different instruments by a team of experts. A sample of nursing students evaluated the validity of the game?s heuristics only. We calculated the content validity index (CVI) for each evaluation. Results: The study included 49 experts and 15 nursing students. All evaluations demonstrated high internal consistency (Cronbach ??.86). The game?s heuristics (experts: CVI 0.75-1.0; students: CVI 0.67-1.0) and the game?s contents demonstrated validity (experts: CVI 0.73-1.0). Participants identified some specific areas for improvement in the next version. Conclusions: The serious game appears to be valid. It is intended as a support tool for nursing students in the teaching?learning process and as a tool for continuing education for nurses. UR - https://games.jmir.org/2022/1/e30738 UR - http://dx.doi.org/10.2196/30738 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179496 ID - info:doi/10.2196/30738 ER - TY - JOUR AU - Gasteiger, Norina AU - van der Veer, N. Sabine AU - Wilson, Paul AU - Dowding, Dawn PY - 2022/2/14 TI - How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis JO - JMIR Serious Games SP - e31644 VL - 10 IS - 1 KW - realist synthesis KW - realist review KW - review KW - virtual reality KW - augmented reality KW - simulation KW - training KW - health KW - health personnel KW - education KW - mobile phone N2 - Background: Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective: The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods: We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results: Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions: Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations. UR - https://games.jmir.org/2022/1/e31644 UR - http://dx.doi.org/10.2196/31644 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156931 ID - info:doi/10.2196/31644 ER - TY - JOUR AU - Samarasekara, Keshinie PY - 2022/2/10 TI - e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates JO - JMIR Med Educ SP - e22096 VL - 8 IS - 1 KW - medical education KW - e-learning KW - Sri Lanka KW - medical students N2 - Background: Medical education has undergone drastic changes with the advent of novel technologies that enable e-learning. Medical students are increasingly using e-learning methods, and universities have incorporated them into their curricula. Objective: This study aimed at delineating the pattern of use of e-learning methods among medical undergraduates and new graduates of the Faculty of Medicine, University of Colombo, and identifying the challenges faced by these students in using e-learning methods. Methods: A cross-sectional descriptive study was conducted in the Faculty of Medicine, University of Colombo, in April 2020, with the participation of current undergraduates and pre-intern medical graduates, using a self-administered questionnaire that collected data on sociodemographic details, pattern of use of learning methods, and challenges faced using e-learning methods. Results: There were 778 respondents, with a response rate of 65.1% (778/1195). All the study participants used e-learning resources with varying frequencies, and all of them had at least 1 smart device with access to the internet. Electronic versions of standard textbooks (e-books), nonmedical websites, online lectures, medical websites, and medical phone apps were used by the majority. When comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. The preference was influenced by the year of study and family income. The 3 most commonly used modalities for learning new study material and revising previously learned content were notes on paper material, textbooks (paper version), and e-books. The majority (98.7% [n=768]) of participants have encountered problems using e-learning resources. The most commonly faced problems were unavailability of free-of-charge access to some e-learning methods, expenses related to internet connection, poor connectivity of mobile internet, distractions while using online resources, and lack of storage space on electronic devices. Conclusions: There is a high uptake of e-learning methods among Sri Lankan medical students. However, when comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. A majority of the students have encountered problems when using e-learning methods, and most of these problems were related to poor economic status. Universities should take these factors into consideration when developing curricula in medical education. UR - https://mededu.jmir.org/2022/1/e22096 UR - http://dx.doi.org/10.2196/22096 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142626 ID - info:doi/10.2196/22096 ER - TY - JOUR AU - Yeung, Kan Andy Wai AU - Parvanov, D. Emil AU - Hribersek, Mojca AU - Eibensteiner, Fabian AU - Klager, Elisabeth AU - Kletecka-Pulker, Maria AU - Rössler, Bernhard AU - Schebesta, Karl AU - Willschke, Harald AU - Atanasov, G. Atanas AU - Schaden, Eva PY - 2022/2/9 TI - Digital Teaching in Medical Education: Scientific Literature Landscape Review JO - JMIR Med Educ SP - e32747 VL - 8 IS - 1 KW - medical education KW - digital teaching KW - virtual reality KW - augmented reality KW - anatomy KW - basic life support KW - satisfaction KW - bibliometric KW - medicine KW - life support KW - online learning KW - literature KW - trend KW - citation N2 - Background: Digital teaching in medical education has grown in popularity in the recent years. However, to the best of our knowledge, no bibliometric report to date has been published that analyzes this important literature set to reveal prevailing topics and trends and their impacts reflected in citation counts. Objective: We used a bibliometric approach to unveil and evaluate the scientific literature on digital teaching research in medical education, demonstrating recurring research topics, productive authors, research organizations, countries, and journals. We further aimed to discuss some of the topics and findings reported by specific highly cited works. Methods: The Web of Science electronic database was searched to identify relevant papers on digital teaching research in medical education. Basic bibliographic data were obtained by the ?Analyze? and ?Create Citation Report? functions of the database. Complete bibliographic data were exported to VOSviewer for further analyses. Visualization maps were generated to display the recurring author keywords and terms mentioned in the titles and abstracts of the publications. Results: The analysis was based on data from 3978 papers that were identified. The literature received worldwide contributions with the most productive countries being the United States and United Kingdom. Reviews were significantly more cited, but the citations between open access vs non?open access papers did not significantly differ. Some themes were cited more often, reflected by terms such as virtual reality, innovation, trial, effectiveness, and anatomy. Different aspects in medical education were experimented for digital teaching, such as gross anatomy education, histology, complementary medicine, medicinal chemistry, and basic life support. Some studies have shown that digital teaching could increase learning satisfaction, knowledge gain, and even cost-effectiveness. More studies were conducted on trainees than on undergraduate students. Conclusions: Digital teaching in medical education is expected to flourish in the future, especially during this era of COVID-19 pandemic. UR - https://mededu.jmir.org/2022/1/e32747 UR - http://dx.doi.org/10.2196/32747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138260 ID - info:doi/10.2196/32747 ER - TY - JOUR AU - Cosimini, Joseph Michael AU - Watsjold, Bjorn AU - Chan, M. Teresa PY - 2022/2/9 TI - Serious Games Without Screens. Comment on ?Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review? JO - JMIR Serious Games SP - e34656 VL - 10 IS - 1 KW - game-based learning KW - health professions education KW - participatory design KW - systematic review KW - user-centered design KW - serious games KW - game development KW - end users KW - education UR - https://games.jmir.org/2022/1/e34656 UR - http://dx.doi.org/10.2196/34656 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138255 ID - info:doi/10.2196/34656 ER - TY - JOUR AU - Mageswaran, Nanthini AU - Ismail, Shareela Noor Akmal PY - 2022/2/3 TI - Preparing Medical Students for the Final Examinations During the COVID-19 Crisis: A Bumpy Ride to the Finishing Line JO - JMIR Med Educ SP - e31392 VL - 8 IS - 1 KW - COVID-19 KW - undergraduate medical education KW - medical students KW - clinical competency KW - pandemic UR - https://mededu.jmir.org/2022/1/e31392 UR - http://dx.doi.org/10.2196/31392 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084354 ID - info:doi/10.2196/31392 ER - TY - JOUR AU - Jiang, Haowen AU - Vimalesvaran, Sunitha AU - Wang, King Jeremy AU - Lim, Boon Kee AU - Mogali, Reddy Sreenivasulu AU - Car, Tudor Lorainne PY - 2022/2/2 TI - Virtual Reality in Medical Students? Education: Scoping Review JO - JMIR Med Educ SP - e34860 VL - 8 IS - 1 KW - virtual reality KW - medical education KW - medical students KW - virtual worlds KW - digital health education N2 - Background: Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. Objective: The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. Methods: We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. Conclusions: Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046986 UR - https://mededu.jmir.org/2022/1/e34860 UR - http://dx.doi.org/10.2196/34860 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107421 ID - info:doi/10.2196/34860 ER - TY - JOUR AU - Ryan, V. Grace AU - Callaghan, Shauna AU - Rafferty, Anthony AU - Higgins, F. Mary AU - Mangina, Eleni AU - McAuliffe, Fionnuala PY - 2022/2/1 TI - Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature JO - J Med Internet Res SP - e30082 VL - 24 IS - 2 KW - Virtual Reality KW - Augmented Reality KW - Mixed Reality KW - Learning Outcomes KW - Medical Education KW - Nursing Education KW - Midwifery Education KW - Systematic Review N2 - Background: There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students. Objective: The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants? learning experience in medical, midwifery, and nursing preclinical university education. Methods: A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020. Results: Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine. Conclusions: Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education. UR - https://www.jmir.org/2022/2/e30082 UR - http://dx.doi.org/10.2196/30082 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103607 ID - info:doi/10.2196/30082 ER - TY - JOUR AU - Teng, Minnie AU - Singla, Rohit AU - Yau, Olivia AU - Lamoureux, Daniel AU - Gupta, Aurinjoy AU - Hu, Zoe AU - Hu, Ricky AU - Aissiou, Amira AU - Eaton, Shane AU - Hamm, Camille AU - Hu, Sophie AU - Kelly, Dayton AU - MacMillan, M. Kathleen AU - Malik, Shamir AU - Mazzoli, Vienna AU - Teng, Yu-Wen AU - Laricheva, Maria AU - Jarus, Tal AU - Field, S. Thalia PY - 2022/1/31 TI - Health Care Students? Perspectives on Artificial Intelligence: Countrywide Survey in Canada JO - JMIR Med Educ SP - e33390 VL - 8 IS - 1 KW - medical education KW - artificial intelligence KW - allied health education KW - medical students KW - health care students KW - medical curriculum KW - education N2 - Background: Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development. Objective: This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum. Methods: The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools. Results: A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula. Conclusions: We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions. UR - https://mededu.jmir.org/2022/1/e33390 UR - http://dx.doi.org/10.2196/33390 UR - http://www.ncbi.nlm.nih.gov/pubmed/35099397 ID - info:doi/10.2196/33390 ER - TY - JOUR AU - Jung, Younhyun PY - 2022/1/28 TI - Virtual Reality Simulation for Disaster Preparedness Training in Hospitals: Integrated Review JO - J Med Internet Res SP - e30600 VL - 24 IS - 1 KW - virtual reality KW - in-hospital disaster preparedness training KW - mass casualty incidents KW - hospitals N2 - Background: A critical component of disaster preparedness in hospitals is experiential education and training of health care professionals. A live drill is a well-established, effective training approach, but cost restraints and logistic constraints make clinical implementation challenging, and training opportunities with live drills may be severely limited. Virtual reality simulation (VRS) technology may offer a viable training alternative with its inherent features of reproducibility, just-in-time training, and repeatability. Objective: This integrated review examines the scientific evidence pertaining to the effectiveness of VRS and its practical usefulness in training health care professionals for in-hospital disaster preparedness. Methods: A well-known 4-stage methodology was used for the integrated review process. It consisted of problem identification, a literature search and inclusion criteria determination, 2-stage validation and analysis of searched studies, and presentation of findings. A search of diverse publication repositories was performed. They included Web of Science (WOS), PubMed (PMD), and Embase (EMB). Results: The integrated review process resulted in 12 studies being included. Principle findings identified 3 major capabilities of VRS: (1) to realistically simulate the clinical environment and medical practices related to different disaster scenarios, (2) to develop learning effects on increased confidence and enhanced knowledge acquisition, and (3) to enable cost-effective implementation of training programs. Conclusions: The findings from the integrated review suggested that VRS could be a competitive, cost-effective adjunct to existing training approaches. Although the findings demonstrated the applicability of VRS to different training scenarios, these do not entirely cover all disaster scenarios that could happen in hospitals. This integrated review expects that the recent advances of VR technologies can be 1 of the catalysts to enable the wider adoption of VRS training on challenging clinical scenarios that require sophisticated modeling and environment depiction. UR - https://www.jmir.org/2022/1/e30600 UR - http://dx.doi.org/10.2196/30600 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089144 ID - info:doi/10.2196/30600 ER - TY - JOUR AU - Haitjema, Saskia AU - Prescott, R. Timothy AU - van Solinge, W. Wouter PY - 2022/1/28 TI - The Applied Data Analytics in Medicine Program: Lessons Learned From Four Years? Experience With Personalizing Health Care in an Academic Teaching Hospital JO - JMIR Form Res SP - e29333 VL - 6 IS - 1 KW - digital health KW - data-driven care KW - multidisciplinarity KW - lessons learned KW - eHealth KW - personalized medicine KW - data analytics KW - implementation KW - collaboration KW - hospital UR - https://formative.jmir.org/2022/1/e29333 UR - http://dx.doi.org/10.2196/29333 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089145 ID - info:doi/10.2196/29333 ER - TY - JOUR AU - Poulin Herron, Alex AU - Agbadje, Tatiana Titilayo AU - Guay-Bélanger, Sabrina AU - Ngueta, Gérard AU - Roch, Geneviève AU - Rousseau, François AU - Légaré, France PY - 2022/1/25 TI - Web-Based Training for Nurses on Using a Decision Aid to Support Shared Decision-making About Prenatal Screening: Parallel Controlled Trial JO - JMIR Nursing SP - e31380 VL - 5 IS - 1 KW - shared decision-making KW - prenatal screening KW - training KW - nurses KW - nursing KW - behavioral intention KW - trisomy KW - Down syndrome KW - continuing professional development KW - continuing education KW - medical education KW - decision aid KW - screening KW - prenatal KW - pediatrics N2 - Background: Nurses play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision-making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective: In this study, we aim to assess the impact of an SDM training program on nurses? intention to use a decision aid with pregnant women deciding on prenatal screening for Down syndrome. Methods: In this 2-arm, parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was the intention to use a decision aid. Secondary outcomes were psychosocial variables of intention, knowledge, satisfaction, acceptability, perceived usefulness, and reaction to the pedagogical approach. All outcomes were self-assessed through web-based questionnaires, including the space for written comments. We used 2-tailed Student t test and Fisher exact test to compare continuous and categorical variables between groups, respectively. Results: Of the 57 participants assessed for eligibility, 40 (70%) were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. The mean age of the participants was 41 (SD 9) years. Most were women (39/40, 98%), White (38/40, 95%), clinical nurses (28/40, 70%), and had completed at least a bachelor?s degree (30/40, 75%). After the intervention, the mean score of intention was 6.3 (SD 0.8; 95% CI 5.9-6.7) for the intervention group and 6.0 (SD 1.2; 95% CI 5.42-6.64) for the control group (scale 1-7). The differences in intention and other psychosocial variable scores between the groups were not statistically significant. Knowledge scores for SDM were significantly higher in the intervention group (79%, 95% CI 70-89 vs 64%, 95% CI 57-71; P=.009). The intervention was significantly more acceptable in the intervention group (4.6, 95% CI 4.4-4.8 vs 4.3, 95% CI 4.1-4.5; P=.02), and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7, 95% CI 4.5-4.8 vs 4.4, 95% CI 4.2-4.5; P=.02). There was no significant difference in overall satisfaction (or in perceived usefulness). Furthermore, 17 participants (9 in the intervention group and 8 in the control group) provided written comments on the intervention. Conclusions: This study focuses on web-based nursing education and its potential to support pregnant women?s decision-making needs. It shows that nurses? intention to use a decision aid to enhance SDM in prenatal care is high, with or without training, but that their knowledge about SDM can be improved with web-based training. International Registered Report Identifier (IRRID): RR2-10.2196/17878 UR - https://nursing.jmir.org/2022/1/e31380 UR - http://dx.doi.org/10.2196/31380 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874274 ID - info:doi/10.2196/31380 ER - TY - JOUR AU - Jung, Dukyoo AU - De Gagne, C. Jennie AU - Choi, Eunju AU - Lee, Kyuri PY - 2022/1/24 TI - An Online International Collaborative Learning Program During the COVID-19 Pandemic for Nursing Students: Mixed Methods Study JO - JMIR Med Educ SP - e34171 VL - 8 IS - 1 KW - COVID-19 KW - distance education KW - global competencies KW - nursing students KW - program evaluation KW - synchronous virtual classroom KW - video conferencing N2 - Background: Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments. Objective: We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students? international and global competencies in South Korea. Methods: We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants? global leadership competencies, and the focus group interviews were used to evaluate the program?s effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods. Results: Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative. Conclusions: The online international collaborative learning program had a positive impact on the development of students? international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era. UR - https://mededu.jmir.org/2022/1/e34171 UR - http://dx.doi.org/10.2196/34171 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982035 ID - info:doi/10.2196/34171 ER - TY - JOUR AU - Herrera, Tara AU - Fiori, P. Kevin AU - Archer-Dyer, Heather AU - Lounsbury, W. David AU - Wylie-Rosett, Judith PY - 2022/1/17 TI - Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study JO - JMIR Med Educ SP - e32818 VL - 8 IS - 1 KW - social determinants of health KW - service-based learning KW - telehealth KW - preclinical education KW - screening KW - referral KW - community health workers KW - determinant KW - medical student KW - case study KW - service KW - preparation KW - pilot KW - feasibility KW - training KW - assessment KW - needs KW - electronic health record KW - questionnaire N2 - Background: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. Objective: This pilot project?s objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020). Methods: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers? notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum. Results: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need. Conclusions: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures. UR - https://mededu.jmir.org/2022/1/e32818 UR - http://dx.doi.org/10.2196/32818 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037885 ID - info:doi/10.2196/32818 ER - TY - JOUR AU - Decker, J. Martha AU - Harrison, Salish AU - Price, Melisa AU - Gutmann-Gonzalez, Abigail AU - Yarger, Jennifer AU - Tenney, Rachel PY - 2022/1/12 TI - Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study JO - JMIR Hum Factors SP - e31381 VL - 9 IS - 1 KW - adolescent KW - sex education KW - technology KW - mobile app KW - implementation KW - California KW - health educator N2 - Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths? sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators? experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators? experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators? familiarity with the app increased and functionality improved. Technology issues were also more common in non?school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents? use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 UR - https://humanfactors.jmir.org/2022/1/e31381 UR - http://dx.doi.org/10.2196/31381 UR - http://www.ncbi.nlm.nih.gov/pubmed/35019842 ID - info:doi/10.2196/31381 ER - TY - JOUR AU - Dederichs, Melina AU - Nitsch, Jan Felix AU - Apolinário-Hagen, Jennifer PY - 2022/1/10 TI - Piloting an Innovative Concept of e?Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study JO - JMIR Med Educ SP - e32017 VL - 8 IS - 1 KW - participatory design KW - co-design KW - mHealth KW - medical student KW - eHealth KW - medical education KW - mental health KW - mobile phone N2 - Background: Medical students show low levels of e?mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students? well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students? preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. Objective: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students? preferences and ideas for mHealth apps through the design of a hypothetical prototype. Methods: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e?mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students? permission. Results: The participants? feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. Conclusions: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education. UR - https://mededu.jmir.org/2022/1/e32017 UR - http://dx.doi.org/10.2196/32017 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006085 ID - info:doi/10.2196/32017 ER - TY - JOUR AU - Tan, Wen Jun AU - Ng, Bee Kian AU - Mogali, Reddy Sreenivasulu PY - 2022/1/10 TI - An Exploratory Digital Board Game Approach to the Review and Reinforcement of Complex Medical Subjects Like Anatomical Education: Cross-sectional and Mixed Methods Study JO - JMIR Serious Games SP - e33282 VL - 10 IS - 1 KW - serious games KW - board games KW - anatomy KW - flow N2 - Background: Serious games have the potential to resolve educational problems faced by medical students, such as insufficient rehearsal due to boredom and lack of motivation. However, serious games? relatively novel concepts in science and many genres of games that are common in recreation remain underresearched in the literature. Board games are one such genre that, despite their potential, affordability, and flexibility, are rarely designed for medical students, and little is known about student perceptions of them and their compatibility with rehearsal. Objective: In this cross-sectional study, we sought to elicit, via an exploratory mixed methods approach, student perceptions of a digital serious board game specifically designed for the gamified rehearsal of complex medical subjects, with the chosen topic of anatomy. Methods: A digital serious board game, based on self-determination theory (SDT), was first designed and developed to facilitate the rehearsal of anatomy information. Students were then voluntarily recruited to partake in the intervention and were randomly split into three teams of 2 players per game session, after which they were administered the Flow Short Scale (FSS), which is a 13-item measure where items were rated on a 7-point Likert scale ranging from 1 (?not at all?) to 7 (?very much?). Students then participated in a focus group discussion to elicit their perceptions of the game. Findings from the FSS were subject to descriptive analysis, and the focus group discussion was subject to inductive thematic analysis. Results: A total of 12 undergraduate, second-year medical students from the Lee Kong Chian School of Medicine in Singapore participated in the study. FSS results indicated a moderate level of overall flow (mean score 4.94, SD 1.07) via the subdomains of fluency (mean score 4.77, SD 1.13) and absorption (mean score 5.21, SD 1.1). Students perceived the game as fun, enjoyable, engaging, and appropriate as a rehearsal tool that alleviated the monotony of traditional methods of rehearsal. Conclusions: Our digital board game?based rehearsal tool, when based on SDT, appeared to be suitable for gamified rehearsal in a fun and enjoyable environment due to its facilitation of intrinsic motivation in its players. UR - https://games.jmir.org/2022/1/e33282 UR - http://dx.doi.org/10.2196/33282 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006080 ID - info:doi/10.2196/33282 ER - TY - JOUR AU - Kim, Sungha AU - Bayer, Ilana AU - Gewurtz, Rebecca AU - Larivière, Nadine AU - Letts, Lori PY - 2022/1/4 TI - Comparing Web-Based and In-Person Educational Workshops for Canadian Occupational Therapists and Understanding Their Learning Experiences: Mixed Methods Study JO - JMIR Med Educ SP - e31634 VL - 8 IS - 1 KW - online education KW - occupational therapy KW - occupational therapist KW - continuing education N2 - Background: The Do-Live-Well (DLW) framework is an occupation-focused health promotion approach. Occupational therapists (OTs) have been interested in training opportunities regarding this framework. Traditionally, in-person continuing educational interventions are the main way that OTs obtain knowledge, but web-based learning has become popular among health care professionals. However, its effectiveness and learners? experience in web-based learning have not been well-studied in occupational therapy education. Objective: This study aims to evaluate the effectiveness of the web-based and in-person educational DLW workshops for Canadian OTs and to understand their experiences in both workshop types. Methods: An explanatory sequential mixed methods study design was used, where quantitative data were collected first, then qualitative data were used to explain the quantitative findings. A quasi-experimental design and interpretative description methodology were used in the quantitative and qualitative phases, respectively. Results: Quantitative results were as follows: a total of 43 OTs completed pre-, post-, and follow-up evaluations (in-person group: 21/43, 49%; web-based group: 22/43, 51%). Practice settings of the participants varied, including geriatric, hospital, long-term, mental health, pediatric, and primary settings. The primary outcome was as follows: there were no statistically significant differences in knowledge changes at the 3 time points (P=.57 to P=.99) between the groups. In the web-based group, the knowledge scores at follow-up were lower compared with the posttest results, meaning that knowledge gain was reduced over time (P=.001). The secondary outcomes were as follows: there were statistically significant differences between the groups in factors influencing DLW adoption at posttest (P=.001) and in satisfaction with the workshop (P<.001) at posttest in favor of the in-person group. Qualitative results were as follows: a total of 18 OTs (9/18, 50% from each group) participated in an individual interview. Five themes were identified regarding learners? workshop experiences: relevance to their practices and interests may improve learning, a familiar learning environment may facilitate learning, synchronous in-person interaction is valuable in the learning process, ease of access to learning should be considered, and flexibility in web-based learning can be both beneficial and challenging. Conclusions: The quantitative results of this study reported no difference in knowledge acquisition between the in-person and web-based groups, indicating that web-based education is as effective as in-person workshops. However, participants? satisfaction with the workshop was statistically significantly higher for the in-person workshop. The qualitative findings described the participants? perceived benefits and challenges of each educational format. The participants in both the web-based and in-person workshop groups valued in-person interactions in learning, but the participants in the web-based workshop group expressed web-based learning lacked in-person-like interactions. Thus, adding synchronous in-person interactions to web-based learning may improve learners? educational experiences in web-based occupational therapy and continuing education. UR - https://mededu.jmir.org/2022/1/e31634 UR - http://dx.doi.org/10.2196/31634 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982719 ID - info:doi/10.2196/31634 ER - TY - JOUR AU - Burgon, Trever AU - Casebeer, Linda AU - Aasen, Holly AU - Valdenor, Czarlota AU - Tamondong-Lachica, Diana AU - de Belen, Enrico AU - Paculdo, David AU - Peabody, John PY - 2021/12/23 TI - Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial JO - J Med Internet Res SP - e31042 VL - 23 IS - 12 KW - quality improvement KW - physician engagement KW - MIPS KW - case simulation KW - feedback KW - value-based care KW - care standardization KW - simulation KW - gamification KW - medical education KW - continuing education KW - outcome KW - serious game KW - decision-support N2 - Background: Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. Objective: In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). Methods: We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians ?cared? for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. Results: We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<.001) and osteoarthritis (+7.6%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. Conclusions: Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. Trial Registration: ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901 UR - https://www.jmir.org/2021/12/e31042 UR - http://dx.doi.org/10.2196/31042 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941547 ID - info:doi/10.2196/31042 ER - TY - JOUR AU - Bouamra, Benjamin AU - Chakroun, Karim AU - Medeiros De Bustos, Elisabeth AU - Dobson, Jennifer AU - Rouge, Jeanne-Antide AU - Moulin, Thierry PY - 2021/12/22 TI - Simulation-Based Teaching of Telemedicine for Future Users of Teleconsultation and Tele-Expertise: Feasibility Study JO - JMIR Med Educ SP - e30440 VL - 7 IS - 4 KW - telemedicine KW - teleconsultation KW - simulation training KW - health care KW - training KW - education KW - digital training KW - medical education N2 - Background: Health care professionals worldwide are increasingly using telemedicine in their daily clinical practice. However, there is still a lack of dedicated education and training even though it is needed to improve the quality of the diverse range of telemedicine activities. Simulation-based training may be a useful tool in telemedicine education and training delivery. Objective: This study aims to assess the feasibility and acceptability of simulation-based telemedicine training. Methods: We assessed five telemedicine training sessions conducted in a simulation laboratory. The training was focused on video teleconsultations between a patient and a health care professional. The assessment included the participants? satisfaction and attitudes toward the training. Results: We included 29 participants in total. Participant satisfaction was high (mean score 4.9 of 5), and those that took part stated the high applicability of the simulation-based training to their telemedicine practices (mean score 4.6 of 5). They also stated that they intended to use telemedicine in the future (mean score 4.5 of 5). Conclusions: Simulation-based training of telemedicine dedicated to video teleconsultation was feasible and showed high satisfaction from participants. However, it remains difficult to scale for a high number of health care professionals. UR - https://mededu.jmir.org/2021/4/e30440 UR - http://dx.doi.org/10.2196/30440 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941553 ID - info:doi/10.2196/30440 ER - TY - JOUR AU - Collins-Pisano, Caroline AU - Velez Court, Juan AU - Johnson, Michael AU - Mois, George AU - Brooks, Jessica AU - Myers, Amanda AU - Muralidharan, Anjana AU - Storm, Marianne AU - Wright, Maggie AU - Berger, Nancy AU - Kasper, Ann AU - Fox, Anthony AU - MacDonald, Sandi AU - Schultze, Sarah AU - Fortuna, Karen PY - 2021/12/16 TI - Core Competencies to Promote Consistency and Standardization of Best Practices for Digital Peer Support: Focus Group Study JO - JMIR Ment Health SP - e30221 VL - 8 IS - 12 KW - COVID-19 KW - peer support KW - competencies KW - training KW - digital N2 - Background: As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective: The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods: Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results: Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions: The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). UR - https://mental.jmir.org/2021/12/e30221 UR - http://dx.doi.org/10.2196/30221 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736223 ID - info:doi/10.2196/30221 ER - TY - JOUR AU - Darnell, Doyanne AU - Areán, A. Patricia AU - Dorsey, Shannon AU - Atkins, C. David AU - Tanana, J. Michael AU - Hirsch, Tad AU - Mooney, D. Sean AU - Boudreaux, D. Edwin AU - Comtois, Anne Katherine PY - 2021/12/15 TI - Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research JO - JMIR Res Protoc SP - e33695 VL - 10 IS - 12 KW - suicide prevention KW - hospital KW - training KW - e-learning KW - artificial intelligence KW - implementation science KW - user-centered design KW - task-shifting KW - quality assessment KW - fidelity N2 - Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence?based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/33695 UR - https://www.researchprotocols.org/2021/12/e33695 UR - http://dx.doi.org/10.2196/33695 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914618 ID - info:doi/10.2196/33695 ER - TY - JOUR AU - Luo, Yue AU - Li, Mei AU - Tang, Jian AU - Ren, JianLan AU - Zheng, Yu AU - Yu, XingLi AU - Jiang, LinRui AU - Fan, DingLin AU - Chen, YanHua PY - 2021/12/14 TI - Design of a Virtual Reality Interactive Training System for Public Health Emergency Preparedness for Major Emerging Infectious Diseases: Theory and Framework JO - JMIR Serious Games SP - e29956 VL - 9 IS - 4 KW - virtual reality KW - major emerging infectious diseases KW - emergency preparedness KW - interactive narrative theory KW - situated learning theory KW - human-computer interaction theory KW - emergency simulation KW - public health KW - training KW - VR KW - epidemic KW - medical education KW - education N2 - Background: Sufficient public health emergency preparedness (PHEP) is the key factor in effectively responding to and recovering from major emerging infectious diseases (MEIDs). However, in the face of MEIDs, PHEP is insufficient, so it is necessary to improve PHEP. The rapid development of virtual reality and human-computer interaction provides unprecedented opportunities for innovative educational methods. Objective: This study designed a virtual reality interactive training system (VRITS) to provide an effective path for improving PHEP in the context of MEIDs so that the public can effectively respond to and recover from MEIDs. Methods: This study used interactive narrative, situated learning and human-computer interaction theories as a theoretical framework to guide the design of the system. We used the literature research method and the Delphi method; consulted multidisciplinary experts, such as infectious diseases, disease control, psychology, and public health personnel, to determine the educational content framework; and set up an interdisciplinary team to construct an operating system framework for the VRITS. Results: We named the VRITS ?People?s War Against Pandemic.? The educational content framework includes 20 knowledge, emotion, and behavior skills in 5 aspects (cooperating with prevention and control work, improving emergency response ability, guaranteeing supplies and equipment, preparing economic resources, and maintaining physical and mental health). The operating system framework includes virtual interactive training, knowledge corner, intelligent evaluation, and community forum modules, and the core module is the virtual interactive training module. In this module, users control virtual characters to move in various scenes, and then identify and analyze the controllability and harmfulness of the evolving pandemic and select the correct prevention and control strategy to avoid infecting themselves and others. Conclusions: The development and sharing of the multidisciplinary theoretical framework adopted by People?s War Against Pandemic can help us clarify the design ideas and assumptions of the VRITS; predict training results; understand the ability of training to change emergency knowledge, emergency emotion, and behavioral responses to MEIDs; and promote the development of more effective training systems based on virtual reality. UR - https://games.jmir.org/2021/4/e29956 UR - http://dx.doi.org/10.2196/29956 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904951 ID - info:doi/10.2196/29956 ER - TY - JOUR AU - Sinnenberg, Lauren AU - Umscheid, A. Craig AU - Shofer, S. Frances AU - Leri, Damien AU - Meisel, F. Zachary PY - 2021/12/13 TI - Communicating Guideline Recommendations Using Graphic Narrative Versus Text-Based Broadcast Screensavers: Design and Implementation Study JO - JMIR Hum Factors SP - e27171 VL - 8 IS - 4 KW - medical informatics KW - screensaver KW - guideline dissemination KW - graphic narratives KW - health communication KW - workstation KW - clinical workstation KW - guidelines KW - medical education KW - education N2 - Background: The use of graphic narratives, defined as stories that use images for narration, is growing in health communication. Objective: The aim of this study was to describe the design and implementation of a graphic narrative screensaver (GNS) to communicate a guideline recommendation (ie, avoiding low-value acid suppressive therapy [AST] use in hospital inpatients) and examine the comparative effectiveness of the GNS versus a text-based screensaver (TBS) on clinical practice (ie, low-value AST prescriptions) and clinician recall. Methods: During a 2-year period, the GNS and the TBS were displayed on inpatient clinical workstations. The numbers of new AST prescriptions were examined in the four quarters before, the three quarters during, and the one quarter after screensavers were implemented. Additionally, an electronic survey was sent to resident physicians 1 year after the intervention to assess screensaver recall. Results: Designing an aesthetically engaging graphic that could be rapidly understood was critical in the development of the GNS. The odds of receiving an AST prescription on medicine and medicine subspecialty services after the screensavers were implemented were lower for all four quarters (ie, GNS and TBS broadcast together, only TBS broadcast, only GNS broadcast, and no AST screensavers broadcast) compared to the quarter prior to implementation (odds ratio [OR] 0.85, 95% CI 0.78-0.92; OR 0.89, 95% CI 0.82-0.97; OR 0.87, 95% CI 0.80-0.95; and OR 0.81, 95% CI 0.75-0.89, respectively; P<.001 for all comparisons). There were no statistically significant decreases for other high-volume services, such as the surgical services. These declines appear to have begun prior to screensaver implementation. When surveyed about the screensaver content 1 year later, resident physicians recalled both the GNS and TBS (43/70, 61%, vs 54/70, 77%; P=.07) and those who recalled the screensaver were more likely to recall the main message of the GNS compared to the TBS (30/43, 70%, vs 1/54, 2%; P<.001). Conclusions: It is feasible to use a graphic narrative embedded in a broadcast screensaver to communicate a guideline recommendation, but further study is needed to determine the impact of graphic narratives on clinical practice. UR - https://humanfactors.jmir.org/2021/4/e27171 UR - http://dx.doi.org/10.2196/27171 UR - http://www.ncbi.nlm.nih.gov/pubmed/34264197 ID - info:doi/10.2196/27171 ER - TY - JOUR AU - Massanelli, Jackson AU - Sexton, W. Kevin AU - Lesher, T. Chris AU - Jensen, K. Hanna AU - Kimbrough, K. Mary AU - Privratsky, Anna AU - Taylor, R. John AU - Bhavaraju, Avi PY - 2021/12/13 TI - Integration of Web Analytics Into Graduate Medical Education: Usability Study JO - JMIR Form Res SP - e29748 VL - 5 IS - 12 KW - graduate medical education KW - website analysis KW - residency recruitment KW - medical education KW - website KW - analytics KW - usage KW - usability KW - user engagement KW - user-centered design KW - website design N2 - Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department?s website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website?s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. UR - https://formative.jmir.org/2021/12/e29748 UR - http://dx.doi.org/10.2196/29748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898459 ID - info:doi/10.2196/29748 ER - TY - JOUR AU - Claflin, B. Suzi AU - Campbell, A. Julie AU - Doherty, Kathleen AU - Farrow, Maree AU - Bessing, Barnabas AU - Taylor, V. Bruce PY - 2021/12/7 TI - Evaluating Course Completion, Appropriateness, and Burden in the Understanding Multiple Sclerosis Massive Open Online Course: Cohort Study JO - J Med Internet Res SP - e21681 VL - 23 IS - 12 KW - multiple sclerosis KW - massive open online course KW - health promotion KW - eHealth education KW - mobile phone N2 - Background: Massive open online course (MOOC) research is an emerging field; to date, most research in this area has focused on participant engagement. Objective: The aim of this study is to evaluate both participant engagement and measures of satisfaction, appropriateness, and burden for a MOOC entitled Understanding Multiple Sclerosis (MS) among a cohort of 3518 international course participants. Methods: We assessed the association of key outcomes with participant education level, MS status, caregiver status, sex, and age using summary statistics, and 2-tailed t tests, and chi-square tests. Results: Of the 3518 study participants, 928 (26.37%) were people living with MS. Among the 2590 participants not living with MS, 862 (33.28%) identified as formal or informal caregivers. Our key findings were as follows: the course completion rate among study participants was 67.17% (2363/3518); the course was well received, with 96.97% (1502/1549) of participants satisfied, with an appropriate pitch and low burden (a mean of 2.2 hours engagement per week); people living with MS were less likely than those not living with MS to complete the course; and people with a recent diagnosis of MS, caregivers, and participants without a university education were more likely to apply the material by course completion. Conclusions: The Understanding MS MOOC is fit for purpose; it presents information in a way that is readily understood by course participants and is applicable in their lives. UR - https://www.jmir.org/2021/12/e21681 UR - http://dx.doi.org/10.2196/21681 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878985 ID - info:doi/10.2196/21681 ER - TY - JOUR AU - Goldin, Shoshanna AU - Kong, Joyce So Yeon AU - Tokar, Anna AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Bahl, Jhilmil AU - Appuhamy, Ranil AU - Moen, Ann PY - 2021/12/3 TI - Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study JO - JMIR Public Health Surveill SP - e33455 VL - 7 IS - 12 KW - COVID-19 KW - vaccination KW - training KW - massive open online course KW - pandemic KW - vaccine KW - education KW - online education KW - preparation KW - evaluation KW - user experience KW - challenge KW - impact KW - knowledge KW - interest N2 - Background: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. Objective: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. Methods: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform?s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. Results: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. Conclusions: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout. UR - https://publichealth.jmir.org/2021/12/e33455 UR - http://dx.doi.org/10.2196/33455 UR - http://www.ncbi.nlm.nih.gov/pubmed/34794116 ID - info:doi/10.2196/33455 ER - TY - JOUR AU - Jorge, Serafim Ana Elisa AU - Bennell, Louise Kim AU - Kimp, Jared Alexander AU - Campbell, Kate Penny AU - Hinman, Shane Rana PY - 2021/12/1 TI - An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data JO - JMIR Med Educ SP - e30378 VL - 7 IS - 4 KW - osteoarthritis KW - knee KW - physiotherapy KW - exercise KW - e-learning KW - telehealth KW - pain KW - education KW - implementation KW - evaluation KW - professional development KW - rehabilitation N2 - Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown. Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules. Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion. Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65% (2463/6720) commencing the program and precourse survey and 19.61% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3%) and patient information booklets in their clinical practice (75/142, 52.8%). Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning. UR - https://mededu.jmir.org/2021/4/e30378 UR - http://dx.doi.org/10.2196/30378 UR - http://www.ncbi.nlm.nih.gov/pubmed/34587585 ID - info:doi/10.2196/30378 ER - TY - JOUR AU - Chao, Yi-Ping AU - Chuang, Hai-Hua AU - Hsin, Li-Jen AU - Kang, Chung-Jan AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu AU - Huang, Chung-Guei AU - Kuo, J. Terry B. AU - Yang, H. Cheryl C. AU - Shyu, Hsin-Yih AU - Wang, Shu-Ling AU - Shyu, Liang-Yu AU - Lee, Li-Ang PY - 2021/11/22 TI - Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e13124 VL - 9 IS - 4 KW - cognitive load KW - heart rate variability KW - video learning KW - learning outcome KW - secondary-task reaction time KW - virtual reality N2 - Background: Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective: The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods: This pilot system?design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. Results: All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ?3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ?3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ?3.6 seconds was not related to a Milestone level of ?3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ?1.43 seemed to be inversely associated with a hedonic stimulation score of ?2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. Conclusions: Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners? needs and prompted learning through the different video modules. Trial Registration: ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 UR - https://games.jmir.org/2021/4/e13124 UR - http://dx.doi.org/10.2196/13124 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813485 ID - info:doi/10.2196/13124 ER - TY - JOUR AU - Vuku?i? Rukavina, Tea AU - Viski?, Jo?ko AU - Machala Popla?en, Lovela AU - Reli?, Danko AU - Mareli?, Marko AU - Jokic, Drazen AU - Sedak, Kristijan PY - 2021/11/17 TI - Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review JO - J Med Internet Res SP - e25770 VL - 23 IS - 11 KW - e-professionalism KW - social media KW - internet KW - health care professionals KW - physicians KW - nurses KW - students KW - medicine KW - dental medicine KW - nursing N2 - Background: As we are witnessing the evolution of social media (SM) use worldwide among the general population, the popularity of SM has also been embraced by health care professionals (HCPs). In the context of SM evolution and exponential growth of users, this scoping review summarizes recent findings of the e-professionalism of HCPs. Objective: The purpose of this scoping review is to characterize the recent original peer-reviewed research studies published between November 1, 2014, to December 31, 2020, on e-professionalism of HCPs; to assess the quality of the methodologies and approaches used; to explore the impact of SM on e-professionalism of HCPs; to recognize the benefits and dangers of SM; and to provide insights to guide future research in this area. Methods: A search of the literature published from November 1, 2014, to December 31, 2020, was performed in January 2021 using 3 databases (PubMed, CINAHL, and Scopus). The searches were conducted using the following defined search terms: ?professionalism? AND ?social media? OR ?social networks? OR ?Internet? OR ?Facebook? OR ?Twitter? OR ?Instagram? OR ?TikTok.? The search strategy was limited to studies published in English. This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: Of the 1632 retrieved papers, a total of 88 studies were finally included in this review. Overall, the quality of the studies was satisfactory. Participants in the reviewed studies were from diverse health care professions. Medical health professionals were involved in about three-quarters of the studies. Three key benefits of SM on e-professionalism of HCPs were identified: (1) professional networking and collaboration, (2) professional education and training, and (3) patient education and health promotion. For the selected studies, there were five recognized dangers of SM on e-professionalism of HCPs: (1) loosening accountability, (2) compromising confidentiality, (3) blurred professional boundaries, (4) depiction of unprofessional behavior, and (5) legal issues and disciplinary consequences. This scoping review also recognizes recommendations for changes in educational curricula regarding e-professionalism as opportunities for improvement and barriers that influence HCPs use of SM in the context of e-professionalism. Conclusions: Findings in the reviewed studies indicate the existence of both benefits and dangers of SM on e-professionalism of HCPs. Even though there are some barriers recognized, this review has highlighted existing recommendations for including e-professionalism in the educational curricula of HCPs. Based on all evidence provided, this review provided new insights and guides for future research on this area. There is a clear need for robust research to investigate new emerging SM platforms, the efficiency of guidelines and educational interventions, and the specifics of each profession regarding their SM potential and use. UR - https://www.jmir.org/2021/11/e25770 UR - http://dx.doi.org/10.2196/25770 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662284 ID - info:doi/10.2196/25770 ER - TY - JOUR AU - Peng, R. Cynthia AU - Schertzer, A. Kimberly AU - Caretta-Weyer, A. Holly AU - Sebok-Syer, S. Stefanie AU - Lu, William AU - Tansomboon, Charissa AU - Gisondi, A. Michael PY - 2021/11/17 TI - Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study JO - JMIR Med Educ SP - e32356 VL - 7 IS - 4 KW - simulation KW - graduate medical education KW - assessment KW - gamification KW - entrustable professional activities KW - emergency medicine KW - undergraduate medical education N2 - Background: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 ?look for? statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results: All participants had at least one missing critical action, and 40% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54%). Other errors included selecting incorrect documentation passages (6/15, 40%) and indiscriminately applying oxygen (9/15, 60%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans. UR - https://mededu.jmir.org/2021/4/e32356 UR - http://dx.doi.org/10.2196/32356 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787582 ID - info:doi/10.2196/32356 ER - TY - JOUR AU - Stunden, Chelsea AU - Zakani, Sima AU - Martin, Avery AU - Moodley, Shreya AU - Jacob, John PY - 2021/11/17 TI - Replicating Anatomical Teaching Specimens Using 3D Modeling Embedded Within a Multimodal e-Learning Course: Pre-Post Study Exploring the Impact on Medical Education During COVID-19 JO - JMIR Med Educ SP - e30533 VL - 7 IS - 4 KW - congenital heart disease KW - cardiac anatomy, pathologic anatomy KW - education KW - learning aids KW - 3D models N2 - Background: The COVID-19 pandemic has had significant effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal method of learning anatomy. We created and tested a customized congenital heart disease e-learning course for medical students that contained interactive 3D models of anonymized pediatric congenital heart defects. Objective: The aim of this study is to assess whether a multimodal e-learning course contributed to learning outcomes in a cohort of first-year undergraduate medical students studying congenital heart diseases. The secondary aim is to assess student attitudes and experiences associated with multimodal e-learning. Methods: The pre-post study design involved 290 first-year undergraduate medical students. Recruitment was conducted by course instructors. Data were collected before and after using the course. The primary outcome was knowledge acquisition (test scores). The secondary outcomes included attitudes and experiences, time to complete the modules, and browser metadata. Results: A total of 141 students were included in the final analysis. Students? knowledge significantly improved by an average of 44.6% (63/141) when using the course (SD 1.7%; Z=?10.287; P<.001). Most students (108/122, 88.3%) were highly motivated to learn with the course, and most (114/122, 93.5%) reported positive experiences with the course. There was a strong correlation between attitudes and experiences, which was statistically significant (rs=0.687; P<.001; n=122). No relationships were found between the change in test scores and attitudes (P=.70) or experiences (P=.47). Students most frequently completed the e-learning course with Chrome (109/141, 77.3%) and on Apple macOS (86/141, 61%) or Windows 10 (52/141, 36.9%). Most students (117/141, 83%) had devices with high-definition screens. Most students (83/141, 58.9%) completed the course in <3 hours. Conclusions: Multimodal e-learning could be a viable solution in improving learning outcomes and experiences for undergraduate medical students who do not have access to cadavers. Future research should focus on validating long-term learning outcomes. UR - https://mededu.jmir.org/2021/4/e30533 UR - http://dx.doi.org/10.2196/30533 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787589 ID - info:doi/10.2196/30533 ER - TY - JOUR AU - Koenig, Leni Julia Felicitas AU - Buentzel, Judith AU - Jung, Wolfram AU - Truemper, Lorenz AU - Wurm-Kuczera, Isabel Rebecca PY - 2021/11/15 TI - Using Instagram to Enhance a Hematology and Oncology Teaching Module During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Med Educ SP - e30607 VL - 7 IS - 4 KW - COVID-19 KW - medical education KW - distance learning KW - undergraduate medical education KW - digital medical education KW - Instagram KW - hematology and medical oncology N2 - Background: The COVID-19 pandemic necessitated the rapid expansion of novel tools for digital medical education. At our university medical center, an Instagram account was developed as a tool for medical education and used for the first time as a supplement to the hematology and medical oncology teaching module of 2020/2021. Objective: We aimed to evaluate the acceptance and role of Instagram as a novel teaching format in the education of medical students in hematology and medical oncology in the German medical curriculum. Methods: To investigate the role of Instagram in student education of hematology and medical oncology, an Instagram account was developed as a tie-in for the teaching module of 2020/21. The account was launched at the beginning of the teaching module, and 43 posts were added over the 47 days of the teaching module (at least 1 post per day). Five categories for the post content were established: (1) engagement, (2) self-awareness, (3) everyday clinical life combined with teaching aids, (4) teaching aids, and (5) scientific resources. Student interaction with the posts was measured based on overall subscription, ?likes,? comments, and polls. Approval to conduct this retrospective study was obtained from the local ethics commission of the University Medical Center Goettingen. Results: Of 164 medical students, 119 (72.6%) subscribed to the Instagram account, showing high acceptance and interest in the use of Instagram for medical education. The 43 posts generated 325 interactions. The highest number of interactions was observed for the category of engagement (mean 15.17 interactions, SD 5.01), followed by self-awareness (mean 14 interactions, SD 7.79). With an average of 7.3 likes per post, overall interaction was relatively low. However, although the category of scientific resources garnered the fewest likes (mean 1.86, SD 1.81), 66% (27/41) of the student participants who answered the related Instagram poll question were interested in studies and reviews, suggesting that although likes aid the estimation of a general trend of interest, there are facets to interest that cannot be represented by likes. Interaction significantly differed between posting categories (P<.001, Welch analysis of variance). Comparing the first category (engagement) with categories 3 to 5 showed a significant difference (Student t test with the Welch correction; category 1 vs 3, P=.01; category 1 vs 4, P=.01; category 1 vs 5, P=.001). Conclusions: Instagram showed high acceptance among medical students participating in the hematology and oncology teaching curriculum. Students were most interested in posts on routine clinical life, self-care topics, and memory aids. More studies need to be conducted to comprehend the use of Instagram in medical education and to define the role Instagram will play in the future. Furthermore, evaluation guidelines and tools need to be developed. UR - https://mededu.jmir.org/2021/4/e30607 UR - http://dx.doi.org/10.2196/30607 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779777 ID - info:doi/10.2196/30607 ER - TY - JOUR AU - Karabacak, Mert AU - Ozkara, Berksu Burak AU - Ozcan, Zeynep PY - 2021/11/12 TI - Adjusting to the Reign of Webinars: Viewpoint JO - JMIR Med Educ SP - e33861 VL - 7 IS - 4 KW - virtual conference KW - student-based organization KW - neuroscience conference KW - COVID-19 KW - medical education KW - webinars KW - web-based education N2 - Background: With the integration of COVID-19 into our lives, the way events are organized has changed. The Cerrahpa?a Neuroscience Days held on May 8-9, 2021, was one of the conferences that was affected. The annual conference of the student-based Cerrahpa?a Neuroscience Society transitioned to the internet for the first time and had the premise of going international. Objective: With this study, we aim to both discuss how a virtual conference is organized and perceived, and where our conference stands within the literature as a completely student-organized event. Methods: The conference was planned in accordance with virtual standards and promoted to primarily medical schools. During the execution, there were no major issues. The feedback was collected via a form developed with Google Forms. Results: Out of 2195 registrations, 299 qualified to receive a certificate. The feedback forms revealed a general satisfaction; the overall quality of the event was rated an average of 4.6 out of 5, and the ratings of various Likert scale?based questions were statistically analyzed. Open-ended questions provided improvement suggestions for future events. Conclusions: The virtual Cerrahpa?a Neuroscience Days was a success in organization and received positive feedback from the participants. We aim to ground future events on this experience. UR - https://mededu.jmir.org/2021/4/e33861 UR - http://dx.doi.org/10.2196/33861 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766916 ID - info:doi/10.2196/33861 ER - TY - JOUR AU - Zuo, Tianming AU - Sun, Baozhi AU - Guan, Xu AU - Zheng, Bin AU - Qu, Bo PY - 2021/11/9 TI - Evidence of Construct Validity of Computer-Based Tests for Clinical Reasoning: Instrument Validation Study JO - JMIR Serious Games SP - e17670 VL - 9 IS - 4 KW - medical education KW - assessment KW - computer-based test KW - clinical reasoning KW - validity N2 - Background: Clinical reasoning (CR) is a fundamental skill for all medical students. In our medical education system, however, there are shortcomings in the conventional methods of teaching CR. New technology is needed to enhance our CR teaching, especially as we are facing an influx of new health trainees. China Medical University (CMU), in response to this need, has developed a computer-based CR training system (CMU-CBCRT). Objective: We aimed to find evidence of construct validity of the CMU-CBCRT. Methods: We recruited 385 students from fifth year undergraduates to postgraduate year (PGY) 3 to complete the test on CMU-CBCRT. The known-groups technique was used to evaluate the construct validity of the CBCRT by comparing the test scores among 4 training levels (fifth year MD, PGY-1, PGY-2, and PGY-3). Results: We found that test scores increased with years of training. Significant differences were found in the test scores on information collection, diagnosis, and treatment and total scores among different training years of participants. However, significant results were not found for treatment errors. Conclusions: We provided evidence of construct validity of the CMU-CBCRT, which could determine the CR skills of medical students at varying early stage in their careers. UR - https://games.jmir.org/2021/4/e17670 UR - http://dx.doi.org/10.2196/17670 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751658 ID - info:doi/10.2196/17670 ER - TY - JOUR AU - Lin, Yuchen AU - Lemos, Martin AU - Neuschaefer-Rube, Christiane PY - 2021/11/5 TI - Digital Health and Digital Learning Experiences Across Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary Survey Study JO - JMIR Med Educ SP - e30873 VL - 7 IS - 4 KW - digital learning KW - e-learning KW - speech-language pathology KW - phoniatrics KW - otolaryngology KW - communication disorders KW - mobile phone N2 - Background: Advances in digital health and digital learning are transforming the lives of patients, health care providers, and health professional students. In the interdisciplinary field of communication sciences and disorders (CSD), digital uptake and incorporation of digital topics and technologies into clinical training programs has lagged behind other medical fields. There is a need to understand professional and student experiences, opinions, and needs regarding digital health and learning topics so that effective strategies for implementation can be optimized. Objective: This cross-sectional survey study aims to interdisciplinarily investigate professional and student knowledge, use, attitudes, and preferences toward digital health and learning in the German-speaking population. Methods: An open-ended, web-based survey was developed and conducted with professionals and students in CSD including phoniatricians and otolaryngologists, speech-language pathologists (German: Logopäd*innen), medical students, and speech-language pathology students. Differences in knowledge, use, attitudes, and preferences across profession, generation, and years of experience were analyzed. Results: A total of 170 participants completed the survey. Respondents demonstrated greater familiarity with digital learning as opposed to eHealth concepts. Significant differences were noted across profession (P<.001), generation (P=.001), and years of experience (P<.001), which demonstrated that students and younger participants were less familiar with digital health terminology. Professional (P<.001) and generational differences were also found (P=.04) in knowledge of digital therapy tools, though no significant differences were found for digital learning tools. Participants primarily used computers, tablets, and mobile phones; non?eHealth-specific tools (eg, word processing and videoconferencing applications); and digital formats such as videos, web courses, and apps. Many indicated a desire for more interactive platforms, such as virtual reality. Significant differences were found across generations for positive views toward digitalization (P<.001) and across profession for feelings of preparedness (P=.04). Interestingly, across profession (P=.03), generation (P=.006), and years of experience (P=.01), students and younger participants demonstrated greater support for medical certification. Commonly reported areas of concern included technical difficulties, quality and validity of digital materials, data privacy, and social presence. Respondents tended to prefer blended learning, a limited to moderate level of interactivity, and time and space?flexible learning environments (63/170, 37.1%), with a notable proportion still preferring traditional time and space?dependent learning (49/170, 28.8%). Conclusions: This comprehensive investigation into the current state of CSD student and professional opinions and experiences has shown that incorporation of digital topics and skills into academic and professional development curricula will be crucial for ensuring that the field is prepared for the ever-digitalizing health care environment. Deeper empirical investigation into efficacy and acceptance of digital learning and practice strategies and systematic training and practical organizational supports must be planned to ensure adaptive education and practice. UR - https://mededu.jmir.org/2021/4/e30873 UR - http://dx.doi.org/10.2196/30873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34738911 ID - info:doi/10.2196/30873 ER - TY - JOUR AU - Meuwly, Jean-Yves AU - Mandralis, Katerina AU - Tenisch, Estelle AU - Gullo, Giuseppe AU - Frossard, Pierre AU - Morend, Laura PY - 2021/11/1 TI - Use of an Online Ultrasound Simulator to Teach Basic Psychomotor Skills to Medical Students During the Initial COVID-19 Lockdown: Quality Control Study JO - JMIR Med Educ SP - e31132 VL - 7 IS - 4 KW - anatomy KW - computers in anatomical education KW - internet application in anatomy KW - medical education KW - ultrasonography KW - ultrasound KW - simulation KW - simulator KW - psychomotor KW - motor skills KW - medical students KW - teaching N2 - Background: Teaching medical ultrasound has increased in popularity in medical schools with hands-on workshops as an essential part of teaching. However, the lockdown due to COVID-19 kept medical schools from conducting these workshops. Objective: The aim of this paper is to describe an alternative method used by our medical school to allow our students to acquire the essential psychomotor skills to produce ultrasound images. Methods: Our students took online ultrasound courses. Consequently, they had to practice ultrasound exercises on a virtual simulator, using the mouse of their computer to control a simulated transducer. Our team measured the precision reached at the completion of simulation exercises. Before and after completion of the courses and simulator?s exercises, students had to complete a questionnaire dedicated to psychomotor skills. A general evaluation questionnaire was also submitted. Results: A total of 193 students returned the precourse questionnaire. A total of 184 performed all the simulator exercises and 181 answered the postcourse questionnaire. Of the 180 general evaluation questionnaires that were sent out, 136 (76%) were returned. The average precourse score was 4.23 (SD 2.14). After exercising, the average postcourse score was 6.36 (SD 1.82), with a significant improvement (P<.001). The postcourse score was related to the accuracy with which the simulator exercises were performed (Spearman rho 0.2664; P<.001). Nearly two-thirds (n=84, 62.6%) of the students said they enjoyed working on the simulator. A total of 79 (58.0%) students felt that they had achieved the course?s objective of reproducing ultrasound images. Inadequate connection speed had been a problem for 40.2% (n=54) of students. Conclusions: The integration of an online simulator for the practical learning of ultrasound in remote learning situations has allowed for substantial acquisitions in the psychomotor field of ultrasound diagnosis. Despite the absence of workshops, the students were able to learn and practice how to handle an ultrasound probe to reproduce standard images. This study enhances the value of online programs in medical education, even for practical skills. UR - https://mededu.jmir.org/2021/4/e31132 UR - http://dx.doi.org/10.2196/31132 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723818 ID - info:doi/10.2196/31132 ER - TY - JOUR AU - Srivastava, Ujwal AU - Price, Amy AU - Chu, F. Larry PY - 2021/10/27 TI - Effects of a 2-Week Remote Learning Program on Empathy and Clinical and Communication Skills in Premedical Students: Mixed Methods Evaluation Study JO - JMIR Med Educ SP - e33090 VL - 7 IS - 4 KW - empathy KW - clinical skills KW - communication skills KW - high school KW - undergraduate KW - summer program KW - premedical program KW - remote learning N2 - Background: Expressing empathy builds trust with patients, increases patient satisfaction, and is associated with better health outcomes. Research shows that expressing empathy to patients improves patient adherence to medications and decreases patient anxiety and the number of malpractice lawsuits. However, there is a dearth of research on teaching empathy to premedical students. The Clinical Science, Technology, and Medicine Summer Internship of Stanford Medicine (also called the Stanford Anesthesia Summer Institute) is a 2-week collaborative medical internship for high school and undergraduate students to inspire learners to be compassionate health care providers. The summer 2020 program was adapted to accomplish these objectives in a fully remote environment because of the COVID-19 global pandemic. Objective: This study aims to measure the change in empathy and competencies of participants in clinical and communication skills before and after program participation. Methods: A total of 41 participants completed only the core track of this program, and 39 participants completed the core + research track of this program. Participants in both tracks received instructions in selected clinical skills and interacted directly with patients to improve their interviewing skills. Research track participants received additional instructions in research methodology. All participants completed web-based pre- and postsurveys containing Knowledge and Skills Assessment (KSA) questions. Participant empathy was assessed using the validated Consultation and Relational Empathy measure. A subset of participants completed optional focus groups to discuss empathy. The pre- and post-KSA and Consultation and Relational Empathy measure scores were compared using paired 2-tailed t tests and a linear regression model. Open-ended focus group answers were then analyzed thematically. Results: Participants in both tracks demonstrated significant improvement in empathy after the 2-week remote learning course (P=.007 in core track; P<.001 in research track). These results remained significant when controlling for gender and age. A lower pretest score was associated with a greater change in empathy. Participants in both tracks demonstrated significant improvement in KSA questions related to surgical skills (P<.001 in core track; P<.001 in research track), epinephrine pen use (P<.001 in core track; P<.001 in research track), x-ray image interpretation (P<.001 in core track; P<.001 in research track), and synthesizing information to solve problems (P<.001 in core track; P=.05 in research track). The core track participants also showed significant improvements in health communication skills (P=.001). Qualitative analysis yielded 3 themes: empathy as action, empathy as a mindset, and empathy in designing health care systems. Conclusions: Summer internships that introduce high school and undergraduate students to the field of health care through hands-on interaction and patient involvement may be an effective way to develop measurable empathy skills when combined with clinical skills training and mentorship. Notably, increases in empathy were observed in a program administered via a remote learning environment. UR - https://mededu.jmir.org/2021/4/e33090 UR - http://dx.doi.org/10.2196/33090 UR - http://www.ncbi.nlm.nih.gov/pubmed/34704956 ID - info:doi/10.2196/33090 ER - TY - JOUR AU - Jeyakumar, Tharshini AU - Ambata-Villanueva, Sharon AU - McClure, Sarah AU - Henderson, Carolyn AU - Wiljer, David PY - 2021/10/22 TI - Best Practices for the Implementation and Sustainment of Virtual Health Information System Training: Qualitative Study JO - JMIR Med Educ SP - e30613 VL - 7 IS - 4 KW - training KW - health care providers KW - educational technology KW - patient care KW - COVID-19 KW - development KW - practice KW - best practice KW - pedagogy KW - teaching KW - implementation KW - medical education KW - online education KW - care delivery KW - perception KW - effectiveness N2 - Background: The COVID-19 pandemic has necessitated the adoption and implementation of digital technologies to help transform the educational ecosystem and the delivery of care. Objective: We sought to understand instructors? and learners? perceptions of the challenges and opportunities faced in implementing health information system virtual training amid the COVID-19 pandemic. Methods: Semistructured interviews were conducted with education specialists and health care staff who provided or had taken part in a virtual instructor-led training at a large Canadian academic health sciences center. Guided by the Technology Acceptance Model and the Community of Inquiry framework, we analyzed interview transcript themes deductively and inductively. Results: Of the 18 individuals participating in the study, 9 were education specialists, 5 were learners, 3 were program coordinators, and 1 was a senior manager at the Centre for Learning, Innovation, and Simulation. We found 3 predominant themes: adopting a learner-centered approach for a meaningful learning experience, embracing the advances in educational technologies to maximize the transfer of learning, and enhancing the virtual user experience. Conclusions: This study adds to the literature on designing and implementing virtual training in health care organizations by highlighting the importance of recognizing learners? needs and maximizing the transfer of learning. Findings from this study can be used to help inform the design and development of training strategies to support learners across an organization during the current climate and to ensure changes are sustainable. UR - https://mededu.jmir.org/2021/4/e30613 UR - http://dx.doi.org/10.2196/30613 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449402 ID - info:doi/10.2196/30613 ER - TY - JOUR AU - Jordan, Louanne Chloe AU - Sathaananthan, Thillainathan AU - Celi, Anthony Leo AU - Jones, Linda AU - Alagha, Abdulhadi M. PY - 2021/10/18 TI - The Use of a Formative Pedagogy Lens to Enhance and Maintain Virtual Supervisory Relationships: Appreciative Inquiry and Critical Review JO - JMIR Med Educ SP - e26251 VL - 7 IS - 4 KW - medical education KW - virtual learning KW - formative pedagogy KW - supervisory relationships KW - pedagogy KW - mentors KW - education KW - virtual education KW - teaching KW - online platforms KW - web-based N2 - Background: Virtual supervisory relationships provide an infrastructure for flexible learning, global accessibility, and outreach, connecting individuals worldwide. The surge in web-based educational activities in recent years provides an opportunity to understand the attributes of an effective supervisor-student or mentor-student relationship. Objective: The aim of this study is to compare the published literature (through a critical review) with our collective experiences (using small-scale appreciative inquiry [AI]) in an effort to structure and identify the dilemmas and opportunities for virtual supervisory and mentoring relationships, both in terms of stakeholder attributes and skills as well as providing instructional recommendations to enhance virtual learning. Methods: A critical review of the literature was conducted followed by an AI of reflections by the authors. The AI questions were derived from the 4D AI framework. Results: Despite the multitude of differences between face-to-face and web-based supervision and mentoring, four key dilemmas seem to influence the experiences of stakeholders involved in virtual learning: informal discourses and approachability of mentors; effective virtual communication strategies; authenticity, trust, and work ethics; and sense of self and cultural considerations. Conclusions: Virtual mentorship or supervision can be as equally rewarding as an in-person relationship. However, its successful implementation requires active acknowledgment of learners? needs and careful consideration to develop effective and mutually beneficial student-educator relationships. UR - https://mededu.jmir.org/2021/4/e26251 UR - http://dx.doi.org/10.2196/26251 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661542 ID - info:doi/10.2196/26251 ER - TY - JOUR AU - Zlamal, Jaroslav AU - Gjevjon, Roth Edith AU - Fossum, Mariann AU - Steindal, Alexander Simen AU - Nes, Gonçalves Andréa Aparecida PY - 2021/10/13 TI - Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Protocol of an Exploratory, Flexible Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e31646 VL - 10 IS - 10 KW - critical thinking KW - guidance model KW - feasibility KW - technology KW - medical education KW - nursing education KW - clinical practice N2 - Background: Critical thinking is an essential set of skills in nursing education, and nursing education therefore needs a sharper focus on effective ways to support the development of these skills, especially through the implementation of technological tools in nursing education. Objective: The aim of this study protocol is to assess the feasibility of a technology-supported guidance model grounded in the metacognition theory for nursing students in clinical practice. Methods: Both quantitative (research questionnaires) and qualitative (focus group interviews) approaches will be used to collect data for a feasibility study with an exploratory, flexible mixed methods design to test a newly developed intervention in clinical practice. Results: The intervention development was completed in December 2020. The intervention will be tested in 3 independent nursing homes in Norway. Conclusions: By determining the feasibility of a technology-supported guidance model for nursing students in clinical practice, the results will provide information on the acceptability of the intervention and the suitability of the outcome measures and data collection strategy. They will also identify the causes of dropout and obstacles to retention and adherence. International Registered Report Identifier (IRRID): DERR1-10.2196/31646 UR - https://www.researchprotocols.org/2021/10/e31646 UR - http://dx.doi.org/10.2196/31646 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643536 ID - info:doi/10.2196/31646 ER - TY - JOUR AU - Haruna, Hussein AU - Okoye, Kingsley AU - Zainuddin, Zamzami AU - Hu, Xiao AU - Chu, Samuel AU - Hosseini, Samira PY - 2021/10/12 TI - Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study JO - JMIR Serious Games SP - e19614 VL - 9 IS - 4 KW - gamified instruction KW - serious gaming KW - gamification KW - educational innovation KW - teenage students KW - digital generation KW - e-learning KW - low-tech setting N2 - Background: Sexual education has become increasingly important as unhealthy sexual practices and subsequent health risks become more prevalent during adolescence. Traditional sex education teaching methodologies are limiting for digital natives exposed to various digital technologies. Harnessing the power of technology applications attractive to the younger generation may be a useful approach for teaching sex education. Objective: The aim of this study was to improve sexual health knowledge and understanding of the problems associated with unhealthy sexual practices and address sexual and reproductive health challenges experienced in a low-tech setting. Methods: A participatory design approach was used to develop the digital gamified methodology. A sample of 120 secondary school students aged 11-15 were randomly assigned to either experimental or control group for each of the 3 teaching approaches: (1) gamified instruction (actual serious games [SG] in teaching); (2) gamification (GM; making nongames, such as game-like learning); and (3) traditional teaching (TT) methods. Results: The SG and GM approaches were more effective than TT methods in teaching sexual health education. Specifically, the average scores across groups demonstrated an increase of mean scores from the pre- to posttest (25.10 [SD 5.50] versus 75.86 [SD 13.16]; t119=41.252; P<.001 [2 tailed]). Analysis of variance indicated no significant differences across groups for pretest scores (F2,117=1.048, P=.35). Significant differences across groups were evident in the posttest scores. Students in the SG and GM groups had higher average scores than the TT group (F2,117=83.98; P<.001). Students reported increased learning motivation, attitude, know-how, and participation in learning (P<.001) when using SG and GM approaches. Conclusions: Digital health technologies (particularly teaching and learning through gamified instruction and other novel approaches) may improve sexual health education. These findings may also be applied by practitioners in health care settings and by researchers wishing to further the development of sex education. UR - https://games.jmir.org/2021/4/e19614 UR - http://dx.doi.org/10.2196/19614 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636739 ID - info:doi/10.2196/19614 ER - TY - JOUR AU - Nakanishi, Miharu AU - Yamasaki, Syudo AU - Endo, Kaori AU - Niimura, Junko AU - Ziylan, Canan AU - Bakker, M. Ton J. E. AU - Granvik, Eva AU - Nägga, Katarina AU - Nishida, Atsushi PY - 2021/10/12 TI - e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study JO - JMIR Med Educ SP - e30652 VL - 7 IS - 4 KW - dementia KW - home care services KW - implementation science KW - nursing homes KW - web-based tool N2 - Background: Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. Objective: The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. Methods: A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. Results: A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (?21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=?0.61, P=.69). Conclusions: The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated. UR - https://mededu.jmir.org/2021/4/e30652 UR - http://dx.doi.org/10.2196/30652 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543224 ID - info:doi/10.2196/30652 ER - TY - JOUR AU - Birrenbach, Tanja AU - Zbinden, Josua AU - Papagiannakis, George AU - Exadaktylos, K. Aristomenis AU - Müller, Martin AU - Hautz, E. Wolf AU - Sauter, Christian Thomas PY - 2021/10/8 TI - Effectiveness and Utility of Virtual Reality Simulation as an Educational Tool for Safe Performance of COVID-19 Diagnostics: Prospective, Randomized Pilot Trial JO - JMIR Serious Games SP - e29586 VL - 9 IS - 4 KW - virtual reality KW - VR KW - simulation KW - medical education KW - hand hygiene KW - COVID-19 KW - PPE KW - nasopharyngeal swab KW - protection KW - effectiveness KW - utility KW - diagnostic KW - testing KW - pilot study N2 - Background: Although the proper use of hygiene and personal protective equipment (PPE) is paramount for preventing the spread of diseases such as COVID-19, health care personnel have been shown to use incorrect techniques for donning/doffing of PPE and hand hygiene, leading to a large number of infections among health professionals. Education and training are difficult owing to the social distancing restrictions in place, shortages of PPE and testing material, and lack of evidence on optimal training. Virtual reality (VR) simulation can offer a multisensory, 3-D, fully immersive, and safe training opportunity that addresses these obstacles. Objective: The aim of this study is to explore the short- and long-term effectiveness of a fully immersive VR simulation versus a traditional learning method regarding a COVID-19?related skill set and media-specific variables influencing training outcomes. Methods: This was a prospective, randomized controlled pilot study on medical students (N=29; intervention VR training, n=15, vs control video-based instruction, n=14) to compare the performance of hand disinfection, nasopharyngeal swab taking, and donning/doffing of PPE before and after training and 1 month later as well as variables of media use. Results: Both groups performed significantly better after training, with the effect sustained over one month. After training, the VR group performed significantly better in taking a nasopharyngeal swab, scoring a median of 14 out of 17 points (IQR 13-15) versus 12 out of 17 points (IQR 11-14) in the control group, P=.03. With good immersion and tolerability of the VR simulation, satisfaction was significantly higher in the VR group compared to the control group (median score of User Satisfaction Evaluation Questionnaire 27/30, IQR 23-28, vs 22/30, IQR 20-24, in the control group; P=.01). Conclusions: VR simulation was at least as effective as traditional learning methods in training medical students while providing benefits regarding user satisfaction. These results add to the growing body of evidence that VR is a useful tool for acquiring simple and complex clinical skills. UR - https://games.jmir.org/2021/4/e29586 UR - http://dx.doi.org/10.2196/29586 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623315 ID - info:doi/10.2196/29586 ER - TY - JOUR AU - Tackett, Sean AU - Green, David AU - Dyal, Michael AU - O'Keefe, Erin AU - Thomas, Emmanuelle Tanya AU - Nguyen, Tiffany AU - Vo, Duyen AU - Patel, Mausam AU - Murdock, J. Christopher AU - Wolfe, M. Erin AU - Shehadeh, A. Lina PY - 2021/10/7 TI - Use of Commercially Produced Medical Education Videos in a Cardiovascular Curriculum: Multiple Cohort Study JO - JMIR Med Educ SP - e27441 VL - 7 IS - 4 KW - commercial videos KW - flipped classroom KW - organ-systems courses KW - medical education KW - medical students KW - teaching KW - education KW - health science education KW - e-Learning N2 - Background: Short instructional videos can make learning more efficient through the application of multimedia principles, and video animations can illustrate the complex concepts and dynamic processes that are common in health sciences education. Commercially produced videos are commonly used by medical students but are rarely integrated into curricula. Objective: Our goal was to examine student engagement with medical education videos incorporated into a preclinical Cardiovascular Systems course. Methods: Students who took the first-year 8-week Cardiovascular Systems course in 2019 and 2020 were included in the study. Videos from Osmosis were recommended to be watched before live sessions throughout the course. Video use was monitored through dashboards, and course credit was given for watching videos. All students were emailed electronic surveys after the final exam asking about the course?s blended learning experience and use of videos. Osmosis usage data for number of video views, multiple choice questions, and flashcards were extracted from Osmosis dashboards. Results: Overall, 232/359 (64.6%) students completed surveys, with rates by class of 81/154 (52.6%) for MD Class of 2022, 39/50 (78%) for MD/MPH Class of 2022, and 112/155 (72.3%) for MD Class of 2023. Osmosis dashboard data were available for all 359 students. All students received the full credit offered for Osmosis engagement, and learning analytics demonstrated regular usage of videos and other digital platform features. Survey responses indicated that most students found Osmosis videos to be helpful for learning (204/232, 87.9%; P=.001) and preferred Osmosis videos to the traditional lecture format (134/232, 57.8%; P<.001). Conclusions: Commercial medical education videos may enhance curriculum with low faculty effort and improve students? learning experiences. Findings from our experience at one medical school can guide the effective use of supplemental digital resources for learning, and related evaluation and research. UR - https://mededu.jmir.org/2021/4/e27441 UR - http://dx.doi.org/10.2196/27441 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617911 ID - info:doi/10.2196/27441 ER - TY - JOUR AU - Bragin, Ilya AU - Cohen, T. Dylan PY - 2021/10/6 TI - Certified Examination Assistants in the Age of Telemedicine: A Blueprint Through Neurology JO - JMIR Med Educ SP - e28335 VL - 7 IS - 4 KW - telemedicine KW - physical examination KW - neurological exam KW - telemedicine assistants KW - telemedicine implementation KW - telemedicine certification KW - telemedicine jobs KW - telemedicine education KW - telehealth KW - teleneurology UR - https://mededu.jmir.org/2021/4/e28335 UR - http://dx.doi.org/10.2196/28335 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612828 ID - info:doi/10.2196/28335 ER - TY - JOUR AU - Pan, Myat AU - San, Myat PY - 2021/10/4 TI - Innovation and Inequality: A Medical Student Perspective. Comment on "The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic" JO - JMIR Med Educ SP - e26790 VL - 7 IS - 4 KW - medical education KW - technology KW - coronavirus KW - medical students KW - COVID-19 KW - pandemic KW - online lecture KW - virtual reality KW - education UR - https://mededu.jmir.org/2021/4/e26790 UR - http://dx.doi.org/10.2196/26790 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081609 ID - info:doi/10.2196/26790 ER - TY - JOUR AU - Yang, Lin AU - Zheng, Si AU - Xu, Xiaowei AU - Sun, Yueping AU - Wang, Xuwen AU - Li, Jiao PY - 2021/10/1 TI - Medical Data Mining Course Development in Postgraduate Medical Education: Web-Based Survey and Case Study JO - JMIR Med Educ SP - e24027 VL - 7 IS - 4 KW - medical data mining KW - course development KW - online teaching KW - postgraduate medical education N2 - Background: Medical postgraduates? demand for data capabilities is growing, as biomedical research becomes more data driven, integrative, and computational. In the context of the application of big data in health and medicine, the integration of data mining skills into postgraduate medical education becomes important. Objective: This study aimed to demonstrate the design and implementation of a medical data mining course for medical postgraduates with diverse backgrounds in a medical school. Methods: We developed a medical data mining course called ?Practical Techniques of Medical Data Mining? for postgraduate medical education and taught the course online at Peking Union Medical College (PUMC). To identify the background knowledge, programming skills, and expectations of targeted learners, we conducted a web-based questionnaire survey. After determining the instructional methods to be used in the course, three technical platforms?Rain Classroom, Tencent Meeting, and WeChat?were chosen for online teaching. A medical data mining platform called Medical Data Mining - R Programming Hub (MedHub) was developed for self-learning, which could support the development and comprehensive testing of data mining algorithms. Finally, we carried out a postcourse survey and a case study to demonstrate that our online course could accommodate a diverse group of medical students with a wide range of academic backgrounds and programming experience. Results: In total, 200 postgraduates from 30 disciplines participated in the precourse survey. Based on the analysis of students? characteristics and expectations, we designed an optimized course structured into nine logical teaching units (one 4-hour unit per week for 9 weeks). The course covered basic knowledge of R programming, machine learning models, clinical data mining, and omics data mining, among other topics, as well as diversified health care analysis scenarios. Finally, this 9-week course was successfully implemented in an online format from May to July in the spring semester of 2020 at PUMC. A total of 6 faculty members and 317 students participated in the course. Postcourse survey data showed that our course was considered to be very practical (83/83, 100% indicated ?very positive? or ?positive?), and MedHub received the best feedback, both in function (80/83, 96% chose ?satisfied?) and teaching effect (80/83, 96% chose ?satisfied?). The case study showed that our course was able to fill the gap between student expectations and learning outcomes. Conclusions: We developed content for a data mining course, with online instructional methods to accommodate the diversified characteristics of students. Our optimized course could improve the data mining skills of medical students with a wide range of academic backgrounds and programming experience. UR - https://mededu.jmir.org/2021/4/e24027 UR - http://dx.doi.org/10.2196/24027 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596575 ID - info:doi/10.2196/24027 ER - TY - JOUR AU - Hicks, Paul Joseph AU - Allsop, John Matthew AU - Akaba, O. Godwin AU - Yalma, M. Ramsey AU - Dirisu, Osasuyi AU - Okusanya, Babasola AU - Tukur, Jamilu AU - Okunade, Kehinde AU - Akeju, David AU - Ajepe, Adegbenga AU - Okuzu, Okey AU - Mirzoev, Tolib AU - Ebenso, Bassey PY - 2021/9/16 TI - Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study JO - JMIR Mhealth Uhealth SP - e24182 VL - 9 IS - 9 KW - primary health worker training KW - digital health technology KW - eHealth KW - video-based training KW - maternal and child health KW - Nigeria KW - mobile phone N2 - Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers? knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders? experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention?s acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs? workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372 UR - https://mhealth.jmir.org/2021/9/e24182 UR - http://dx.doi.org/10.2196/24182 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528891 ID - info:doi/10.2196/24182 ER - TY - JOUR AU - Evans, Yolanda AU - Hutchinson, Jeffrey AU - Ameenuddin, Nusheen PY - 2021/9/15 TI - Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning JO - JMIR Ment Health SP - e26484 VL - 8 IS - 9 KW - pandemic KW - technology KW - media KW - bullying KW - mental health KW - distance learning UR - https://mental.jmir.org/2021/9/e26484 UR - http://dx.doi.org/10.2196/26484 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524094 ID - info:doi/10.2196/26484 ER - TY - JOUR AU - Bickham, S. David AU - Moukalled, Summer AU - Inyart, K. Heather AU - Zlokower, Rona PY - 2021/9/15 TI - Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study JO - JMIR Ment Health SP - e26197 VL - 8 IS - 9 KW - digital citizenship KW - cyberbullying KW - evaluation KW - media literacy KW - middle school KW - conflict resolution KW - internet safety KW - mobile phone N2 - Background: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people?s mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. Objective: This study aims to determine the effectiveness of the Screenshots program in increasing participants? knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males? and females? conflict and bullying resolution strategies. Methods: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. Results: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52% (33/63) to 84% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. Conclusions: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students? increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students? high ratings of the relevance of Screenshots? content reinforce the need for this type of intervention. UR - https://mental.jmir.org/2021/9/e26197 UR - http://dx.doi.org/10.2196/26197 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524098 ID - info:doi/10.2196/26197 ER - TY - JOUR AU - Liu, Fang AU - Weng, Huiting AU - Xu, Rong AU - Li, Xia AU - Zhang, Zhe AU - Zhao, Kuaile AU - Zhou, Zhiguang AU - Wang, Qin PY - 2021/9/9 TI - Nursing Interns? Attitudes Toward, Preferences for, and Use of Diabetes Virtual Simulation Teaching Applications in China: National Web-Based Survey JO - JMIR Mhealth Uhealth SP - e29498 VL - 9 IS - 9 KW - nursing interns KW - virtual simulation KW - China KW - nursing education KW - diabetes N2 - Background: Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns? current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications. Objective: This study aimed to identify the determinants of nursing interns? intentions to use simulation-based education applications. Methods: From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants? WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients. Results: Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6% (314/883) and the awareness rate was 10.2% (90/883). In addition, among the interns, only 10.2% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (P<.05). Skills and knowledge that the interns most wanted to acquire included the treatment of hypoglycemia (626/883, 70.9%), functional test simulation (610/883, 69.1%), and blood glucose monitoring technology (485/883, 54.9%). A total of 60.5% (534/883) of the interns wanted to acquire clinical thinking skills, while 16.0% (141/883) wanted to acquire operational skills. Nursing trainees believed that the greatest obstacles to virtual simulation included limited time (280/883, 31.7%), the degree of simulation (129/883, 14.6%), the demand for satisfaction (108/883, 12.2%), and test scores (66/883, 7.5%). Conclusions: The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students? interest in learning and help improve diabetes knowledge among nursing interns. UR - https://mhealth.jmir.org/2021/9/e29498 UR - http://dx.doi.org/10.2196/29498 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499047 ID - info:doi/10.2196/29498 ER - TY - JOUR AU - Szeto, D. Mindy AU - Strock, Daniel AU - Anderson, Jarett AU - Sivesind, E. Torunn AU - Vorwald, M. Victoria AU - Rietcheck, R. Hope AU - Weintraub, S. Gil AU - Dellavalle, P. Robert PY - 2021/8/30 TI - Gamification and Game-Based Strategies for Dermatology Education: Narrative Review JO - JMIR Dermatol SP - e30325 VL - 4 IS - 2 KW - games KW - game-playing KW - gamification KW - serious games KW - simulations KW - education KW - medical education KW - dermatology education KW - patient education KW - review N2 - Background: Game-based approaches, or gamification, are popular learning strategies in medical education for health care providers and patients alike. Gamification has taken the form of serious educational games and simulations to enable learners to rehearse skills and knowledge in a safe environment. Dermatology learners in particular may benefit from gamification methods, given the visual and procedural nature of the field. Objective: This narrative review surveys current applications of gamification within general medical training, in the education of dermatology students, and in dermatology patient outreach. Methods: A literature search was performed using PubMed, Google Scholar, and ResearchGate to access and review relevant medical education- and dermatology-related gamification studies published in peer-reviewed journals. Two independent researchers with education and experience in dermatology screened publications to select studies featuring a diversity of gamification approaches and study subjects for in-depth examination. Results: A total of 6 general medical education?related and 7 dermatology-specific gamification studies were selected. Gamification generally increased motivation and engagement, improved reinforcement of learning objectives, and contributed to more enjoyable and positive educational experiences compared to traditional modes of instruction. Enhancing examination scores, building confidence, and developing stronger team dynamics were additional benefits for medical trainees. Despite the abundance of gamification studies in general medical education, comparatively few instances were specific to dermatology learning, although large organizations such as the American Academy of Dermatology have begun to implement these strategies nationally. Gamification may also a provide promising alternative means of diversifying patient education and outreach methods, especially for self-identification of malignant melanoma. Conclusions: Serious games and simulations in general medical education have successfully increased learner motivation, enjoyment, and performance. In limited preliminary studies, gamified approaches to dermatology-specific medical education enhanced diagnostic accuracy and interest in the field. Game-based interventions in patient-focused educational pilot studies surrounding melanoma detection demonstrated similar efficacy and knowledge benefits. However, small study participant numbers and large variability in outcome measures may indicate decreased generalizability of findings regarding the current impact of gamification approaches, and further investigation in this area is warranted. Additionally, some relevant studies may have been omitted by the simplified literature search strategy of this narrative review. This could be expanded upon in a secondary systematic review of gamified educational platforms. UR - https://derma.jmir.org/2021/2/e30325 UR - http://dx.doi.org/10.2196/30325 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632819 ID - info:doi/10.2196/30325 ER - TY - JOUR AU - Newman, Julliana AU - Liew, Andrew AU - Bowles, Jon AU - Soady, Kelly AU - Inglis, Steven PY - 2021/8/27 TI - Podcasts for the Delivery of Medical Education and Remote Learning JO - J Med Internet Res SP - e29168 VL - 23 IS - 8 KW - digital KW - hepatitis C virus KW - health care professionals KW - hepatology KW - HIV KW - continuous professional development KW - podcasts KW - remote learning KW - virology UR - https://www.jmir.org/2021/8/e29168 UR - http://dx.doi.org/10.2196/29168 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448719 ID - info:doi/10.2196/29168 ER - TY - JOUR AU - Wei, Chapman AU - Bernstein, Sophie AU - Adusumilli, Nagasai AU - Marchitto, Mark AU - Chen, Frank AU - Rajpara, Anand PY - 2021/8/26 TI - Assessment and Evaluation of Social Engagement in Dermatology Residency Programs on Instagram: Cross-sectional Study JO - JMIR Dermatol SP - e32105 VL - 4 IS - 2 KW - Instagram KW - social media KW - dermatology residency KW - Instagram engagement score KW - residency recruitment KW - medical education UR - https://derma.jmir.org/2021/2/e32105 UR - http://dx.doi.org/10.2196/32105 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632856 ID - info:doi/10.2196/32105 ER - TY - JOUR AU - Maheu-Cadotte, Marc-André AU - Dubé, Véronique AU - Cossette, Sylvie AU - Lapierre, Alexandra AU - Fontaine, Guillaume AU - Deschênes, Marie-France AU - Lavoie, Patrick PY - 2021/8/19 TI - Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review JO - JMIR Serious Games SP - e28650 VL - 9 IS - 3 KW - game-based learning KW - health professions education KW - participatory design KW - systematic review KW - user-centered design KW - serious games KW - game development KW - end users KW - education N2 - Background: On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users? involvement in SG development. Objective: The aim of this study is to describe how end users are involved in the development of SGs for health care professions education. Methods: We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages. Results: End users? involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7). Conclusions: Researchers mentioned end users? involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement. UR - https://games.jmir.org/2021/3/e28650 UR - http://dx.doi.org/10.2196/28650 UR - http://www.ncbi.nlm.nih.gov/pubmed/34129514 ID - info:doi/10.2196/28650 ER - TY - JOUR AU - Schoenmakers, Birgitte AU - Wens, Johan PY - 2021/8/16 TI - Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study JO - JMIR Form Res SP - e23834 VL - 5 IS - 8 KW - primary care KW - education KW - graduate KW - medical education KW - testing KW - assessment KW - app KW - COVID-19 KW - efficiency KW - accuracy N2 - Background: The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates? behaviors. Objective: We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure?s impact on exam scores. Methods: The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students? exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results: Of the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions: This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates? awareness of being monitored via a safe browser plug-in for exams. UR - https://formative.jmir.org/2021/8/e23834 UR - http://dx.doi.org/10.2196/23834 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398786 ID - info:doi/10.2196/23834 ER - TY - JOUR AU - Li, Li AU - Liu, Xiaobin AU - Chen, Zeyuan AU - Wang, Liyuan AU - Lian, Xiaoli AU - Zou, Huiru PY - 2021/8/13 TI - The Application of a Case-Based Social Media?Assisted Teaching Method in Cariology Education?Comparative Study JO - J Med Internet Res SP - e29372 VL - 23 IS - 8 KW - social media KW - case-based learning KW - cariology KW - dental cavity preparation KW - college students N2 - Background: Current cariology education based on the traditional teaching method faces a lot of challenges. Meanwhile, the COVID-19 pandemic caused an unprecedented disruption in medical education and health care systems worldwide. Innovation in the teaching mode of cariology education is required to change the situation. Objective: The goal of the research was to evaluate the application effects of a case-based social media?assisted teaching method in cariology education. Methods: Dental students of class 2019 were enrolled into the experimental group, while students of class 2018 served as control. A case-based social media?assisted teaching method was used in the experimental group, which included preclass activity via social media, additional discussion and practice process record in class, and questions and answers on the platform after class. The traditional teaching method, which consisted of conventional preparation before class, traditional lectures and demonstrations followed by students practice in class, and questions and answers step after class, was used in the control group. The teaching materials were the same in both groups. At the end of the program, students from both groups took cavity preparation skill evaluation tests. Questionnaires were tested on the case-based social media?assisted teaching group students anonymously. All data were analyzed using SPSS statistical software (version 22.0, IBM Corp). Results: The mean student cavity preparation skill evaluation scores was 82.51 (SD 6.82) in the experimental group and 77.19 (SD 5.98) in the control group (P<.05). The questionnaire response rate was 100%. Of those, 94.3% (100/106) of the students recommended the case-based social media?assisted teaching method in cariology education. The majority of the participants agreed that it helped them memorize the theoretical knowledge of cariology, facilitated in-depth discussion, improved their enthusiasm and initiative in learning, and enhanced the relationship between teachers and students (104/106, 98.1%). They also recognized that the classroom atmosphere was active (94/106, 88.7%). Conclusions: The case-based social media?assisted teaching method was beneficial in terms of learning, as demonstrated by the statistically significant improvement of the cavity preparation skill evaluation scores and satisfaction from attending students. This method could be used to supplement the teaching of cariology. UR - https://www.jmir.org/2021/8/e29372 UR - http://dx.doi.org/10.2196/29372 UR - http://www.ncbi.nlm.nih.gov/pubmed/34397390 ID - info:doi/10.2196/29372 ER - TY - JOUR AU - Walia, Bhavneet AU - Shridhar, Anshu AU - Arasu, Pratap AU - Singh, Kaur Gursimar PY - 2021/8/12 TI - US Physicians? Perspective on the Sudden Shift to Telehealth: Survey Study JO - JMIR Hum Factors SP - e26336 VL - 8 IS - 3 KW - physician survey KW - US telehealth training KW - US telehealth care KW - COVID-19 KW - pandemic KW - snowball sampling KW - health care access KW - health care quality KW - telehealth KW - telemedicine KW - survey KW - physician KW - perspective KW - recommendation KW - policy KW - public health KW - implication KW - quality KW - access N2 - Background: Given the sudden shift to telemedicine during the early COVID-19 pandemic, we conducted a survey of practicing physicians? experience with telehealth during the prepandemic and early pandemic periods. Our survey estimates that most patient visits in the United States during the early COVID-19 pandemic period were conducted via telehealth. Given this magnitude and the potential benefits and challenges of telehealth for the US health care system, in this paper, we obtain, summarize, and analyze telehealth views and experiences of US-based practicing-physicians. Objective: The aim of this study was to examine the extent of shift toward telehealth training and care provision during the early pandemic from the US-based practicing physicians? perspective. We also sought to determine the short- and long-term implications of this shift on the quality, access, and mode of US health care delivery. Methods: We conducted a purposive, snowball-sampled survey of US practicing-physicians. A total of 148 physician completed the survey. Data were collected from July 17, 2020, through September 4, 2020. Results: Sample training intensity scaled 21-fold during the early pandemic period, and patient-care visits conducted via telehealth increased, on average, from 13.1% directly before the pandemic to 59.7% during the early pandemic period. Surveyed physician respondents reported that telehealth patient visits and face-to-face patient visits are comparable in quality. The difference was not statistically significant based on a nonparametric sign test (P=.11). Moreover, physicians feel that telehealth care should continue to play a larger role (44.9% of total visits) in postpandemic health care in the United States. Our survey findings suggest a high market concentration in telehealth software, which is a market structural characteristic that may have implications on the cost and access of telehealth. The results varied markedly by physician employer type. Conclusions: During the shift toward telehealth, there has been a considerable discovery among physicians regarding US telehealth physicians. Physicians are now better prepared to undertake telehealth care from a training perspective. They are favorable toward a permanently expanded telehealth role, with potential for enhanced health care access, and the realization of enhanced access may depend on market structural characteristics of telehealth software platforms. UR - https://humanfactors.jmir.org/2021/3/e26336 UR - http://dx.doi.org/10.2196/26336 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938813 ID - info:doi/10.2196/26336 ER - TY - JOUR AU - Van Gaalen, J. A. E. AU - Jaarsma, C. A. D. AU - Georgiadis, R. J. PY - 2021/7/28 TI - Medical Students? Perceptions of Play and Learning: Qualitative Study With Focus Groups and Thematic Analysis JO - JMIR Serious Games SP - e25637 VL - 9 IS - 3 KW - gamification KW - serious games KW - game-based learning KW - medical education KW - computers KW - new technology KW - focus group KW - play KW - qualitative N2 - Background: In times where distance learning is becoming the norm, game-based learning (GBL) is increasingly applied to health profession education. Yet, decisions for if, when, how, and for whom GBL should be designed cannot be made on a solid empirical basis. Though the act of play seems to be intertwined with GBL, it is generally ignored in the current scientific literature. Objective: The objective of our study was to explore students? perceptions of play in leisure time and of GBL as part of a mechanistic, bottom-up approach towards evidence-informed design and implementation of GBL in health profession education. Methods: We conducted 6 focus group discussions with medical and dentistry students, which were analyzed using thematic analysis. Results: A total of 58 students participated. We identified 4 major themes based on the students? perception of play in leisure time and on the combination of play and learning. Our results indicate that, while play preferences were highly various in our health profession student cohort, pleasure was the common ground reported for playing. Crucially, play and the serious act of learning seemed paradoxical, indicating that the value and meaning of play are strongly context-dependent for students. Conclusions: Four key points can be constructed from our study. First, students play for pleasure. Perceptions of pleasure vary considerably among students. Second, students consider play as inefficient. Inefficiency will only be justified when it increases learning. Third, play should be balanced with the serious and only be used for difficult or tedious courses. Fourth, GBL activities should not be made compulsory for students. We provide practical implications and directions for future research. UR - https://games.jmir.org/2021/3/e25637 UR - http://dx.doi.org/10.2196/25637 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319237 ID - info:doi/10.2196/25637 ER - TY - JOUR AU - Kagawa, Nantamu Mike AU - Chipamaunga, Shalote AU - Prozesky, Detlef AU - Kafumukache, Elliot AU - Gwini, Rudo AU - Kandawasvika, Gwendoline AU - Katowa-Mukwato, Patricia AU - Masanganise, Rangarirai AU - Pretorius, Louise AU - Wessels, Quenton AU - Dithole, S. Kefalotse AU - Marimo, Clemence AU - Mubuuke, Gonzaga Aloysius AU - Mbalinda, Nalugo Scovia AU - van der Merwe, Lynette AU - Nyoni, N. Champion PY - 2021/7/28 TI - Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach JO - JMIR Res Protoc SP - e28905 VL - 10 IS - 7 KW - Africa KW - COVID-19 KW - emergency remote teaching KW - formal online learning KW - pandemic N2 - Background: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask?wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID): DERR1-10.2196/28905 UR - https://www.researchprotocols.org/2021/7/e28905 UR - http://dx.doi.org/10.2196/28905 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254943 ID - info:doi/10.2196/28905 ER - TY - JOUR AU - Lin, Yuchen AU - Neuschaefer-Rube, Christiane PY - 2021/7/27 TI - Digital Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary and Exploratory Analysis of Content, Organizing Structures, and Formats JO - JMIR Med Educ SP - e27901 VL - 7 IS - 3 KW - digital learning KW - e-learning KW - speech-language pathology KW - phoniatrics KW - otolaryngology KW - communication disorders KW - mobile phone N2 - Background: The digital revolution is rapidly transforming health care and clinical teaching and learning. Relative to other medical fields, the interdisciplinary fields of speech-language pathology (SLP), phoniatrics, and otolaryngology have been slower to take up digital tools for therapeutic, teaching, and learning purposes?a process that was recently expedited by the COVID-19 pandemic. Although many current teaching and learning tools have restricted or institution-only access, there are many openly accessible tools that have gone largely unexplored. To find, use, and evaluate such resources, it is important to be familiar with the structures, concepts, and formats of existing digital tools. Objective: This descriptive study aims to investigate digital learning tools and resources in SLP, phoniatrics, and otolaryngology. Differences in content, learning goals, and digital formats between academic-level learners and clinical-professional learners are explored. Methods: A systematic search of generic and academic search engines (eg, Google and PubMed); the App Store; Google Play Store; and websites of established SLP, phoniatrics, and otolaryngology organizations was conducted. By using specific search terms and detailed inclusion and exclusion criteria, relevant digital resources were identified. These were organized and analyzed according to learner groups, content matter, learning goals and architectures, and digital formats. Results: Within- and between-learner group differences among 125 identified tools were investigated. In terms of content, the largest proportion of tools for academic-level learners pertained to anatomy and physiology (60/214, 28%), and that for clinical-professional learners pertained to diagnostic evaluation (47/185, 25.4%). Between groups, the largest differences were observed for anatomy and physiology (academic-level learners: 60/86, 70%; clinical-professional learners: 26/86, 30%) and professional issues (8/28, 29% vs 20/28, 71%). With regard to learning goals, most tools for academic-level learners targeted the performance of procedural skills (50/98, 51%), and those for clinical-professional learners targeted receptive information acquisition (44/62, 71%). Academic-level learners had more tools for supporting higher-level learning goals than clinical-professional learners, specifically tools for performing procedural skills (50/66, 76% vs 16/66, 24%) and strategic skills (8/10, 80% vs 2/10, 20%). Visual formats (eg, pictures or diagrams) were dominant across both learner groups. The greatest between-group differences were observed for interactive formats (45/66, 68% vs 21/66, 32%). Conclusions: This investigation provides initial insights into openly accessible tools across SLP, phoniatrics, and otolaryngology and their organizing structures. Digital tools in these fields addressed diverse content, although the tools for academic-level learners were greater in number, targeted higher-level learning goals, and had more interactive formats than those for clinical-professional learners. The crucial next steps include investigating the actual use of such tools in practice and students? and professionals? attitudes to better improve upon such tools and incorporate them into current and future learning milieus. UR - https://mededu.jmir.org/2021/3/e27901 UR - http://dx.doi.org/10.2196/27901 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313592 ID - info:doi/10.2196/27901 ER - TY - JOUR AU - Gopwani, R. Sumeet AU - Adams, Erin AU - Rooney, Alexandra AU - Tousimis, Eleni AU - Ramsey, Katherine AU - Warusha, Sohan PY - 2021/7/26 TI - Impact of a Workflow-Integrated Web Tool on Resource Utilization and Information-Seeking Behavior in an Academic Anesthesiology Department: Longitudinal Cohort Survey Study JO - JMIR Med Educ SP - e26325 VL - 7 IS - 3 KW - graduate medical education KW - learning technology KW - anesthesiology KW - information-seeking behavior KW - web tool KW - teaching KW - millennial learners N2 - Background: Medical resident reading and information-seeking behavior is limited by time constraints as well as comfort in accessing and assessing evidence-based resources. Educational technology interventions, as the preferred method for millennial leaners, can reduce these barriers. We implemented an educational web tool, consisting of peer-reviewed articles as well as local and national protocols and policies, built into the daily workflow of a university-based anesthesiology department. We hypothesized that this web tool would increase resource utilization and overall perceptions of the educational environment. Objective: The goal of this study was to demonstrate that an educational web tool designed and built into the daily workflow of an academic anesthesia department for trainees could significantly decrease barriers to resource utilization, improve faculty-trainee teaching interactions, and improve the perceptions of the educational environment. Methods: Following Institutional Review Board approval, a longitudinal cohort survey study was conducted to assess trainee resource utilization, faculty evaluation of trainees? resource utilization, and trainee and faculty perceptions about the educational environment. The survey study was conducted in a pre-post fashion 3 months prior to web tool implementation and 3 months following implementation. Data were deidentified and analyzed unpaired using Student t tests for continuous data and chi-square tests for ordinal data. Results: Survey response rates were greater than 50% in all groups: of the 43 trainees, we obtained 27 (63%) preimplementation surveys and 22 (51%) postimplementation surveys; of the 46 faculty members, we obtained 25 (54%) preimplementation surveys and 23 (50%) postimplementation surveys. Trainees showed a significant improvement in utilization of peer-reviewed articles (preimplementation mean 8.67, SD 6.45; postimplementation mean 18.27, SD 12.23; P=.02), national guidelines (preimplementation mean 2.3, SD 2.40; postimplementation mean 6.14, SD 5.01; P<.001), and local policies and protocols (preimplementation mean 2.23, SD 2.72; postimplementation mean 6.95, SD 6.09; P=.02). There was significant improvement in faculty-trainee educational interactions (preimplementation mean 1.67, SD 1.33; postimplementation mean 6.05, SD 8.74; P=.01). Faculty assessment of trainee resource utilization also demonstrated statistically significant improvements across all resource categories. Subgroups among trainees and faculty showed similar trends toward improvement. Conclusions: Learning technology interventions significantly decrease the barriers to resource utilization, particularly among millennial learners. Further investigation has been undertaken to assess how this may impact learning, knowledge retention, and patient outcomes. UR - https://mededu.jmir.org/2021/3/e26325 UR - http://dx.doi.org/10.2196/26325 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309566 ID - info:doi/10.2196/26325 ER - TY - JOUR AU - Du Plessis, S. Stefan AU - Otaki, Farah AU - Zaher, Shroque AU - Zary, Nabil AU - Inuwa, Ibrahim AU - Lakhtakia, Ritu PY - 2021/7/23 TI - Taking a Leap of Faith: A Study of Abruptly Transitioning an Undergraduate Medical Education Program to Distance-Learning Owing to the COVID-19 Pandemic JO - JMIR Med Educ SP - e27010 VL - 7 IS - 3 KW - action research KW - change management KW - COVID-19 KW - curriculum content KW - curriculum delivery KW - distance-learning KW - learning KW - medical education KW - pandemic KW - teaching UR - https://mededu.jmir.org/2021/3/e27010 UR - http://dx.doi.org/10.2196/27010 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227994 ID - info:doi/10.2196/27010 ER - TY - JOUR AU - Nathan, Arjun AU - Fricker, Monty AU - Patel, Sonam AU - Georgi, Maria AU - Hang, Kien Man AU - Asif, Aqua AU - Sinha, Amil AU - Mullins, William AU - Shea, Jessie AU - Hanna, Nancy AU - Lamb, Benjamin AU - Kelly, John AU - Sridhar, Ashwin AU - Collins, Justin PY - 2021/7/22 TI - Virtual Interactive Surgical Skills Classroom: Protocol for a Parallel-Group, Noninferiority, Adjudicator-Blinded, Randomized Controlled Trial (VIRTUAL) JO - JMIR Res Protoc SP - e28671 VL - 10 IS - 7 KW - digital education KW - digital health KW - education KW - surgery KW - surgical skills KW - surgical training KW - surgical KW - suturing KW - telemedicine KW - virtual classroom KW - virtual training N2 - Background: Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and increase accessibility. Objective: We aim to investigate whether VCT is superior to computer-based learning and noninferior to FFT in improving proficiency in basic surgical skills. Methods: This is a protocol for a parallel-group, noninferiority, randomized controlled trial. A sample of 72 undergraduates will be recruited from 5 medical schools in London. Participants will be stratified by subjective and objective suturing experience level and allocated to 3 intervention groups at a 1:1:1 ratio. VCT will be delivered using the BARCO weConnect software, and FFT will be provided by expert instructors. Optimal student-to-teacher ratios of 12:1 for VCT and 4:1 for FFT will be maintained. The assessed task will be interrupted suturing with hand-tied knots. Results: The primary outcome will be the postintervention Objective Structured Assessment of Technical Skills score, adjudicated by 2 experts blinded to the study and adjusted for baseline proficiency. The noninferiority margin (?) will be defined using historical data. Conclusions: This study will serve as a comprehensive appraisal of the suitability of virtual basic surgical skills classroom training as an alternative to FFT. Our findings will assist the development and implementation of further resource-efficient, accessible, virtual basic surgical skills training programs during the COVID-19 pandemic and in the future. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN12448098; https://www.isrctn.com/ISRCTN12448098 International Registered Report Identifier (IRRID): PRR1-10.2196/28671 UR - https://www.researchprotocols.org/2021/7/e28671 UR - http://dx.doi.org/10.2196/28671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292162 ID - info:doi/10.2196/28671 ER - TY - JOUR AU - Tudor Car, Lorainne AU - Kyaw, Myint Bhone AU - Nannan Panday, S. Rishi AU - van der Kleij, Rianne AU - Chavannes, Niels AU - Majeed, Azeem AU - Car, Josip PY - 2021/7/21 TI - Digital Health Training Programs for Medical Students: Scoping Review JO - JMIR Med Educ SP - e28275 VL - 7 IS - 3 KW - digital health KW - education KW - eHealth KW - medical students KW - scoping review KW - electronic health records KW - computer literacy N2 - Background: Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. The COVID-19 pandemic has contributed to this swift and widespread transition to digital health and education. However, the need for digital health competencies goes beyond the COVID-19 pandemic because they are becoming essential for the delivery of effective, efficient, and safe care. Objective: This review aims to collate and analyze studies evaluating digital health education for medical students to inform the development of future courses and identify areas where curricula may need to be strengthened. Methods: We carried out a scoping review by following the guidance of the Joanna Briggs Institute, and the results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 6 major bibliographic databases and gray literature sources for articles published between January 2000 and November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussions between the authors. The findings were analyzed using thematic analysis and presented narratively. Results: A total of 34 studies focusing on different digital courses were included in this review. Most of the studies (22/34, 65%) were published between 2010 and 2019 and originated in the United States (20/34, 59%). The reported digital health courses were mostly elective (20/34, 59%), were integrated into the existing curriculum (24/34, 71%), and focused mainly on medical informatics (17/34, 50%). Most of the courses targeted medical students from the first to third year (17/34, 50%), and the duration of the courses ranged from 1 hour to 3 academic years. Most of the studies (22/34, 65%) reported the use of blended education. A few of the studies (6/34, 18%) delivered courses entirely digitally by using online modules, offline learning, massive open online courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in-person observations, and online assessments. Most of the studies (30/34, 88%) evaluated courses mostly by using an uncontrolled before-and-after design and generally reported improvements in students? learning outcomes. Conclusions: Digital health courses reported in literature are mostly elective, focus on a single area of digital health, and lack robust evaluation. They have diverse delivery, development, and assessment approaches. There is an urgent need for high-quality studies that evaluate digital health education. UR - https://mededu.jmir.org/2021/3/e28275 UR - http://dx.doi.org/10.2196/28275 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287206 ID - info:doi/10.2196/28275 ER - TY - JOUR AU - Barteit, Sandra AU - Lanfermann, Lucia AU - Bärnighausen, Till AU - Neuhann, Florian AU - Beiersmann, Claudia PY - 2021/7/8 TI - Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review JO - JMIR Serious Games SP - e29080 VL - 9 IS - 3 KW - virtual reality KW - augmented reality KW - global health KW - income-limited countries KW - medical education N2 - Background: Augmented reality (AR), mixed reality (MR), and virtual reality (VR), realized as head-mounted devices (HMDs), may open up new ways of teaching medical content for low-resource settings. The advantages are that HMDs enable repeated practice without adverse effects on the patient in various medical disciplines; may introduce new ways to learn complex medical content; and may alleviate financial, ethical, and supervisory constraints on the use of traditional medical learning materials, like cadavers and other skills lab equipment. Objective: We examine the effectiveness of AR, MR, and VR HMDs for medical education, whereby we aim to incorporate a global health perspective comprising low- and middle-income countries (LMICs). Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and Cochrane guidelines. Seven medical databases (PubMed, Cochrane Library, Web of Science, Science Direct, PsycINFO, Education Resources Information Centre, and Google Scholar) were searched for peer-reviewed publications from January 1, 2014, to May 31, 2019. An extensive search was carried out to examine relevant literature guided by three concepts of extended reality (XR), which comprises the concepts of AR, MR, and VR, and the concepts of medicine and education. It included health professionals who took part in an HMD intervention that was compared to another teaching or learning method and evaluated with regard to its effectiveness. Quality and risk of bias were assessed with the Medical Education Research Study Quality Instrument, the Newcastle-Ottawa Scale-Education, and A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions. We extracted relevant data and aggregated the data according to the main outcomes of this review (knowledge, skills, and XR HMD). Results: A total of 27 studies comprising 956 study participants were included. The participants included all types of health care professionals, especially medical students (n=573, 59.9%) and residents (n=289, 30.2%). AR and VR implemented with HMDs were most often used for training in the fields of surgery (n=13, 48%) and anatomy (n=4, 15%). A range of study designs were used, and quantitative methods were clearly dominant (n=21, 78%). Training with AR- and VR-based HMDs was perceived as salient, motivating, and engaging. In the majority of studies (n=17, 63%), HMD-based interventions were found to be effective. A small number of included studies (n=4, 15%) indicated that HMDs were effective for certain aspects of medical skills and knowledge learning and training, while other studies suggested that HMDs were only viable as an additional teaching tool (n=4, 15%). Only 2 (7%) studies found no effectiveness in the use of HMDs. Conclusions: The majority of included studies suggested that XR-based HMDs have beneficial effects for medical education, whereby only a minority of studies were from LMICs. Nevertheless, as most studies showed at least noninferior results when compared to conventional teaching and training, the results of this review suggest applicability and potential effectiveness in LMICs. Overall, users demonstrated greater enthusiasm and enjoyment in learning with XR-based HMDs. It has to be noted that many HMD-based interventions were small-scale and conducted as short-term pilots. To generate relevant evidence in the future, it is key to rigorously evaluate XR-based HMDs with AR and VR implementations, particularly in LMICs, to better understand the strengths and shortcomings of HMDs for medical education. UR - https://games.jmir.org/2021/3/e29080 UR - http://dx.doi.org/10.2196/29080 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255668 ID - info:doi/10.2196/29080 ER - TY - JOUR AU - Herbst, Rachel AU - Rybak, Tiffany AU - Meisman, Andrea AU - Whitehead, Monica AU - Rosen, Brittany AU - Crosby, E. Lori AU - Klein, D. Melissa AU - Real, J. Francis PY - 2021/6/29 TI - A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study JO - JMIR Pediatr Parent SP - e29518 VL - 4 IS - 2 KW - resident education KW - virtual reality KW - behavioral health promotion KW - COVID-19 N2 - Background: Behavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines. Objective: This study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents. Methods: This mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents? perspectives on the curriculum?s content and format. The interviews were analyzed using conventional content analysis. Results: Quantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills. Conclusions: Pilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families. UR - https://pediatrics.jmir.org/2021/2/e29518 UR - http://dx.doi.org/10.2196/29518 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081601 ID - info:doi/10.2196/29518 ER - TY - JOUR AU - Zamberg, Ido AU - Schiffer, Eduardo AU - Stoermann-Chopard, Catherine PY - 2021/6/28 TI - Novice and Advanced Learners? Satisfaction and Perceptions of an e-Learning Renal Semiology Module During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Med Educ SP - e29216 VL - 7 IS - 2 KW - COVID-19 KW - e-learning KW - medical education KW - eHealth KW - novice KW - advanced KW - students KW - undergraduate education KW - satisfaction KW - perception KW - renal KW - qualitative KW - prospective KW - case study KW - design KW - clinical skills KW - clinical skills education N2 - Background: Nephrotic syndrome is a unique clinical disorder, which provides interesting teaching opportunities that connect physiological and pathological aspects to clinical practice. During the current COVID-19 outbreak, in-person teaching in our institution was not permitted, thus creating a unique challenge for clinical skills teaching. A case-based electronic learning (e-learning) activity was designed to replace the traditional in-person teaching of renal semiology. e-Learning activities have been shown to be effective for knowledge retention and increasing novice learners? performance. However, major knowledge gaps exist concerning the satisfaction of learners with e-learning activities as the sole form of teaching, specifically for undergraduate clinical skills education. Objective: Our study aimed to prospectively assess undergraduate medical students? perceptions of and satisfaction with an e-learning activity teaching renal semiology. Methods: All second-year medical students (novice learners) from the medical faculty of the University of Geneva, Switzerland, undertook the e-learning activity and were invited to participate in a nonmandatory, validated web-based survey, comprising questions answered using a 10-point Likert scale and one qualitative open-ended question. For comparison and to provide further insights, 17 fourth- to sixth-year students (advanced learners) were prospectively recruited to participate in both the e-learning activity and the evaluation. A mixed methods analysis was performed. Results: A total of 88 (63%) out of 141 novice learners and all advanced learners responded to the evaluation survey. Advanced learners reported significantly higher satisfaction with the e-learning activity (mean 8.7, SD 1.0 vs mean 7.3, SD 1.8; P<.001), clarity of objectives (mean 9.6, SD 0.8 vs mean 7.7, SD 1.7; P<.001), and attainability of objectives (mean 9.8, SD 0.5 vs mean 7.3, SD 1.3; P<.001). Both groups showed high interest in the inclusion of the activity as part of a blended learning approach; however, there was low interest in the activity being the sole means of teaching. Conclusions: Case-based e-learning activities might be better suited for advanced learners and could increase learners? satisfaction within a blended teaching instructional design. More research on students? satisfaction with e-learning activities in the field of clinical skills education should be done. In addition, more effort should be put into finding alternative teaching tools for clinical skills education in light of the ongoing COVID-19 pandemic and future health crises. UR - https://mededu.jmir.org/2021/2/e29216 UR - http://dx.doi.org/10.2196/29216 UR - http://www.ncbi.nlm.nih.gov/pubmed/34048357 ID - info:doi/10.2196/29216 ER - TY - JOUR AU - Jamal, Amr AU - Tharkar, Shabana AU - Alenazi, Hanan AU - Julaidan, Saud Bedoor AU - Al Hindawi, Ali Dania AU - AlAkeel, Suleman Norah AU - AlNuhayer, Mohammed Ola AU - AlDubaikhi, Hamoud Raneem PY - 2021/6/24 TI - Usability Analysis of a Health Sciences Digital Library by Medical Residents: Cross-sectional Survey JO - JMIR Form Res SP - e23293 VL - 5 IS - 6 KW - digital library usability KW - medical education KW - system usability scale KW - medical residents KW - Saudi Arabia N2 - Background: The usability of a digital library depends on a myriad of factors ranging from the end users? ability to website complexity. Although digital libraries provide instant access to online content, offering an efficient reference platform, their usability is highly variable. Objective: The aim of this study was to measure users? perspectives and usability of the digital library of the Saudi Commission for Health Specialties (SCFHS). Methods: A web-based questionnaire survey was conducted using a validated System Usability Scale (SUS) containing 5 positive and 5 negative items on the usability of the digital library. The SUS standard cut-off score of 68 was considered for interpretation. Results: The overall mean SUS score of digital library usability was 52.9 (SD 15.2) with a grade ?D? categorization, indicating low usability. The perceived measures of attributes of the 10 SUS items of findability, complexity, consistency, and confidence obtained below average scores. Only item 1 relating to perceived willingness to use the digital library frequently obtained a score above the targeted benchmark score (mean score 3.6). Higher SUS scores were associated with training (P=.02). Men felt the digital library to be more complex (P=.04) and board-certified physicians perceived a greater need for training on digital library use (P=.05). Only the UpToDate database was widely used (72/90, 80%). Conclusions: These findings demonstrate the low usability of the extensive facilities offered by the SCFHS digital library. It is pivotal to improve awareness of the availability of the digital library and popularize the databases. There is also a need for improved user training to enhance the accessibility and usability of the multiple databases. UR - https://formative.jmir.org/2021/6/e23293/ UR - http://dx.doi.org/10.2196/23293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34184992 ID - info:doi/10.2196/23293 ER - TY - JOUR AU - Miao, H. Julia PY - 2021/6/14 TI - Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic JO - JMIR Med Educ SP - e26797 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - medical student KW - community service KW - telemedicine KW - telehealth KW - community outreach KW - peer teaching KW - student-led initiative KW - clinical assessment KW - adaptability KW - team-based learning UR - https://mededu.jmir.org/2021/2/e26797 UR - http://dx.doi.org/10.2196/26797 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061763 ID - info:doi/10.2196/26797 ER - TY - JOUR AU - Jacklin, Simon AU - Maskrey, Neal AU - Chapman, Stephen PY - 2021/6/10 TI - Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study JO - JMIR Med Educ SP - e22745 VL - 7 IS - 2 KW - shared decision making KW - virtual patient KW - communication KW - medical education N2 - Background: Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient?s informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. Objective: This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. Methods: Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants? views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants? experience of using the VP. Results: The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. Conclusions: The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice. UR - https://mededu.jmir.org/2021/2/e22745 UR - http://dx.doi.org/10.2196/22745 UR - http://www.ncbi.nlm.nih.gov/pubmed/34110299 ID - info:doi/10.2196/22745 ER - TY - JOUR AU - Ko, Po-Jen AU - Yu, Sheng-Yueh AU - Chang, Chien-Hwa John AU - Hsieh, Ming-Ju AU - Chu, Sung-Yu AU - Tan, Wei-Hwa Jimmy AU - Cheng, Wan-Ling AU - Ho, Pei PY - 2021/6/9 TI - Using a Web-Based Platform as an Alternative for Conducting International, Multidisciplinary Medical Conferences During the Novel COVID-19 Pandemic: Analysis of a Conference JO - JMIR Med Educ SP - e23980 VL - 7 IS - 2 KW - web-based conference KW - live broadcast KW - medical education KW - dialysis access KW - coronavirus KW - COVID-19 KW - conference KW - social media KW - web-based platform KW - internet KW - interaction KW - teleconference N2 - Background: The COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative. Objective: The unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic. Methods: The program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference. Results: We used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90%) were retained in the web-based conference via live broadcasting. The conference was attended by 71% (37/52) of the original international faculties and 71% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92%) were delivered. A special session??Dialysis access management under the impact of viral epidemics??was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively. Conclusions: Switching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic. UR - https://mededu.jmir.org/2021/2/e23980 UR - http://dx.doi.org/10.2196/23980 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970866 ID - info:doi/10.2196/23980 ER - TY - JOUR AU - Gambril, Alan John AU - Boyd, J. Carter AU - Egbaria, Jamal PY - 2021/6/9 TI - The Numerous Benefits of Social Media for Medicine. Comment on ?Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions? JO - J Med Internet Res SP - e27664 VL - 23 IS - 6 KW - social media KW - medical education KW - internet KW - academic medicine KW - promotion KW - tenure KW - health professions KW - scholarship KW - medicine KW - research KW - accomplishment KW - crowd source KW - contribution KW - innovation KW - education KW - dissemination UR - https://www.jmir.org/2021/6/e27664 UR - http://dx.doi.org/10.2196/27664 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106082 ID - info:doi/10.2196/27664 ER - TY - JOUR AU - Plackett, Ruth AU - Kassianos, P. Angelos AU - Timmis, Jessica AU - Sheringham, Jessica AU - Schartau, Patricia AU - Kambouri, Maria PY - 2021/6/4 TI - Using Virtual Patients to Explore the Clinical Reasoning Skills of Medical Students: Mixed Methods Study JO - J Med Internet Res SP - e24723 VL - 23 IS - 6 KW - computer simulation KW - web-based patient simulation KW - computer-assisted instruction KW - educational technology KW - medical education KW - clinical decision support systems KW - clinical decision making KW - clinical reasoning KW - clinical skills KW - primary care KW - diagnosis N2 - Background: Improving clinical reasoning skills?the thought processes used by clinicians to formulate appropriate questions and diagnoses?is essential for reducing missed diagnostic opportunities. The electronic Clinical Reasoning Educational Simulation Tool (eCREST) was developed to improve the clinical reasoning of future physicians. A feasibility trial demonstrated acceptability and potential impacts; however, the processes by which students gathered data were unknown. Objective: This study aims to identify the data gathering patterns of final year medical students while using eCREST and how eCREST influences the patterns. Methods: A mixed methods design was used. A trial of eCREST across 3 UK medical schools (N=148) measured the potential effects of eCREST on data gathering. A qualitative think-aloud and semistructured interview study with 16 medical students from one medical school identified 3 data gathering strategies: Thorough, Focused, and Succinct. Some had no strategy. Reanalysis of the trial data identified the prevalence of data gathering patterns and compared patterns between the intervention and control groups. Patterns were identified based on 2 variables that were measured in a patient case 1 month after the intervention: the proportion of Essential information students identified and the proportion of irrelevant information gathered (Relevant). Those who scored in the top 3 quartiles for Essential but in the lowest quartile for Relevant displayed a Thorough pattern. Those who scored in the top 3 quartiles for Relevant but in the lowest quartile for Essential displayed a Succinct pattern. Those who scored in the top 3 quartiles on both variables displayed a Focused pattern. Those whose scores were in the lowest quartile on both variables displayed a Nonspecific pattern. Results: The trial results indicated that students in the intervention group were more thorough than those in the control groups when gathering data. The qualitative data identified data gathering strategies and the mechanisms by which eCREST influenced data gathering. Students reported that eCREST promoted thoroughness by prompting them to continuously reflect and allowing them to practice managing uncertainty. However, some found eCREST to be less useful, and they randomly gathered information. Reanalysis of the trial data revealed that the intervention group was significantly more likely to display a Thorough data gathering pattern than controls (21/78, 27% vs 6/70, 9%) and less likely to display a Succinct pattern (13/78, 17% vs 20/70, 29%; ?23=9.9; P=.02). Other patterns were similar across groups. Conclusions: Qualitative data suggested that students applied a range of data gathering strategies while using eCREST and that eCREST encouraged thoroughness by continuously prompting the students to reflect and manage their uncertainty. Trial data suggested that eCREST led students to demonstrate more Thorough data gathering patterns. Virtual patients that encourage thoroughness could help future physicians avoid missed diagnostic opportunities and enhance the delivery of clinical reasoning teaching. UR - https://www.jmir.org/2021/6/e24723 UR - http://dx.doi.org/10.2196/24723 UR - http://www.ncbi.nlm.nih.gov/pubmed/34085940 ID - info:doi/10.2196/24723 ER - TY - JOUR AU - Zimianiti, Ioanna AU - Thanaraaj, Vyshnavi AU - Watson, Francesca AU - Osibona, Oluwapelumi PY - 2021/6/1 TI - Medical Students Learning on the COVID-19 Front Line JO - JMIR Med Educ SP - e28264 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - frontline workers KW - medical student KW - viewpoint KW - perspective KW - infectious disease KW - experience KW - barrier KW - motivation UR - https://mededu.jmir.org/2021/2/e28264 UR - http://dx.doi.org/10.2196/28264 UR - http://www.ncbi.nlm.nih.gov/pubmed/34038377 ID - info:doi/10.2196/28264 ER - TY - JOUR AU - Balaji, Aanika AU - Clever, Lou Sarah PY - 2021/5/28 TI - Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial JO - JMIR Med Educ SP - e24300 VL - 7 IS - 2 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 N2 - Background: The COVID-19 pandemic has brought about sweeping change in health care delivery, which has shifted from in-person consultations to a web-based format. Few medical schools provide web-based medicine or telemedicine training to their learners, though this is likely to be important for future medical practice. Objective: This tutorial communicates a framework for incorporating medical students into primary care telemedicine clinics. Methods: A third-year medical student and internal medicine attending physician from the Johns Hopkins University completed telemedicine clinic visits in April 2020 by using a variety of video platforms and via telephone calls. Results: Nine telemedicine visits were completed over 4 clinic days. Our patients were, on average, aged 68 years. The majority of patients were female (6/9, 67%), and most appointments were completed via a video platform (6/9, 67%). Additionally, our experience is summarized and describe (1) practical tips for how to prepare for a telehealth visit; (2) technology considerations; (3) recommendations for participation during a telehealth visit; (4) debriefing and feedback; (5) challenges to care; and (6) student, care provider, and patient reactions to telemedicine visits. Conclusions: Telemedicine clinics have been successfully used for managing patients with chronic conditions, those who have attended low-risk urgent care visits, and those with mental health concerns. Patients have reported high patient satisfaction scores for telemedicine visits, and the majority of patients are comfortable with having medical students as part of their care team. Moving forward, telemedicine will remain a popular method for receiving health care. This study has highlighted that medical students can successfully be integrated into telemedicine clinics and that they should be exposed to telehealth whenever possible prior to residency. UR - https://mededu.jmir.org/2021/2/e24300 UR - http://dx.doi.org/10.2196/24300 UR - http://www.ncbi.nlm.nih.gov/pubmed/33974552 ID - info:doi/10.2196/24300 ER - TY - JOUR AU - Naylor, Katarzyna AU - Torres, Kamil PY - 2021/5/25 TI - Transitioning to Web-Based Learning in Basic Life Support Training During the COVID-19 Pandemic to Battle the Fear of Out-of-Hospital Cardiac Arrest: Presentation of Novel Methods JO - J Med Internet Res SP - e27108 VL - 23 IS - 5 KW - COVID-19 KW - web-based training KW - basic life support KW - formative assessment KW - out-of-hospital cardiac arrest KW - web-based learning KW - web-based education KW - first aid KW - medical education KW - life support KW - transition KW - outcome KW - formative UR - https://www.jmir.org/2021/5/e27108 UR - http://dx.doi.org/10.2196/27108 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886488 ID - info:doi/10.2196/27108 ER - TY - JOUR AU - Elkhadragy, Nervana AU - Aviado, Jeremie AU - Huang, Henry AU - Corelli, L. Robin AU - Hudmon, Suchanek Karen PY - 2021/5/25 TI - Shared Tobacco Cessation Curriculum Website for Health Professionals: Longitudinal Analysis of User and Utilization Data Over a Period of 15 Years JO - JMIR Med Educ SP - e20704 VL - 7 IS - 2 KW - health professional education KW - interprofessional education KW - shared curricula KW - website KW - end-user data KW - tobacco cessation N2 - Background: Because tobacco use is a major cause of morbidity and mortality worldwide, it is essential to prepare health care providers to assist patients with quitting smoking. Created in 1999, the ?Rx for Change? tobacco cessation curriculum was designed to fill an educational gap in cessation training of health professional students. In 2004, a website was launched to host teaching materials and tools to support the efforts of educators and clinicians. Objective: The objective of this study was to characterize users and utilization of a website hosting shared teaching materials over a period of 15 years. Methods: Data from the Rx for Change website have been collected prospectively since its inception. In this study, end-user data were analyzed to determine user characteristics, how they heard about the website, intended use of the materials, and numbers of logins and file downloads over time. Results: Total number of website registrants was 15,576, representing all 50 states in the United States and 94 countries. The most represented discipline was pharmacy (6393/15,505, 41.2%), and nearly half of users were students or residents. The most common source of referral to the website was a faculty member or colleague (33.4%, 2591/7758), and the purpose of enhancing personal knowledge and skills was the most commonly cited intended use of the curricular materials. A total of 259,835 file downloads occurred during the 15-year period, and the most commonly downloaded file type was ancillary handouts. Conclusions: The Rx for Change website demonstrated sustained use, providing immediate access to tobacco cessation teaching and practice tools for educators and clinicians over the first 15 years of its existence. The website has a broad interprofessional reach, and the consistent utilization over time and large number of downloads provide evidence for the feasibility and utility of a public-access website hosting teaching materials. The shared curriculum approach averts the need for educators to create their own materials for teaching tobacco cessation to students in the health professions. UR - https://mededu.jmir.org/2021/2/e20704 UR - http://dx.doi.org/10.2196/20704 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032582 ID - info:doi/10.2196/20704 ER - TY - JOUR AU - Luo, Ping AU - Pang, Wenwen AU - Wang, Yingying AU - Liu, Minghui AU - Zhou, Shu AU - Liu, Shuai AU - Zhang, Xian AU - Liu, Li AU - Liu, Yanan AU - Zhou, Fuling PY - 2021/5/25 TI - WeChat as a Platform for Problem-Based Learning Among Hematological Postgraduates: Feasibility and Acceptability Study JO - J Med Internet Res SP - e16463 VL - 23 IS - 5 KW - problem-based learning KW - PBL KW - WeChat KW - hematology KW - postgraduate KW - education N2 - Background: Hematological medicine is a practical discipline that is difficult to study. Problem-based learning (PBL) is an innovative student-centered teaching method wherein students define their own learning objectives from clinically based problems. Considering that WeChat is the most popular communication app in China, we selected it as a new platform for online PBL to reduce the limitations of traditional PBL in hematology teaching. Objective: This study aims to explore a new pedagogical method called WeChat-PBL, which is based on real micro clinical cases for postgraduates majoring in hematology and to demonstrate its feasibility and acceptability. Methods: A total of 48 hematological postgraduates and 7 tutors participated in this study. We divided the participants into 7 groups where students can learn theoretical knowledge. After each course, the members of each group were required to complete in-class quizzes. Moreover, the students and tutors were required to fill out periodic (after each class) and overall (after each semester) evaluations. Results: A total of 8 micro clinical cases were presented in WeChat-PBL. The average quiz score for acute myelogenous leukemia, chronic myeloid leukemia, multiple myeloma, acute promyelocytic leukemia, and lymphoma were 89.0%, 86.0%, 83.4%, 88.8%, and 77.5%, respectively. Periodic evaluations showed that both students and tutors were satisfied with the process of WeChat-PBL. The overall evaluation results showed that WeChat-PBL was able to positively impact the learning experiences of hematological postgraduates. Conclusions: Our results indicate the feasibility and acceptability of the WeChat-PBL teaching method for postgraduates majoring in hematology. UR - https://www.jmir.org/2021/5/e16463 UR - http://dx.doi.org/10.2196/16463 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032573 ID - info:doi/10.2196/16463 ER - TY - JOUR AU - Godoy, Barros Ivan Rodrigues AU - Neto, Pecci Luís AU - Skaf, Abdalla AU - Leão-Filho, Muniz Hilton AU - Freddi, Lourenço Tomás De Andrade AU - Jasinowodolinski, Dany AU - Yamada, Fukunishi André PY - 2021/5/20 TI - Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study JO - JMIR Med Educ SP - e28733 VL - 7 IS - 2 KW - audiovisual reports KW - COVID-19 KW - fellowship KW - radiology KW - smartphones KW - video recording KW - web technology N2 - Background: Traditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program. Objective: This study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing. Methods: One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation. Results: Most of the applicants (n=122, 99%) answered positively (with responses of ?agree? or ?strongly agree?) that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms. Conclusions: The use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicant?s experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones. UR - https://mededu.jmir.org/2021/2/e28733 UR - http://dx.doi.org/10.2196/28733 UR - http://www.ncbi.nlm.nih.gov/pubmed/33956639 ID - info:doi/10.2196/28733 ER - TY - JOUR AU - Kanzow, Philipp AU - Krantz-Schäfers, Christiane AU - Hülsmann, Michael PY - 2021/5/14 TI - Remote Teaching in a Preclinical Phantom Course in Operative Dentistry During the COVID-19 Pandemic: Observational Case Study JO - JMIR Med Educ SP - e25506 VL - 7 IS - 2 KW - acceptance KW - COVID-19 KW - dental education KW - distance learning KW - effectiveness KW - e-learning KW - medical education KW - medical student KW - observational KW - screencasts KW - preclinical education KW - remote teaching N2 - Background: During the acute COVID-19 pandemic, physical access to the University Medical Center Göttingen was restricted for students. For the first time at our dental school, theoretical knowledge was imparted to students via asynchronous online screencasts and discussed via synchronous video meetings only. Objective: We aimed to assess the acceptance and effectiveness of distance education as a new teaching format for theoretical knowledge within the preclinical course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany). Methods: The phantom course comprised distance education (first phase, 11 weeks) and subsequent on-site practical demonstrations and training (second phase, 10 weeks). All theoretical knowledge was taught via online screencasts during distance education (except for the first week, 3 screencasts were uploaded per week resulting in a total of 30 screencasts). Until the end of the term, all students (N=33) were able to view the screencasts for an unlimited number of times. Theoretical knowledge was assessed in a summative examination after practical on-site teaching. Acceptance and effectiveness of the new curriculum and distance education were also measured based on an evaluation survey and students? self-perceived learning outcome, which was compared to the outcome from the two pre?COVID-19 terms. Results: Each screencast was viewed by a mean of 24 (SD 3.3) students and accessed a mean of 5.6 (SD 1.2) times per user (ie, by students who accessed the respective screencast at least once). During distance education, the number of accesses showed a linear trend over time. During the practical training phase, screencast views declined and increased again prior to the examination. Screencasts covering topics in Cariology, Restorative Dentistry, and Preventive Dentistry were viewed by more students than screencasts covering topics in Endodontology or Periodontology (both P=.047). Examination items in Periodontology showed inferior results compared to the other topics (P<.001). Within the different topics, students? self-perceived learning outcome did not differ from that during the pre?COVID-19 terms. Although most students agreed that the presented screencasts contributed to their learning outcome, pre?COVID-19 term students more strongly felt that lectures significantly contributed to their learning outcome (P=.03). Conclusions: Screencasts showed high acceptance and effectiveness among the students but were not used as a learning tool by all students. However, students who viewed the screencasts accessed each screencast more frequently than they could have attended a conventional lecture. Screencast views were mostly due to intrinsic motivation. UR - https://mededu.jmir.org/2021/2/e25506 UR - http://dx.doi.org/10.2196/25506 UR - http://www.ncbi.nlm.nih.gov/pubmed/33941512 ID - info:doi/10.2196/25506 ER - TY - JOUR AU - Wilcha, Robyn-Jenia PY - 2021/5/14 TI - Author?s Reply to: Virtual vs Online: Insight From Medical Students. Comment on ?Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review? JO - JMIR Med Educ SP - e29335 VL - 7 IS - 2 KW - virtual teaching KW - medical student KW - medical education KW - COVID-19 KW - review KW - search term KW - virus KW - pandemic KW - quarantine UR - https://mededu.jmir.org/2021/2/e29335 UR - http://dx.doi.org/10.2196/29335 UR - http://www.ncbi.nlm.nih.gov/pubmed/33852412 ID - info:doi/10.2196/29335 ER - TY - JOUR AU - Kaini, Shahil AU - Motie, Zahrah Lucinda PY - 2021/5/14 TI - Virtual vs Online: Insight From Medical Students. Comment on ?Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review? JO - JMIR Med Educ SP - e27020 VL - 7 IS - 2 KW - virtual teaching KW - medical student KW - medical education KW - COVID-19 KW - review KW - search term KW - virus KW - pandemic KW - quarantine UR - https://mededu.jmir.org/2021/2/e27020 UR - http://dx.doi.org/10.2196/27020 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988518 ID - info:doi/10.2196/27020 ER - TY - JOUR AU - Klemm, Philipp AU - Kleyer, Arnd AU - Tascilar, Koray AU - Schuster, Louis AU - Meinderink, Timo AU - Steiger, Florian AU - Lange, Uwe AU - Müller-Ladner, Ulf AU - Knitza, Johannes AU - Sewerin, Philipp AU - Mucke, Johanna AU - Pfeil, Alexander AU - Schett, Georg AU - Hartmann, Fabian AU - Hueber, J. Axel AU - Simon, David PY - 2021/5/11 TI - A Virtual Reality?Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study JO - JMIR Serious Games SP - e23835 VL - 9 IS - 2 KW - feasibility KW - virtual reality KW - inflammatory arthritis KW - psoriatic arthritis KW - rheumatoid arthritis N2 - Background: Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective: We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods: We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography?generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the ?2 or Fisher test was used as appropriate. Two-sided P values ?.05 were regarded as significant. Results: A total of 125 individuals participated in this study. Among them, 56% of the participants identified as female, 43% identified as male, and 1% identified as nonbinary; 59% of the participants were 18-30 years of age, 18% were 31-40 years old, 10% were 41-50 years old, 8% were 51-60 years old, and 5% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions: The data show that IA-targeting innovative teaching approaches based on VR technology are feasible. UR - https://games.jmir.org/2021/2/e23835 UR - http://dx.doi.org/10.2196/23835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973858 ID - info:doi/10.2196/23835 ER - TY - JOUR AU - Rivera, Ronald AU - Smart, Jonathan AU - Sakaria, Sangeeta AU - Wray, Alisa AU - Wiechmann, Warren AU - Boysen-Osborn, Megan AU - Toohey, Shannon PY - 2021/5/11 TI - Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era JO - JMIR Med Educ SP - e25213 VL - 7 IS - 2 KW - distance education KW - videoconferencing KW - emergency medicine KW - teaching KW - learning KW - web-based lecture KW - medical education KW - technology KW - SARS-CoV-2 KW - COVID-19 UR - https://mededu.jmir.org/2021/2/e25213 UR - http://dx.doi.org/10.2196/25213 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872191 ID - info:doi/10.2196/25213 ER - TY - JOUR AU - Baalsrud Hauge, Jannicke AU - Söbke, Heinrich AU - Bröker, Thomas AU - Lim, Theodore AU - Luccini, Marco Angelo AU - Kornevs, Maksims AU - Meijer, Sebastiaan PY - 2021/5/5 TI - Current Competencies of Game Facilitators and Their Potential Optimization in Higher Education: Multimethod Study JO - JMIR Serious Games SP - e25481 VL - 9 IS - 2 KW - facilitation KW - higher education KW - competency KW - simulation KW - gaming KW - educational games N2 - Background: Serious games can be a powerful learning tool in higher education. However, the literature indicates that the learning outcome in a serious game depends on the facilitators? competencies. Although professional facilitators in commercial game-based training have undergone specific instruction, facilitators in higher education cannot rely on such formal instruction, as game facilitation is only an occasional part of their teaching activities. Objective: This study aimed to address the actual competencies of occasional game facilitators and their perceived competency deficits. Methods: Having many years of experience as professional and occasional facilitators, we (n=7) defined requirements for the occasional game facilitator using individual reflection and focus discussion. Based on these results, guided interviews were conducted with additional occasional game facilitators (n=4) to check and extend the requirements. Finally, a group of occasional game facilitators (n=30) answered an online questionnaire based on the results of the requirement analysis and existing competency models. Results: Our review produced the following questions: Which competencies are needed by facilitators and what are their training needs? What do current training courses for occasional game facilitators in higher education look like? How do the competencies of occasional game facilitators differ from other competencies required in higher education? The key findings of our analysis are that a mix of managerial and technical competencies is required for facilitating serious games in higher educational contexts. Further, there is a limited or no general competence model for game facilitators, and casual game facilitators rarely undergo any specific, formal training. Conclusions: The results identified the competencies that game facilitators require and a demand for specific formal training. Thus, the study contributes to the further development of a competency model for game facilitators and enhances the efficiency of serious games. UR - https://games.jmir.org/2021/2/e25481 UR - http://dx.doi.org/10.2196/25481 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949956 ID - info:doi/10.2196/25481 ER - TY - JOUR AU - Said, Sadiq AU - Roche, Raoul Tadzio AU - Braun, Julia AU - Ganter, Thomas Micheal AU - Meybohm, Patrick AU - Herrmann, Johannes AU - Zacharowski, Kai AU - Raimann, Jürgen Florian AU - Piekarski, Florian AU - Rivas, Eva AU - López-Baamonde, Manuel AU - Spahn, R. Donat AU - Nöthiger, Beat Christoph AU - Tscholl, Werner David PY - 2021/5/3 TI - Effects of an Animated Blood Clot Technology (Visual Clot) on the Decision-Making of Users Inexperienced in Viscoelastic Testing: Multicenter Trial JO - J Med Internet Res SP - e27124 VL - 23 IS - 5 KW - avatar technology KW - coagulation management KW - hemostasis KW - intuitive design KW - rotational thromboelastometry KW - user-centered design KW - Visual Clot KW - testing N2 - Background: Viscoelastic test?guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3D blood clot that illustrates raw rotational thromboelastometry (ROTEM) parameters in a user-centered and situation awareness?oriented method. Objective: This study aimed to evaluate the applicability of Visual Clot by examining its effects on users that are novices in viscoelastic-guided resuscitation. Methods: We conducted an investigator-initiated, international, multicenter study between September 16, 2020, and October 6, 2020, in 5 tertiary care hospitals in central Europe. We randomly recruited medical students and inexperienced resident physicians without significant prior exposure to viscoelastic testing. The 7 participants per center managed 9 different ROTEM outputs twice, once as standard ROTEM tracings and once as the corresponding Visual Clot. We randomly presented the 18 viscoelastic cases and asked the participants for their therapeutic decisions. We assessed the performance, diagnostic confidence, and perceived workload in managing the tasks using mixed statistical models and adjusted for possible confounding factors. Results: Analyzing a total of 630 results, we found that the participants solved more cases correctly (odds ratio [OR] 33.66, 95% CI 21.13-53.64; P<.001), exhibited more diagnostic confidence (OR 206.2, 95% CI 93.5-454.75; P<.001), and perceived less workload (coefficient ?41.63; 95% CI ?43.91 to ?39.36; P<.001) using Visual Clot compared to using standard ROTEM tracings. Conclusions: This study emphasizes the practical benefit of presenting viscoelastic test results in a user-centered way. Visual Clot may allow inexperienced users to be involved in the decision-making process to treat bleeding-associated coagulopathy. The increased diagnostic confidence, diagnostic certainty, reduced workload, and positive user feedback associated with this visualization may promote the further adoption of viscoelastic methods in diverse health care settings. UR - https://www.jmir.org/2021/5/e27124 UR - http://dx.doi.org/10.2196/27124 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843602 ID - info:doi/10.2196/27124 ER - TY - JOUR AU - Fatima, Rawish AU - Assaly, R. Ahmad AU - Aziz, Muhammad AU - Moussa, Mohamad AU - Assaly, Ragheb PY - 2021/4/30 TI - The United States Medical Licensing Exam Step 2 Clinical Skills Examination: Potential Alternatives During and After the COVID-19 Pandemic JO - JMIR Med Educ SP - e25903 VL - 7 IS - 2 KW - USMLE KW - United States Medical Licensing Examination KW - The National Resident Matching Program KW - NRMP KW - Step 2 Clinical Skills KW - Step 2 CS KW - medical school KW - medical education KW - test KW - medical student KW - United States KW - online learning KW - exam KW - alternative KW - model KW - COVID-19 UR - https://mededu.jmir.org/2021/2/e25903 UR - http://dx.doi.org/10.2196/25903 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878014 ID - info:doi/10.2196/25903 ER - TY - JOUR AU - Jones, E. Sarah AU - Campbell, K. Penny AU - Kimp, J. Alexander AU - Bennell, Kim AU - Foster, E. Nadine AU - Russell, Trevor AU - Hinman, S. Rana PY - 2021/4/30 TI - Evaluation of a Novel e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis via Telehealth: Qualitative Study Nested in the PEAK (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis) Randomized Controlled Trial JO - J Med Internet Res SP - e25872 VL - 23 IS - 4 KW - osteoarthritis KW - knee KW - physiotherapy KW - exercise KW - e-learning KW - qualitative KW - telehealth KW - pain KW - education N2 - Background: The delivery of physiotherapy via telehealth could provide more equitable access to services for patients. Videoconference-based telehealth has been shown to be an effective and acceptable mode of service delivery for exercise-based interventions for chronic knee pain; however, specific training in telehealth is required for physiotherapists to effectively and consistently deliver care using telehealth. The development and evaluation of training programs to upskill health care professionals in the management of osteoarthritis (OA) has also been identified as an important priority to improve OA care delivery. Objective: This study aims to explore physiotherapists? experiences with and perceptions of an e-learning program about best practice knee OA management (focused on a structured program of education, exercise, and physical activity) that includes telehealth delivery via videoconferencing. Methods: We conducted a qualitative study using individual semistructured telephone interviews, nested within the Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis randomized controlled trial, referred to as the PEAK trial. A total of 15 Australian physiotherapists from metropolitan and regional private practices were interviewed following the completion of an e-learning program. The PEAK trial e-learning program involved self-directed learning modules, a mock video consultation with a researcher (simulated patient), and 4 audited practice video consultations with pilot patients with chronic knee pain. Interviews were audio recorded and transcribed verbatim. Data were thematically analyzed. Results: A total of five themes (with associated subthemes) were identified: the experience of self-directed e-learning (physiotherapists were more familiar with in-person learning; however, they valued the comprehensive, self-paced web-based modules. Unwieldy technological features could be frustrating); practice makes perfect (physiotherapists benefited from the mock consultation with the researcher and practice sessions with pilot patients alongside individualized performance feedback, resulting in confidence and preparedness to implement new skills); the telehealth journey (although inexperienced with telehealth before training, physiotherapists were confident and able to deliver remote care following training; however, they still experienced some technological challenges); the whole package (the combination of self-directed learning modules, mock consultation, and practice consultations with pilot patients was felt to be an effective learning approach, and patient information booklets supported the training package); and impact on broader clinical practice (training consolidated and refined existing OA management skills and enabled a switch to telehealth when the COVID-19 pandemic affected in-person clinical care). Conclusions: Findings provide evidence for the perceived effectiveness and acceptability of an e-learning program to train physiotherapists (in the context of a clinical trial) on best practice knee OA management, including telehealth delivery via videoconferencing. The implementation of e-learning programs to upskill physiotherapists in telehealth appears to be warranted, given the increasing adoption of telehealth service models for the delivery of clinical care. UR - https://www.jmir.org/2021/4/e25872 UR - http://dx.doi.org/10.2196/25872 UR - http://www.ncbi.nlm.nih.gov/pubmed/33929326 ID - info:doi/10.2196/25872 ER - TY - JOUR AU - Stuby, Loric AU - Currat, Ludivine AU - Gartner, Birgit AU - Mayoraz, Mathieu AU - Harbarth, Stephan AU - Suppan, Laurent AU - Suppan, Mélanie PY - 2021/4/30 TI - Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e26927 VL - 10 IS - 4 KW - personal protective equipment KW - electronic learning KW - prehospital KW - student paramedics KW - infection prevention KW - face-to-face learning KW - protection KW - student KW - online learning KW - online education KW - protocol KW - randomized controlled trial KW - gamification N2 - Background: The COVID-19 pandemic has brought attention to the importance of correctly using personal protective equipment (PPE). Doffing is a critical phase that increases the risk of contamination of health care workers. Although a gamified electronic learning (e-learning) module has been shown to increase the adequate choice of PPE among prehospital personnel, it failed to enhance knowledge regarding donning and doffing sequences. Adding other training modalities such as face-to-face training to these e-learning tools is therefore necessary to increase prehospital staff proficiency and thus help reduce the risk of contamination. Objective: The aim of this study is to assess the impact of the Peyton 4-step approach in addition to a gamified e-learning module for teaching the PPE doffing sequence to first-year paramedic students. Methods: Participants will first follow a gamified e-learning module before being randomized into one of two groups. In the control group, participants will be asked to perform a PPE doffing sequence, which will be video-recorded to allow for subsequent assessment. In the experimental group, participants will first undergo face-to-face training performed by third-year students using the Peyton 4-step approach before performing the doffing sequence themselves, which will also be video-recorded. All participants will then be asked to reconstruct the doffing sequence on an online platform. The recorded sequences will be assessed independently by two investigators: a prehospital emergency medicine expert and an infection prevention and control specialist. The assessors will be blinded to group allocation. Four to eight weeks after this first intervention, all participants will be asked to record the doffing sequence once again for a subsequent skill retention assessment and to reconstruct the sequence on the same online platform to assess knowledge retention. Finally, participants belonging to the control group will follow face-to-face training. Results: The study protocol has been presented to the regional ethics committee (Req-2020-01340), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Study sessions were performed in January and February 2021 in Geneva, and will be performed in April and June 2021 in Bern. Conclusions: This study should help to determine whether face-to-face training using the Peyton 4-step approach improves the application and knowledge retention of a complex procedure when combined with an e-learning module. International Registered Report Identifier (IRRID): PRR1-10.2196/26927 UR - https://www.researchprotocols.org/2021/4/e26927 UR - http://dx.doi.org/10.2196/26927 UR - http://www.ncbi.nlm.nih.gov/pubmed/33929334 ID - info:doi/10.2196/26927 ER - TY - JOUR AU - Kleib, Manal AU - Jackman, Deirdre AU - Duarte Wisnesky, Uirá AU - Ali, Shamsa PY - 2021/4/27 TI - Academic Electronic Health Records in Undergraduate Nursing Education: Mixed Methods Pilot Study JO - JMIR Nursing SP - e26944 VL - 4 IS - 2 KW - academic electronic health record KW - Lippincott DocuCare KW - simulation KW - nursing informatics education N2 - Background: Teaching students about electronic health records presents challenges for most nursing programs, primarily because of the limited training opportunities within clinical practice settings. A simulated electronic health record is an experiential, learner-centered strategy that enables students to acquire and apply the informatics knowledge needed for working with electronic records in a safe learning environment before the students have encounters with real patients. Objective: The aim of this study is to provide a preliminary evaluation of the Lippincott DocuCare simulated electronic health record and determine the feasibility issues associated with its implementation. Methods: We used one-group pretest-posttest, surveys, and focus group interviews with students and instructors to pilot the DocuCare simulated electronic health record within an undergraduate nursing program in Western Canada. Volunteering students worked through 4 case scenarios during a 1-month pilot. Self-reported informatics knowledge and attitudes toward the electronic health record, accuracy of computerized documentation, satisfaction, and students? and educators? experiences were examined. Demographic and general information regarding informatics learning was also collected. Results: Although 23 students participated in this study, only 13 completed surveys were included in the analysis. Almost two-thirds of the students indicated their overall understanding of nursing informatics as being fair or inadequate. The two-tailed paired samples t test used to evaluate the impact of DocuCare on students? self-reported informatics knowledge and attitudes toward the electronic health record revealed a statistically significant difference in the mean score of knowledge before and after using DocuCare (before: mean 2.95, SD 0.58; after: mean 3.83, SD 0.39; t12=5.80, two-tailed; P<.001). There was no statistically significant difference in the mean scores of attitudes toward the electronic health record before and after using DocuCare (before: mean 3.75, SD 0.40; after: mean 3.70, SD 0.34; t12=0.39, two-tailed; P=.70). Students? documentation scores varied from somewhat accurate to completely accurate; however, performance improved for the majority of students as they progressed from case scenarios 1 to 4. Both the faculty and students were highly satisfied with DocuCare and highly recommended its integration. Focus groups with 7 students and 3 educators revealed multiple themes. The participants shared suggestions regarding the DocuCare product customization and strategies for potential integration in undergraduate nursing programs. Conclusions: This study demonstrated the feasibility and suitability of the DocuCare program as a tool to enhance students? learning about informatics and computerized documentation in electronic health records. Recommendations will be made to academic leadership in undergraduate programs on the basis of this study. Furthermore, a controlled evaluation study will be conducted in the future. UR - https://nursing.jmir.org/2021/2/e26944 UR - http://dx.doi.org/10.2196/26944 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345797 ID - info:doi/10.2196/26944 ER - TY - JOUR AU - Utunen, Heini AU - Van Kerkhove, D. Maria AU - Tokar, Anna AU - O'Connell, Gillian AU - Gamhewage, M. Gaya AU - Fall, Socé Ibrahima PY - 2021/4/21 TI - One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization?s Technical Guidance JO - JMIR Public Health Surveill SP - e28945 VL - 7 IS - 4 KW - COVID-19 KW - e-learning KW - massive open web-based courses KW - OpenWHO KW - pandemic KW - public health KW - web-based learning KW - World Health Organization UR - https://publichealth.jmir.org/2021/4/e28945 UR - http://dx.doi.org/10.2196/28945 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881404 ID - info:doi/10.2196/28945 ER - TY - JOUR AU - Katz, Marc AU - Nandi, Neilanjan PY - 2021/4/12 TI - Social Media and Medical Education in the Context of the COVID-19 Pandemic: Scoping Review JO - JMIR Med Educ SP - e25892 VL - 7 IS - 2 KW - social media KW - medical education KW - COVID-19 KW - medical student KW - review KW - doctor KW - communication KW - online learning KW - e-learning KW - online education KW - delivery KW - dissemination N2 - Background: The COVID-19 pandemic has brought virtual web-based learning to the forefront of medical education as training programs adapt to physical distancing challenges while maintaining the rigorous standards of medical training. Social media has unique and partially untapped potential to supplement formal medical education. Objective: The aim of this review is to provide a summary of the incentives, applications, challenges, and pitfalls of social media?based medical education for both trainees and educators. Methods: We performed a literature review via PubMed of medical research involving social media platforms, including Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts. Papers were reviewed for inclusion based on the integrity and power of the study. Results: The unique characteristics of social media platforms such as Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts endow them with unique communication capabilities that serve different educational purposes in both formal and informal education settings. However, contemporary medical education curricula lack widespread guidance on meaningful use, application, and deployment of social media in medical education. Conclusions: Clinicians and institutions must evolve to embrace the use of social media platforms for medical education. Health care professionals can approach social media engagement in the same ethical manner that they would with patients in person; however, health care institutions ultimately must enable their health care professionals to achieve this by enacting realistic social media policies. Institutions should appoint clinicians with strong social media experience to leadership roles to spearhead these generational and cultural changes. Further studies are needed to better understand how health care professionals can most effectively use social media platforms as educational tools. Ultimately, social media is here to stay, influencing lay public knowledge and trainee knowledge. Clinicians and institutions must embrace this complementary modality of trainee education and champion social media as a novel distribution platform that can also help propagate truth in a time of misinformation, such as the COVID-19 pandemic. UR - https://mededu.jmir.org/2021/2/e25892 UR - http://dx.doi.org/10.2196/25892 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755578 ID - info:doi/10.2196/25892 ER - TY - JOUR AU - Li, Yaning AU - Ye, Hongqiang AU - Ye, Fan AU - Liu, Yunsong AU - Lv, Longwei AU - Zhang, Ping AU - Zhang, Xiao AU - Zhou, Yongsheng PY - 2021/4/8 TI - The Current Situation and Future Prospects of Simulators in Dental Education JO - J Med Internet Res SP - e23635 VL - 23 IS - 4 KW - dental simulator KW - dental education KW - virtual reality UR - https://www.jmir.org/2021/4/e23635 UR - http://dx.doi.org/10.2196/23635 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830059 ID - info:doi/10.2196/23635 ER - TY - JOUR AU - Lovey, Thibault AU - O'Keeffe, Paul AU - Petignat, Ianis PY - 2021/3/24 TI - Basic Medical Training for Refugees via Collaborative Blended Learning: Quasi-Experimental Design JO - J Med Internet Res SP - e22345 VL - 23 IS - 3 KW - refugees KW - blended learning KW - basic medical training KW - higher education in emergencies KW - innovation KW - mobile phone N2 - Background: Globally, there is an excess of 68.5 million people who have been forced to leave their homes and seek sanctuary elsewhere because of poverty, persecution, conflict, violence, and human rights violations. Although international humanitarian responses usually focus on ensuring that the basic needs of these people are being met, there is growing attention on the role that development-oriented interventions can play in the longer term. Higher education in a refugee context is one such intervention that can equip refugees with the knowledge and skills they need to serve their communities and move forward. Objective: This study aims to evaluate the outcomes and effectiveness of the University of Geneva InZone-Raft Basic Medical Training Course in the Kakuma refugee camp in Kenya compared with a previous incarnation of the same course in the Dadaab refugee camp in Kenya. Methods: We used a quasi-experimental design to compare the posttest scores of both inequivalent student groups: control group (n=18) and intervention group (n=16). Factors that influenced refugee students? knowledge acquisition, the amount of knowledge they acquired, and their academic outcomes were assessed, and the pedagogical evolution of the project is presented. Results: We found that the Kakuma intervention course yielded better outcomes and was more effective in terms of learning than the Dadaab control course. Of the 16 students who took part in the intervention course, 10 (63%) completed the program successfully and received accreditation from the University of Geneva. We observed that they received new knowledge well and scored higher on all learning modalities than those in the control course. Comparison of written and oral examinations between the courses showed statistical significance for the intervention group in written and oral exams (two-tailed: P=.006 and P=.05; one-tailed: P=.003 and P=.03, respectively). The Kakuma course was not effective in addressing electricity and internet access problems, nor in reducing the challenge of tight deadlines in the syllabus. Pedagogical adjustments to the intervention course improved student involvement, with higher participation rates in quizzes (10/11, 91%), and overall satisfaction and learning. Conclusions: The intervention group?with an improved mode of delivery, better contextualized content, and further interaction?reached a higher level of medical knowledge acquisition and developed more complex questions on medical topics than the control group. The positive outcome of this project shows that given the right resources and support, refugees can contribute to the improvement and development of health care in their communities. Nonetheless, a more focused effort is necessary to meet the educational needs of refugee learners and better understand their living conditions. UR - https://www.jmir.org/2021/3/e22345 UR - http://dx.doi.org/10.2196/22345 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759802 ID - info:doi/10.2196/22345 ER - TY - JOUR AU - Smit, A. Marloes AU - van Pelt, W. Gabi AU - Dequeker, MC Elisabeth AU - Al Dieri, Raed AU - Tollenaar, AEM Rob AU - van Krieken, JM J. Han AU - Mesker, E. Wilma AU - PY - 2021/3/19 TI - e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study JO - JMIR Form Res SP - e19408 VL - 5 IS - 3 KW - colon cancer KW - tumor-stroma ratio KW - validation KW - e-Learning KW - reproducibility study KW - cancer KW - tumor KW - colon KW - reproducibility KW - carcinoma KW - prognosis KW - diagnostic KW - implementation KW - online learning N2 - Background: The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement. Objective: The Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool (UNITED) study was developed to bring the TSR to clinical implementation. As part of the study, an e-Learning module was constructed to confirm the reproducibility of scoring the TSR after proper instruction. Methods: The e-Learning module consists of an autoinstruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training, test, and repetition sets). Scoring the TSR is performed on hematoxylin and eosin?stained sections and takes only 1-2 minutes. Cases are considered stroma-low if the amount of stroma is ?50%, whereas a stroma-high case is defined as >50% stroma. Inter- and intraobserver agreements were determined based on the Cohen ? score after each set to evaluate the reproducibility. Results: Pathologists and pathology residents (N=63) with special interest in colorectal cancer participated in the e-Learning. Forty-nine participants started the e-Learning and 31 (63%) finished the whole cycle (3 sets). A significant improvement was observed from the training set to the test set; the median ? score improved from 0.72 to 0.77 (P=.002). Conclusions: e-Learning is an effective method to instruct pathologists and pathology residents for scoring the TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method. Trial Registration: The Netherlands Trial Registry NTR7270; https://www.trialregister.nl/trial/7072 International Registered Report Identifier (IRRID): RR2-10.2196/13464 UR - https://formative.jmir.org/2021/3/e19408 UR - http://dx.doi.org/10.2196/19408 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739293 ID - info:doi/10.2196/19408 ER - TY - JOUR AU - Chiu, Yen-Lin AU - Lee, Yu-Chen AU - Tsai, Chin-Chung PY - 2021/3/18 TI - Internet-Specific Epistemic Beliefs in Medicine and Intention to Use Evidence-Based Online Medical Databases Among Health Care Professionals: Cross-sectional Survey JO - J Med Internet Res SP - e20030 VL - 23 IS - 3 KW - evidence-based medicine (EBM) KW - health care professionals KW - internet-specific epistemic beliefs KW - medical informatics N2 - Background: Evidence-based medicine has been regarded as a prerequisite for ensuring health care quality. The increase in health care professionals? adoption of web-based medical information and the lack of awareness of alternative access to evidence-based online resources suggest the need for an investigation of their information-searching behaviors of using evidence-based online medical databases. Objective: The main purposes of this study were to (1) modify and validate the internet-specific epistemic beliefs in medicine (ISEBM) questionnaire and (2) explore the associations between health care professionals? demographics, ISEBM, and intention to use evidence-based online medical databases for clinical practice. Methods: Health care professionals in a university-affiliated teaching hospital were surveyed using the ISEBM questionnaire. The partial least squares-structural equation modeling was conducted to analyze the reliability and validity of ISEBM. Furthermore, the structural model was analyzed to examine the possible linkages between health professionals? demographics, ISEBM, and intention to utilize the evidence-based online medical databases for clinical practice. Results: A total of 273 health care professionals with clinical working experience were surveyed. The results of the measurement model analysis indicated that all items had significant loadings ranging from 0.71 to 0.92 with satisfactory composite reliability values ranging from 0.87 to 0.94 and average variance explained values ranging from 0.70 to 0.84. The results of the structural relationship analysis revealed that the source of internet-based medical knowledge (path coefficient ?0.26, P=.01) and justification of internet-based knowing in medicine (path coefficient 0.21, P=.001) were correlated with the intention to use evidence-based online medical databases. However, certainty and simplicity of internet-based medical knowledge were not. In addition, gender (path coefficient 0.12, P=.04) and academic degree (path coefficient 0.15, P=.004) were associated with intention to use evidence-based online medical databases for clinical practice. Conclusions: Advancing health care professionals? ISEBM regarding source and justification may encourage them to retrieve valid medical information through evidence-based medical databases. Moreover, providing support for specific health care professionals (ie, females, without a master?s degree) may promote their intention to use certain databases for clinical practice. UR - https://www.jmir.org/2021/3/e20030 UR - http://dx.doi.org/10.2196/20030 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734092 ID - info:doi/10.2196/20030 ER - TY - JOUR AU - Liu, Qinlai AU - Sun, Wenping AU - Du, Changqing AU - Yang, Leiying AU - Yuan, Na AU - Cui, Haiqing AU - Song, Wengang AU - Ge, Li PY - 2021/3/15 TI - Medical Morphology Training Using the Xuexi Tong Platform During the COVID-19 Pandemic: Development and Validation of a Web-Based Teaching Approach JO - JMIR Med Inform SP - e24497 VL - 9 IS - 3 KW - COVID-19 KW - histology and embryology KW - pathology KW - web-based teaching KW - Xuexi Tong platform N2 - Background: Histology and Embryology and Pathology are two important basic medical morphology courses for studying human histological structures under healthy and pathological conditions, respectively. There is a natural succession between the two courses. At the beginning of 2020, the COVID-19 pandemic suddenly swept the world. During this unusual period, to ensure that medical students would understand and master basic medical knowledge and to lay a solid foundation for future medical bridge courses and professional courses, a web-based medical morphology teaching team, mainly including teachers of courses in Histology and Embryology and Pathology, was established. Objective: This study aimed to explore a new teaching mode of Histology and Embryology and Pathology courses during the COVID-19 pandemic and to illustrate its feasibility and acceptability. Methods: From March to July 2020, our team selected clinical medicine undergraduate students who started their studies in 2018 and 2019 as recipients of web-based teaching. Meanwhile, nursing undergraduate students who started their studies in 2019 and 2020 were selected for traditional offline teaching as the control group. For the web-based teaching, our team used the Xuexi Tong platform as the major platform to realize a new ?seven-in-one? teaching method (ie, videos, materials, chapter tests, interactions, homework, live broadcasts, and case analysis/discussion). This new teaching mode involved diverse web-based teaching methods and contents, including flipped classroom, screen-to-screen experimental teaching, a drawing competition, and a writing activity on the theme of ?What I Know About COVID-19.? When the teaching was about to end, a questionnaire was administered to obtain feedback regarding the teaching performance. In the meantime, the final written pathology examination results of the web-based teaching and traditional offline teaching groups were compared to examine the mastery of knowledge of the students. Results: Using the Xuexi Tong platform as the major platform to conduct ?seven-in-one? teaching is feasible and acceptable. With regard to the teaching performance of this new web-based teaching mode, students demonstrated a high degree of satisfaction, and the questionnaire showed that 71.3% or more of the students in different groups reported a greater degree of satisfaction or being very satisfied. In fact, more students achieved high scores (90-100) in the web-based learning group than in the offline learning control group (P=.02). Especially, the number of students with objective scores >60 in the web-based learning group was greater than that in the offline learning control group (P=.045). Conclusions: This study showed that the web-based teaching mode was not inferior to the traditional offline teaching mode for medical morphology courses, proving the feasibility and acceptability of web-based teaching during the COVID-19 pandemic. Our findings lay a solid theoretical foundation for follow-up studies of medical students. UR - https://medinform.jmir.org/2021/3/e24497 UR - http://dx.doi.org/10.2196/24497 UR - http://www.ncbi.nlm.nih.gov/pubmed/33566792 ID - info:doi/10.2196/24497 ER - TY - JOUR AU - Zhang, Cevin AU - Baalsrud Hauge, Jannicke AU - Härenstam, Pukk Karin AU - Meijer, Sebastiaan PY - 2021/3/11 TI - Game Experience and Learning Effects of a Scoring-Based Mechanic for Logistical Aspects of Pediatric Emergency Medicine: Development and Feasibility Study JO - JMIR Serious Games SP - e21988 VL - 9 IS - 1 KW - serious game KW - emergency department KW - experience KW - learning engagement KW - learning behavior transition KW - logistical performance N2 - Background: Using serious games for learning in operations management is well established. However, especially for logistics skills in health care operations, there is little work on the design of game mechanics for learning engagement and the achievement of the desired learning goals. Objective: This contribution presents a serious game design representing patient flow characteristics, systemic resource configurations, and the roles of the players based on a real Swedish emergency ward. The game was tested in a set of game-based learning practices in the modalities of a physical board game and an online multiplayer serious game that implemented the same game structure. Methods: First, survey scores were collected using the Game Experience Questionnaire Core and Social Presence Modules to evaluate the experience and acceptance of the proposed design to gamify real processes in emergency care. Second, lag sequential analysis was applied to analyze the impact of the game mechanics on learning behavior transitions. Lastly, regression analysis was used to understand whether learning engagement attributes could potentially serve as significant predicting variables for logistical performance in a simulated learning environment. Results: A total of 36 students from courses in engineering and management at KTH Royal Institute of Technology participated in both game-based learning practices during the autumn and spring semesters of 2019 and 2020. For the Core Module, significant differences were found for the scores for negative affect and tension compared with the rest of the module. For the Social Presence Module, significant differences were found in the scores for the psychological involvement ? negative feelings dimension compared with the rest of the module. During the process of content generation, the participant had access to circulating management resources and could edit profiles. The standard regression analysis output yielded a ?R2 of 0.796 (F14,31=2725.49, P<.001) for the board version and 0.702 (F24,31=2635.31, P<.001) for the multiplayer online version after the learning engagement attributes. Conclusions: The high scores of positive affect and immersion compared to the low scores of negative feelings demonstrated the motivating and cognitive involvement impact of the game. The proposed game mechanics have visible effects on significant correlation parameters between the majority of scoring features and changes in learning engagement attributes. Therefore, we conclude that for enhancing learning in logistical aspects of health care, serious games that are steered by well-designed scoring mechanisms can be used. UR - https://games.jmir.org/2021/1/e21988 UR - http://dx.doi.org/10.2196/21988 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704081 ID - info:doi/10.2196/21988 ER - TY - JOUR AU - Meinert, Edward AU - Eerens, Jessie AU - Banks, Christina AU - Maloney, Stephen AU - Rivers, George AU - Ilic, Dragan AU - Walsh, Kieran AU - Majeed, Azeem AU - Car, Josip PY - 2021/3/11 TI - Exploring the Cost of eLearning in Health Professions Education: Scoping Review JO - JMIR Med Educ SP - e13681 VL - 7 IS - 1 KW - education KW - distance education KW - professional education KW - online education KW - online learning KW - costs and cost analysis KW - economics N2 - Background: Existing research on the costs associated with the design and deployment of eLearning in health professions education is limited. The relative costs of these learning platforms to those of face-to-face learning are also not well understood. The lack of predefined costing models used for eLearning cost data capture has made it difficult to complete cost evaluation. Objective: The key aim of this scoping review was to explore the state of evidence concerning cost capture within eLearning in health professions education. The review explores the available data to define cost calculations related to eLearning. Methods: The scoping review was performed using a search strategy with Medical Subject Heading terms and related keywords centered on eLearning and cost calculation with a population scope of health professionals in all countries. The search was limited to articles published in English. No restriction was placed on literature publication date. Results: In total, 7344 articles were returned from the original search of the literature. Of these, 232 were relevant to associated keywords or abstract references following screening. Full-text review resulted in 168 studies being excluded. Of these, 61 studies were excluded because they were unrelated to eLearning and focused on general education. In addition, 103 studies were excluded because of lack of detailed information regarding costs; these studies referred to cost in ways either indicating cost favorability or unfavorability, but without data to support findings. Finally, 4 studies were excluded because of limited cost data that were insufficient for analysis. In total, 42 studies provided data and analysis of the impact of cost and value in health professions education. The most common data source was total cost of training (n=29). Other sources included cost per learner, referring to the cost for individual students (n=13). The population most frequently cited was medical students (n=15), although 12 articles focused on multiple populations. A further 22 studies provide details of costing approaches for the production and delivery of eLearning. These studies offer insight into the ways eLearning has been budgeted and project-managed through implementation. Conclusions: Although cost is a recognized factor in studies detailing eLearning design and implementation, the way cost is captured is inconsistent. Despite a perception that eLearning is more cost-effective than face-to-face instruction, there is not yet sufficient evidence to assert this conclusively. A rigorous, repeatable data capture method is needed, in addition to a means to leverage existing economic evaluation methods that can then test eLearning cost-effectiveness and how to implement eLearning with cost benefits and advantages over traditional instruction. UR - https://mededu.jmir.org/2021/1/e13681 UR - http://dx.doi.org/10.2196/13681 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704073 ID - info:doi/10.2196/13681 ER - TY - JOUR AU - Fink, C. Maximilian AU - Reitmeier, Victoria AU - Stadler, Matthias AU - Siebeck, Matthias AU - Fischer, Frank AU - Fischer, R. Martin PY - 2021/3/4 TI - Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking JO - J Med Internet Res SP - e21196 VL - 23 IS - 3 KW - clinical reasoning KW - medical education KW - performance-based assessment KW - simulation KW - standardized patient KW - virtual patient N2 - Background: Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. Objective: The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. Methods: We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. Results: Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=?0.30; P=.003) and extraneous load (1-tailed r=?0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). Conclusions: The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students? grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods. UR - https://www.jmir.org/2021/3/e21196 UR - http://dx.doi.org/10.2196/21196 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661122 ID - info:doi/10.2196/21196 ER - TY - JOUR AU - Cerqueira-Silva, Thiago AU - Carreiro, Roberto AU - Nunes, Victor AU - Passos, Louran AU - Canedo, F. Bernardo AU - Andrade, Sofia AU - Ramos, P. Pablo Ivan AU - Khouri, Ricardo AU - Santos, Souza Carolina Barbosa AU - Nascimento, Santos Jedson Dos AU - Paste, Angélica Aurea AU - Paiva Filho, Mattos Ivan De AU - Santini-Oliveira, Marília AU - Cruz, Álvaro AU - Barral-Netto, Manoel AU - Boaventura, Viviane PY - 2021/3/4 TI - Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study JO - JMIR Public Health Surveill SP - e24795 VL - 7 IS - 3 KW - medical education KW - surveillance KW - COVID-19 KW - education KW - telehealth KW - training KW - impact KW - medical student KW - triage KW - epidemiology KW - monitoring N2 - Background: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. Objective: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. Methods: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. Results: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians? and students? perceptions. Conclusions: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions. UR - https://publichealth.jmir.org/2021/3/e24795 UR - http://dx.doi.org/10.2196/24795 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630746 ID - info:doi/10.2196/24795 ER - TY - JOUR AU - Kim, Kyung Sun AU - Lee, Youngho AU - Yoon, Hyoseok AU - Choi, Jongmyung PY - 2021/3/2 TI - Adaptation of Extended Reality Smart Glasses for Core Nursing Skill Training Among Undergraduate Nursing Students: Usability and Feasibility Study JO - J Med Internet Res SP - e24313 VL - 23 IS - 3 KW - nursing education KW - skill training KW - self-practice KW - smart glass KW - usability KW - feasibility N2 - Background: Skill training in nursing education has been highly dependent on self-training because of Korea?s high student-faculty ratio. Students tend to have a passive attitude in self-practice, and it is hard to expect effective learning outcomes with traditional checklist-dependent self-practice. Smart glasses have a high potential to assist nursing students with timely information, and a hands-free device does not interrupt performance. Objective: This study aimed to develop a smart glass?based nursing skill training program and evaluate its usability and feasibility for the implementation of self-practice. Methods: We conducted a usability and feasibility study with 30 undergraduate nursing students during a 2-hour open lab for self-practice of core nursing skills, wearing smart glasses for visualized guidance. The usability test was conducted using a 16-item self-reporting questionnaire and 7 open-ended questions. Learning satisfaction was assessed using a 7-item questionnaire. The number of practice sessions was recorded, and perceived competency in core nursing skills was measured before and after the intervention. At the final evaluation, performance accuracy and time consumed for completion were recorded. Results: Smart glass?assisted self-practice of nursing skills was perceived as helpful, convenient, and interesting. Participants reported improved recollection of sequences of skills, and perceived competency was significantly improved. Several issues were raised by participants regarding smart glasses, including small screen size, touch sensors, fogged lenses with masks, heaviness, and heat after a period of time. Conclusions: Smart glasses have the potential to assist self-practice, providing timely information at students? own paces. Having both hands free from holding a device, participants reported the convenience of learning as they could practice and view the information simultaneously. Further revision correcting reported issues would improve the applicability of smart glasses in other areas of nursing education. UR - https://www.jmir.org/2021/3/e24313 UR - http://dx.doi.org/10.2196/24313 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650975 ID - info:doi/10.2196/24313 ER - TY - JOUR AU - Parker, L. Belinda AU - Chakouch, Cassandra AU - Subotic-Kerry, Mirjana AU - Batterham, J. Philip AU - Mackinnon, Andrew AU - Newby, M. Jill AU - Whitton, E. Alexis AU - McGoldrick, Janey AU - Cockayne, Nicole AU - O'Dea, Bridianne PY - 2021/2/24 TI - The Building Educators? Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e25870 VL - 10 IS - 2 KW - mental health training KW - schools KW - teachers KW - educators KW - mental health KW - student mental health KW - secondary school N2 - Background: In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators? Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed. Objective: The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators? confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators? frequency of providing help to students and improving their mental health knowledge and reducing educators? psychological distress and stigma toward students with mental health issues. Methods: The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment. Results: Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021. Conclusions: This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students? mental health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208 International Registered Report Identifier (IRRID): DERR1-10.2196/25870 UR - https://www.researchprotocols.org/2021/2/e25870 UR - http://dx.doi.org/10.2196/25870 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625374 ID - info:doi/10.2196/25870 ER - TY - JOUR AU - Sturny, Ludovic AU - Regard, Simon AU - Larribau, Robert AU - Niquille, Marc AU - Savoldelli, Louis Georges AU - Sarasin, François AU - Schiffer, Eduardo AU - Suppan, Laurent PY - 2021/2/23 TI - Differences in Basic Life Support Knowledge Between Junior Medical Students and Lay People: Web-Based Questionnaire Study JO - J Med Internet Res SP - e25125 VL - 23 IS - 2 KW - basic life support KW - cardiopulmonary resuscitation KW - medical students KW - undergraduate medical education KW - out-of-hospital cardiac arrest KW - life support KW - cardiopulmonary KW - medical education N2 - Background: Early cardiopulmonary resuscitation and prompt defibrillation markedly increase the survival rate in the event of out-of-hospital cardiac arrest (OHCA). As future health care professionals, medical students should be trained to efficiently manage an unexpectedly encountered OHCA. Objective: Our aim was to assess basic life support (BLS) knowledge in junior medical students at the University of Geneva Faculty of Medicine (UGFM) and to compare it with that of the general population. Methods: Junior UGFM students and lay people who had registered for BLS classes given by a Red Cross?affiliated center were sent invitation links to complete a web-based questionnaire. The primary outcome was the between-group difference in a 10-question score regarding cardiopulmonary resuscitation knowledge. Secondary outcomes were the differences in the rate of correct answers for each individual question, the level of self-assessed confidence in the ability to perform resuscitation, and a 6-question score, ?essential BLS knowledge,? which only contains key elements of the chain of survival. Continuous variables were first analyzed using the Student t test, then by multivariable linear regression. Fisher exact test was used for between-groups comparison of binary variables. Results: The mean score was higher in medical students than in lay people for both the 10-question score (mean 5.8, SD 1.7 vs mean 4.2, SD 1.7; P<.001) and 6-question score (mean 3.0, SD 1.1 vs mean 2.0, SD 1.0; P<.001). Participants who were younger or already trained scored consistently better. Although the phone number of the emergency medical dispatch center was well known in both groups (medical students, 75/80, 94% vs lay people, 51/62, 82%; P=.06), most participants were unable to identify the criteria used to recognize OHCA, and almost none were able to correctly reorganize the BLS sequence. Medical students felt more confident than lay people in their ability to perform resuscitation (mean 4.7, SD 2.2 vs mean 3.1, SD 2.1; P<.001). Female gender and older age were associated with lower confidence, while participants who had already attended a BLS course prior to taking the questionnaire felt more confident. Conclusions: Although junior medical students were more knowledgeable than lay people regarding BLS procedures, the proportion of correct answers was low in both groups, and changes in BLS education policy should be considered. UR - https://www.jmir.org/2021/2/e25125 UR - http://dx.doi.org/10.2196/25125 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620322 ID - info:doi/10.2196/25125 ER - TY - JOUR AU - Klompstra, Leonie AU - Liljeroos, Maria AU - Lundgren, Johan AU - Ingadottir, Brynja PY - 2021/2/17 TI - A Clinical Tool (CUE-tool) for Health Care Professionals to Assess the Usability and Quality of the Content of Medical Information Websites: Electronic Delphi Study JO - J Med Internet Res SP - e22668 VL - 23 IS - 2 KW - self-care KW - smartphone KW - internet KW - apps KW - websites KW - eDelphi N2 - Background: As patients are increasingly searching for information about their medical condition on the internet, there is a need for health professionals to be able to guide patients toward reliable and suitable information sources on the internet. Objective: The aim of the study was to develop a clinical tool for health care professionals to assess the usability and quality of the content of websites containing medical information that could be recommended to patients. Methods: A 3-round modified electronic Delphi (eDelphi) study was conducted with 20 health care professionals. Results: In round one of the eDelphi study, of the 68 items initially created, 41 items (29 on usability and 12 on content) were rated as important or very important by more than half of the panel and thus selected for further evaluation in round two. In round two, of the 41 items chosen from round 1, 19 were selected (9 on usability and 10 on content) as important or very important by more than half of the panel for further evaluation. As a result of round three, 2 items were combined as a single item, leaving the instrument with 18 items in total (8 on usability and 10 on content). The tool is freely accessible online. Conclusions: The CUE-tool can be used to (1) evaluate the usability and reliability of the content of websites before recommending them to patients as a good information source; (2) identify websites that do not have reliable content or may be difficult for patients to use; (3) develop quality websites by using the criteria in the CUE-tool; and (4) identify different qualities between different websites. UR - http://www.jmir.org/2021/2/e22668/ UR - http://dx.doi.org/10.2196/22668 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595439 ID - info:doi/10.2196/22668 ER - TY - JOUR AU - Ramirez, Magaly AU - Duran, C. Miriana AU - Pabiniak, J. Chester AU - Hansen, E. Kelly AU - Kelley, Ann AU - Ralston, D. James AU - McCurry, M. Susan AU - Teri, Linda AU - Penfold, B. Robert PY - 2021/2/10 TI - Family Caregiver Needs and Preferences for Virtual Training to Manage Behavioral and Psychological Symptoms of Dementia: Interview Study JO - JMIR Aging SP - e24965 VL - 4 IS - 1 KW - dementia KW - Alzheimer disease KW - behavioral symptoms KW - caregivers KW - internet-based intervention KW - education KW - behavior KW - symptom KW - psychology KW - qualitative KW - caregiver KW - intervention KW - training KW - virtual care KW - digital health N2 - Background: Behavioral and psychological symptoms of dementia (BPSD) are associated with increased stress, burden, and depression among family caregivers of people with dementia. STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is adapted from an evidence-based, in-person program that trains family caregivers to manage BPSD. We used a human-centered design approach to obtain feedback from family caregivers about STAR-VTF. The program will be evaluated using a pragmatic randomized trial. Objective: The objective of the study was to understand the needs of family caregivers for improving BPSD management and the extent to which caregivers perceived that STAR-VTF could address those needs. Methods: Between July and September 2019, we conducted 15 semistructured interviews with family caregivers of people with dementia who receive care at Kaiser Permanente Washington in the Seattle metropolitan area. We identified participants from electronic health records, primarily based on a prescription for antipsychotic medication for the person with dementia (a proxy for caregivers dealing with BPSD). We showed caregivers low-fidelity prototypes of STAR-VTF online self-directed materials and verbally described potential design elements. We obtained caregiver feedback on these elements, focusing on their needs and preferences and perceived barriers to using STAR-VTF. We used a hybrid approach of inductive and deductive coding and aggregated codes to develop themes. Results: The idea of a virtual training program for learning to manage BPSD appealed to caregivers. They said health care providers did not provide adequate education in the early disease stages about the personality and behavior symptoms that can affect people with dementia. Caregivers found it unexpected and frustrating when the person with dementia began experiencing BPSD, symptoms they felt unprepared to manage. Accordingly, caregivers expressed a strong desire for the health care organization to offer programs such as STAR-VTF much sooner. Caregivers had already put considerable effort into problem solving challenging behaviors. They anticipated deriving less value from STAR-VTF at that point. Nonetheless, many were interested in the virtual aspect of the training due to the convenience of receiving help from home and the perception that help from a virtual program would be timelier than traditional service modalities (eg, face to face). Given caregivers? limited time, they suggested dividing the STAR-VTF content into chunks to review as time permitted. Caregivers were interested in having a STAR-VTF provider for additional support in managing challenging behaviors. Caregivers reported a preference for having the same coach for the program duration. Conclusions: Caregivers we interviewed would likely accept a virtual training program such as STAR-VTF to obtain information about BPSD and receive help managing it. Family caregivers anticipated deriving more value if STAR-VTF was offered earlier in the disease course. UR - http://aging.jmir.org/2021/1/e24965/ UR - http://dx.doi.org/10.2196/24965 UR - http://www.ncbi.nlm.nih.gov/pubmed/33565984 ID - info:doi/10.2196/24965 ER - TY - JOUR AU - Akour, Iman AU - Alshurideh, Muhammad AU - Al Kurdi, Barween AU - Al Ali, Amel AU - Salloum, Said PY - 2021/2/4 TI - Using Machine Learning Algorithms to Predict People?s Intention to Use Mobile Learning Platforms During the COVID-19 Pandemic: Machine Learning Approach JO - JMIR Med Educ SP - e24032 VL - 7 IS - 1 KW - COVID-19 KW - pandemic KW - mobile learning KW - fear KW - technology acceptance model KW - theory of planned behavior KW - prediction KW - intent KW - online learning KW - machine learning KW - behavior N2 - Background: Mobile learning has become an essential instruction platform in many schools, colleges, universities, and various other educational institutions across the globe, as a result of the COVID-19 pandemic crisis. The resulting severe, pandemic-related circumstances have disrupted physical and face-to-face contact teaching practices, thereby requiring many students to actively use mobile technologies for learning. Mobile learning technologies offer viable web-based teaching and learning platforms that are accessible to teachers and learners worldwide. Objective: This study investigated the use of mobile learning platforms for instruction purposes in United Arab Emirates higher education institutions. Methods: An extended technology acceptance model and theory of planned behavior model were proposed to analyze university students? adoption of mobile learning platforms for accessing course materials, searching the web for information related to their disciplines, sharing knowledge, and submitting assignments during the COVID-19 pandemic. We collected a total of 1880 questionnaires from different universities in the United Arab Emirates. Partial least squares-structural equation modeling and machine learning algorithms were used to assess the research model, which was based on the data gathered from a student survey. Results: Based on our results, each hypothesized relationship within the research model was supported by our data analysis results. It should also be noted that the J48 classifier (89.37% accuracy) typically performed better than the other classifiers when it came to the prediction of the dependent variable. Conclusions: Our study revealed that teaching and learning could considerably benefit from adopting remote learning systems as educational tools during the COVID-19 pandemic. However, the value of such systems could be lessened because of the emotions that students experience, including a fear of poor grades, stress resulting from family circumstances, and sadness resulting from a loss of friends. Accordingly, these issues can only be resolved by evaluating the emotions of students during the pandemic. UR - http://mededu.jmir.org/2021/1/e24032/ UR - http://dx.doi.org/10.2196/24032 UR - http://www.ncbi.nlm.nih.gov/pubmed/33444154 ID - info:doi/10.2196/24032 ER - TY - JOUR AU - Guinez-Molinos, Sergio AU - Gonzalez Díaz, Jaime AU - Gomar Sancho, Carmen AU - Espinoza, Paulina AU - Constenla, Gustavo PY - 2021/1/26 TI - A Web Platform (MOSAICO) to Design, Perform, and Assess Collaborative Clinical Scenarios for Medical Students: Viewpoint JO - JMIR Med Educ SP - e23370 VL - 7 IS - 1 KW - collaborative clinical simulation KW - electronic simulation record KW - medical students KW - medical education KW - MOSAICO N2 - Background: The collaborative clinical simulation (CCS) model is a structured method for the development and assessment of clinical competencies through small groups working collaboratively in simulated environments. From 2016 onward, the CCS model has been applied successfully among undergraduate and graduate medical students from the Universidad de Talca, Chile; the Universität de Barcelona, Spain; and the Universidad de Vic-Manresa, Spain. All the templates for building the clinical cases and the assessment instruments with CCS were printed on paper. Considering the large number of CCS sessions and the number of participating students that are required throughout the medical degree curriculum, it is impossible to keep an organized record when the instruments are printed on paper. Moreover, with the COVID-19 pandemic, web platforms have become important as safe training environments for students and medical faculties; this new educational environment should include the consolidation and adaptation of didactic sessions that create and use available virtual cases and use different web platforms. Objective: The goal of this study is to describe the design and development of a web platform that was created to strengthen the CCS model. Methods: The design of the web platform aimed to support each phase of the CCS by incorporating functional requirements (ie, features that the web platform will be able to perform) and nonfunctional requirements (ie, how the web platform should behave) that are needed to run collaborative sessions. The software was developed under the Model-View-Controller architecture to separate the views from the data model and the business logic. Results: MOSAICO is a web platform used to design, perform, and assess collaborative clinical scenarios for medical students. MOSAICO has four modules: educational design, students? collaborative design, collaborative simulation, and collaborative debriefing. The web platform has three different user profiles: academic simulation unit, teacher, and student. These users interact under different roles in collaborative simulations. MOSAICO enables a collaborative environment, which is connected via the internet, to design clinical scenarios guided by the teacher and enables the use of all data generated to be discussed in the debriefing session with the teacher as a guide. The web platform is running at the Universidad de Talca in Chile and is supporting collaborative simulation activities via the internet for two medical courses: (1) Semiology for third-year students (70 students in total) and (2) Medical Genetics for fifth-year students (30 students in total). Conclusions: MOSAICO is applicable within the CCS model and is used frequently in different simulation sessions at the Universidad de Talca, where medical students can work collaboratively via the internet. MOSAICO simplifies the application and reuse of clinical simulation scenarios, allowing its use in multiple simulation centers. Moreover, its applications in different courses (ie, a large part of the medical curriculum) support the automatic tracking of simulation activities and their assessment. UR - http://mededu.jmir.org/2021/1/e23370/ UR - http://dx.doi.org/10.2196/23370 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496676 ID - info:doi/10.2196/23370 ER - TY - JOUR AU - Zlamal, Jaroslav AU - Gjevjon, Roth Edith AU - Fossum, Mariann AU - Solberg, Trygg Marianne AU - Steindal, Alexander Simen AU - Strandell-Laine, Camilla AU - Larsen, Hamilton Marie AU - Pettersen, Solvang Fredrik AU - Nes, Gonçalves Andréa Aparecida PY - 2021/1/19 TI - Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: Protocol for a Mixed Methods Systematic Review JO - JMIR Res Protoc SP - e25126 VL - 10 IS - 1 KW - critical thinking KW - technology KW - guidance models KW - nursing education KW - clinical practice N2 - Background: Critical thinking is an essential skill that nursing students need to develop. Technological tools have opened new avenues for technology-supported guidance models, but the challenges and facilitators of such guidance models, as well as how they stimulate the development of critical thinking, remain unclear. Objective: We developed a protocol for a mixed methods systematic review to investigate the use of technology-supported guidance models that stimulate the development of critical thinking in nursing education clinical practice. Methods: A convergent integrated design following the Joanna Briggs Institute Manual for Evidence Synthesis will be employed. A pair of authors will select the articles by screening titles and abstracts, and the methodological quality of the articles included in the review will be assessed by a pair of authors according to checklists for specific study designs. The data will be extracted using the standardized Joanna Briggs Institute mixed methods data extraction form and following a convergent integrated approach. The thematic synthesis for data transformation will be used. Results: Development of a comprehensive systematic search strategy was completed in October 2020. The database searches were performed on October 21, 2020. As of January 2021, analysis and synthesis is ongoing. Completion of this review is expected by January 2021. Conclusions: By combining evidence from studies with varied methodological approaches, the results should provide broad insight into the use of technology-supported guidance models for clinical practice in nursing education with a focus on the development of nursing students? critical thinking. The results of this mixed methods systematic review can also be used to develop or improve current technology-supported guidance models for clinical practice in nursing education. International Registered Report Identifier (IRRID): PRR1-10.2196/25126 UR - http://www.researchprotocols.org/2021/1/e25126/ UR - http://dx.doi.org/10.2196/25126 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464214 ID - info:doi/10.2196/25126 ER - TY - JOUR AU - Suppan, Mélanie AU - Stuby, Loric AU - Carrera, Emmanuel AU - Cottet, Philippe AU - Koka, Avinash AU - Assal, Frédéric AU - Savoldelli, Louis Georges AU - Suppan, Laurent PY - 2021/1/15 TI - Asynchronous Distance Learning of the National Institutes of Health Stroke Scale During the COVID-19 Pandemic (E-Learning vs Video): Randomized Controlled Trial JO - J Med Internet Res SP - e23594 VL - 23 IS - 1 KW - stroke KW - COVID-19 KW - e-learning KW - medical student KW - medical education KW - online learning KW - randomized controlled trial KW - video N2 - Background: The COVID-19 pandemic has considerably altered the regular medical education curriculum while increasing the need for health care professionals. Senior medical students are being incrementally deployed to the front line to address the shortage of certified physicians. These students, some of whom will be fast-tracked as physicians, may lack knowledge regarding the initial management of time-critical emergencies such as stroke. Objective: Our aim was to determine whether an e-learning module could improve asynchronous distance knowledge acquisition of the National Institutes of Health Stroke Scale (NIHSS) in senior medical students compared to the traditional didactic video. Methods: A randomized, data analyst?blinded web-based trial was conducted at the University of Geneva Faculty of Medicine between April and June 2020. Fifth year medical students followed a distance learning path designed to teach the NIHSS. The control group followed the traditional didactic video created by Patrick Lyden, while the e-learning group followed the updated version of a previously tested, highly interactive e-learning module. The main outcome was the score on a 50-question quiz displayed upon completion of the learning material. The difference in the proportion of correct answers for each specific NIHSS item was also assessed. Results: Out of 158 potential participants, 88 started their allocated learning path and 75 completed the trial. Participants who followed the e-learning module performed better than those who followed the video (38 correct answers, 95% CI 37-39, vs 35 correct answers, 95% CI 34-36, P<.001). Participants in the e-learning group scored better on five elements than the video group: key NIHSS concepts (P=.02), the consciousness ? global item (P<.001), the facial palsy item (P=.04), the ataxia item (P=.03), and the sensory item (P=.04). Conclusions: Compared to the traditional didactic video, a highly interactive e-learning module enhances asynchronous distance learning and NIHSS knowledge acquisition in senior medical students. UR - http://www.jmir.org/2021/1/e23594/ UR - http://dx.doi.org/10.2196/23594 UR - http://www.ncbi.nlm.nih.gov/pubmed/33428581 ID - info:doi/10.2196/23594 ER - TY - JOUR AU - Mitre-Hernandez, Hugo AU - Covarrubias Carrillo, Roberto AU - Lara-Alvarez, Carlos PY - 2021/1/11 TI - Pupillary Responses for Cognitive Load Measurement to Classify Difficulty Levels in an Educational Video Game: Empirical Study JO - JMIR Serious Games SP - e21620 VL - 9 IS - 1 KW - video games KW - pupil KW - metacognitive monitoring KW - educational technology KW - machine learning N2 - Background: A learning task recurrently perceived as easy (or hard) may cause poor learning results. Gamer data such as errors, attempts, or time to finish a challenge are widely used to estimate the perceived difficulty level. In other contexts, pupillometry is widely used to measure cognitive load (mental effort); hence, this may describe the perceived task difficulty. Objective: This study aims to assess the use of task-evoked pupillary responses to measure the cognitive load measure for describing the difficulty levels in a video game. In addition, it proposes an image filter to better estimate baseline pupil size and to reduce the screen luminescence effect. Methods: We conducted an experiment that compares the baseline estimated from our filter against that estimated from common approaches. Then, a classifier with different pupil features was used to classify the difficulty of a data set containing information from students playing a video game for practicing math fractions. Results: We observed that the proposed filter better estimates a baseline. Mauchly?s test of sphericity indicated that the assumption of sphericity had been violated (?214=0.05; P=.001); therefore, a Greenhouse-Geisser correction was used (?=0.47). There was a significant difference in mean pupil diameter change (MPDC) estimated from different baseline images with the scramble filter (F5,78=30.965; P<.001). Moreover, according to the Wilcoxon signed rank test, pupillary response features that better describe the difficulty level were MPDC (z=?2.15; P=.03) and peak dilation (z=?3.58; P<.001). A random forest classifier for easy and hard levels of difficulty showed an accuracy of 75% when the gamer data were used, but the accuracy increased to 87.5% when pupillary measurements were included. Conclusions: The screen luminescence effect on pupil size is reduced with a scrambled filter on the background video game image. Finally, pupillary response data can improve classifier accuracy for the perceived difficulty of levels in educational video games. UR - http://games.jmir.org/2021/1/e21620/ UR - http://dx.doi.org/10.2196/21620 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427677 ID - info:doi/10.2196/21620 ER - TY - JOUR AU - Isangula, Kahabi AU - Edwards, Grace AU - Mwansisya, Tumbwene AU - Mbekenga, Columba AU - Pallangyo, Eunice AU - Sarki, Ahmed AU - Ndirangu-Mugo, Eunice PY - 2021/1/11 TI - Open and Distance Learning Programs for Nursing and Midwifery Education in East Africa: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e17765 VL - 10 IS - 1 KW - open and distance KW - learning KW - health care KW - nurses KW - midwifery KW - health KW - East Africa N2 - Background: In the face of growing modernity and the coronavirus disease 2019 (COVID-19) pandemic, open and distance learning (ODL) is considered to play an important role in increasing access to education worldwide. There is a robust evidence base demonstrating its cost effectiveness in comparison with conventional class-based teaching; however, the transition to this new paradigm of learning for nursing and midwifery courses has been difficult in low-income countries. While there are notable efforts to increase internet and education access to health care professionals, not much is known about ODL for nurses and midwives in East African countries. Objective: The objective of this scoping review is to understand whether ODL programs for nursing and midwifery education exist, the drivers of their adoption, their implementation, the topics/courses covered, their acceptability, and their impacts in East African countries. Methods: The scoping review methodology employs the framework developed by Arksey and O?Malley. Using an exploratory approach, a two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing ODL initiative for nurses and midwives in Uganda, Tanzania, and Kenya. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardized form. Results: Details of ODL for nursing and midwifery education initiatives and study outcomes will be summarized in a table. The extracted data will undergo exploratory descriptive analysis, and the results will be classified into learner and clinical outcomes. Conclusions: Evidence on ODL for nursing and midwifery education will inform the ongoing development and restructuring of health care professional education in East Africa amidst the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/17765 UR - http://www.researchprotocols.org/2021/1/e17765/ UR - http://dx.doi.org/10.2196/17765 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427679 ID - info:doi/10.2196/17765 ER - TY - JOUR AU - Egilsdottir, Ösp H. AU - Heyn, Günterberg Lena AU - Brembo, Andreas Espen AU - Byermoen, Røland Kirsten AU - Moen, Anne AU - Eide, Hilde PY - 2021/1/7 TI - Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach JO - JMIR Mhealth Uhealth SP - e22633 VL - 9 IS - 1 KW - learning KW - mobile phone KW - mobile application KW - education, nursing KW - students, nursing KW - education, clinical KW - nursing skills KW - physical examination KW - computer simulation KW - clinical competence N2 - Background: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor?s degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. Objective: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. Methods: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. Results: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. Conclusions: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students? perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts. UR - https://mhealth.jmir.org/2021/1/e22633 UR - http://dx.doi.org/10.2196/22633 UR - http://www.ncbi.nlm.nih.gov/pubmed/33410756 ID - info:doi/10.2196/22633 ER - TY - JOUR AU - Peters-Geven, M. Marije AU - Rollema, Corine AU - Metting, I. Esther AU - van Roon, N. Eric AU - de Vries, W. Tjalling PY - 2020/12/30 TI - The Quality of Instructional YouTube Videos for the Administration of Intranasal Spray: Observational Study JO - JMIR Med Educ SP - e23668 VL - 6 IS - 2 KW - allergic rhinitis KW - administration KW - intranasal spray KW - instruction videos KW - nasal KW - YouTube KW - educational video KW - corticosteroid KW - allergic KW - intranasal KW - allergy N2 - Background: Allergic rhinitis is a common disorder affecting both children and adults. Recommended treatment consists of intranasal corticosteroid spray administration, but only few patients administer the nasal spray in the correct technical manner. A wrong administration technique may result in side effects and affect the efficacy and adherence, thus making accurate administration instructions indispensable. Unfortunately, information about intranasal drug administration is generally not explained accurately, thereby leading to confusion among patients and inaccuracy in the self-administration of drugs. Objective: In this study, we analyzed instructional videos available on YouTube for the administration of nasal sprays for allergic rhinitis. Our aim was to determine if the videos provided instructions in accordance with the standardized nationwide patient protocol in the Netherlands for intranasal spray administration. Methods: Instructional videos for the administration of aqueous formulations of nasal spray for allergic rhinitis were found on YouTube. All videos were reviewed by 2 researchers and scored using the instructions from the Dutch standardized protocol. Correct instructions were given a score of 1, while incorrect or missing instructions were given a score of 0. The interrater reliability using Cohen ? was used to determine the differences in the scores between the researchers. Results: We identified 33 YouTube videos made by different health care professionals and pharmaceutical companies around the world. None of the videos displayed all the steps correctly, while 5 of the 33 (15%) videos displayed over 75% of the steps correctly. The median score of the correctly displayed steps was 11 out of 19 (range 2-17, IQR 6). The interrater reliability using Cohen ? was statistically significant (range 0.872-1.00, P<.001). The steps ?neutral position of the head,? ?breathing out through the mouth,? and ?periodically cleaning with water? scored the lowest and were incorrectly displayed in 28 (85%), 28 (85%), and 30 (91%) of the 33 videos, respectively. Conclusions: The findings of our study revealed that only few instructional videos on YouTube provided correct instructions for the administration of nasal sprays to patients. The inaccuracy of the instructions for nasal spray administration in the majority of the videos may lead to confusion in patients and incorrect use of nasal sprays. In the future, it is important to make evidence-based instructional videos that show patients the correct technique of nasal spray administration. Trial Registration: Not applicable UR - http://mededu.jmir.org/2020/2/e23668/ UR - http://dx.doi.org/10.2196/23668 UR - http://www.ncbi.nlm.nih.gov/pubmed/33377873 ID - info:doi/10.2196/23668 ER - TY - JOUR AU - Björn, Henrik Marko AU - Laurila, MM Jonne AU - Ravyse, Werner AU - Kukkonen, Jari AU - Leivo, Sanna AU - Mäkitalo, Kati AU - Keinonen, Tuula PY - 2020/12/30 TI - Learning Impact of a Virtual Brain Electrical Activity Simulator Among Neurophysiology Students: Mixed-Methods Intervention Study JO - JMIR Serious Games SP - e18768 VL - 8 IS - 4 KW - virtual simulation KW - electroencephalography KW - theoretical knowledge KW - neurophysiology KW - brain activity KW - psychomotor N2 - Background: Virtual simulation is the re-creation of reality depicted on a computer screen. It offers the possibility to exercise motor and psychomotor skills. In biomedical and medical education, there is an attempt to find new ways to support students? learning in neurophysiology. Traditionally, recording electroencephalography (EEG) has been learned through practical hands-on exercises. To date, virtual simulations of EEG measurements have not been used. Objective: This study aimed to examine the development of students? theoretical knowledge and practical skills in the EEG measurement when using a virtual EEG simulator in biomedical laboratory science in the context of a neurophysiology course. Methods: A computer-based EEG simulator was created. The simulator allowed virtual electrode placement and EEG graph interpretation. The usefulness of the simulator for learning EEG measurement was tested with 35 participants randomly divided into three equal groups. Group 1 (experimental group 1) used the simulator with fuzzy feedback, group 2 (experimental group 2) used the simulator with exact feedback, and group 3 (control group) did not use a simulator. The study comprised pre- and posttests on theoretical knowledge and practical hands-on evaluation of EEG electrode placement. Results: The Wilcoxon signed-rank test indicated that the two groups that utilized a computer-based electrode placement simulator showed significant improvement in both theoretical knowledge (Z=1.79, P=.074) and observed practical skills compared with the group that studied without a simulator. Conclusions: Learning electrode placement using a simulator enhances students? ability to place electrodes and, in combination with practical hands-on training, increases their understanding of EEG measurement. UR - http://games.jmir.org/2020/4/e18768/ UR - http://dx.doi.org/10.2196/18768 UR - http://www.ncbi.nlm.nih.gov/pubmed/33377872 ID - info:doi/10.2196/18768 ER - TY - JOUR AU - Carson, Y. Thaddeus AU - Hatzigeorgiou, Christos AU - Wyatt, R. Tasha AU - Egan, Sarah AU - Beidas, O. Sary PY - 2020/12/29 TI - Development and Implementation of a Web-Based Learning Environment for an Inpatient Internal Medicine Team: Questionnaire Study JO - JMIR Med Educ SP - e18102 VL - 6 IS - 2 KW - inpatient internal medicine KW - academic hospitalist KW - medical education KW - blended learning environment KW - social media KW - online education KW - internal medicine ward KW - internal medicine education N2 - Background: The notion of anytime, anyplace communication is characteristic of the current generation of learners. Such communications have facilitated the growth and integration of a blended or hybrid learning platform in multiple educational settings. However, there are limited reports on the use of an anytime, anyplace communication platform in clinical inpatient medical education. Objective: The setting of a high-demand inpatient clinical rotation is ideal for the use of collaborative software, and this integration is expected to positively influence medical education. The purpose of this study is to evaluate medical students? and residents? educational experiences with incorporating a simple, web-based content management and file sharing platform into an internal medicine inpatient rotation. Methods: During an inpatient internal medicine rotation, faculty and learners jointly used collaborative software for educational purposes, and a postrotation survey tool was used to measure the educational influence of the software. Results: Based on the results of the postrotation survey, the integration of a collaborative software application during clinical rotations improved the learning experience. Learning climate, the communication of rotation goals, and self-directed learning all scored favorably, but feedback from the survey participants was mixed. The learners enthusiastically accepted the practical use of this tool for both communication and information sharing. Conclusions: This generation of learners is accustomed to frequent electronic communication. Based on our survey, these learners appear to be highly receptive to this web-based intervention design for improving clinical education during active patient care. Adding effective blended learning features to a traditional clinical setting is achievable. UR - http://mededu.jmir.org/2020/2/e18102/ UR - http://dx.doi.org/10.2196/18102 UR - http://www.ncbi.nlm.nih.gov/pubmed/33372895 ID - info:doi/10.2196/18102 ER - TY - JOUR AU - Fonteneau, Tristan AU - Billion, Elodie AU - Abdoul, Cindy AU - Le, Sebastien AU - Hadchouel, Alice AU - Drummond, David PY - 2020/12/16 TI - Simulation Game Versus Multiple Choice Questionnaire to Assess the Clinical Competence of Medical Students: Prospective Sequential Trial JO - J Med Internet Res SP - e23254 VL - 22 IS - 12 KW - serious game KW - simulation game KW - assessment KW - professional competence KW - asthma KW - pediatrics N2 - Background: The use of simulation games (SG) to assess the clinical competence of medical students has been poorly studied. Objective: The objective of this study was to assess whether an SG better reflects the clinical competence of medical students than a multiple choice questionnaire (MCQ). Methods: Fifth-year medical students in Paris (France) were included and individually evaluated on a case of pediatric asthma exacerbation using three successive modalities: high-fidelity simulation (HFS), considered the gold standard for the evaluation of clinical competence, the SG Effic?Asthme, and an MCQ designed for the study. The primary endpoint was the median kappa coefficient evaluating the correlation of the actions performed by the students between the SG and HFS modalities and the MCQ and HFS modalities. Student satisfaction was also evaluated. Results: Forty-two students were included. The actions performed by the students were more reproducible between the SG and HFS modalities than between the MCQ and HFS modalities (P=.04). Students reported significantly higher satisfaction with the SG (P<.01) than with the MCQ modality. Conclusions: The SG Effic?Asthme better reflected the actions performed by medical students during an HFS session than an MCQ on the same asthma exacerbation case. Because SGs allow the assessment of more dimensions of clinical competence than MCQs, they are particularly appropriate for the assessment of medical students on situations involving symptom recognition, prioritization of decisions, and technical skills. Trial Registration: ClinicalTrials.gov NCT03884114; https://clinicaltrials.gov/ct2/show/NCT03884114 UR - http://www.jmir.org/2020/12/e23254/ UR - http://dx.doi.org/10.2196/23254 UR - http://www.ncbi.nlm.nih.gov/pubmed/33325833 ID - info:doi/10.2196/23254 ER - TY - JOUR AU - Acquaviva, D. Kimberly AU - Mugele, Josh AU - Abadilla, Natasha AU - Adamson, Tyler AU - Bernstein, L. Samantha AU - Bhayani, K. Rakhee AU - Büchi, Elisabeth Annina AU - Burbage, Darcy AU - Carroll, L. Christopher AU - Davis, P. Samantha AU - Dhawan, Natasha AU - Eaton, Alice AU - English, Kim AU - Grier, T. Jennifer AU - Gurney, K. Mary AU - Hahn, S. Emily AU - Haq, Heather AU - Huang, Brendan AU - Jain, Shikha AU - Jun, Jin AU - Kerr, T. Wesley AU - Keyes, Timothy AU - Kirby, R. Amelia AU - Leary, Marion AU - Marr, Mollie AU - Major, Ajay AU - Meisel, V. Jason AU - Petersen, A. Erika AU - Raguan, Barak AU - Rhodes, Allison AU - Rupert, D. Deborah AU - Sam-Agudu, A. Nadia AU - Saul, Naledi AU - Shah, R. Jarna AU - Sheldon, Kennedy Lisa AU - Sinclair, T. Christian AU - Spencer, Kerry AU - Strand, H. Natalie AU - Streed Jr, G. Carl AU - Trudell, M. Avery PY - 2020/12/2 TI - Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions JO - J Med Internet Res SP - e25070 VL - 22 IS - 12 KW - social media KW - promotion KW - tenure KW - health professions KW - scholarship KW - medicine KW - research KW - accomplishment KW - crowdsource KW - contribution KW - innovation KW - education KW - dissemination N2 - Background: The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider audiences in creative ways and have a broader impact. Conventional metrics like the h-index do not account for social media impact. Social media engagement is poorly represented in most curricula vitae (CV) and therefore is undervalued in promotion and tenure reviews. Objective: The objective was to develop crowdsourced guidelines for documenting social media scholarship. These guidelines aimed to provide a structure for documenting a scholar?s general impact on social media, as well as methods of documenting individual social media contributions exemplifying innovation, education, mentorship, advocacy, and dissemination. Methods: To create unifying guidelines, we created a crowdsourced process that capitalized on the strengths of social media and generated a case example of successful use of the medium for academic collaboration. The primary author created a draft of the guidelines and then sought input from users on Twitter via a publicly accessible Google Document. There was no limitation on who could provide input and the work was done in a democratic, collaborative fashion. Contributors edited the draft over a period of 1 week (September 12-18, 2020). The primary and secondary authors then revised the draft to make it more concise. The guidelines and manuscript were then distributed to the contributors for edits and adopted by the group. All contributors were given the opportunity to serve as coauthors on the publication and were told upfront that authorship would depend on whether they were able to document the ways in which they met the 4 International Committee of Medical Journal Editors authorship criteria. Results: We developed 2 sets of guidelines: Guidelines for Listing All Social Media Scholarship Under Public Scholarship (in Research/Scholarship Section of CV) and Guidelines for Listing Social Media Scholarship Under Research, Teaching, and Service Sections of CV. Institutions can choose which set fits their existing CV format. Conclusions: With more uniformity, scholars can better represent the full scope and impact of their work. These guidelines are not intended to dictate how individual institutions should weigh social media contributions within promotion and tenure cases. Instead, by providing an initial set of guidelines, we hope to provide scholars and their institutions with a common format and language to document social media scholarship. UR - https://www.jmir.org/2020/12/e25070 UR - http://dx.doi.org/10.2196/25070 UR - http://www.ncbi.nlm.nih.gov/pubmed/33263554 ID - info:doi/10.2196/25070 ER - TY - JOUR AU - Paul, Nadine AU - Kohara, Sae AU - Khera, Kaur Gursharan AU - Gunawardena, Ramith PY - 2020/11/18 TI - Integration of Technology in Medical Education on Primary Care During the COVID-19 Pandemic: Students? Viewpoint JO - JMIR Med Educ SP - e22926 VL - 6 IS - 2 KW - clinical education KW - curriculum development KW - personal characteristics KW - physician/patient relationship KW - professional development KW - education KW - medical student KW - telemedicine KW - simulation KW - COVID-19 UR - http://mededu.jmir.org/2020/2/e22926/ UR - http://dx.doi.org/10.2196/22926 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112760 ID - info:doi/10.2196/22926 ER - TY - JOUR AU - Wilcha, Robyn-Jenia PY - 2020/11/18 TI - Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review JO - JMIR Med Educ SP - e20963 VL - 6 IS - 2 KW - virtual teaching KW - medical student KW - medical education KW - COVID-19 KW - review KW - virus KW - pandemic KW - quarantine N2 - Background: In December 2019, COVID-19 emerged and rapidly spread worldwide. Transmission of SARS-CoV-2, the virus that causes COVID-19, is high; as a result, countries worldwide have imposed rigorous public health measures, such as quarantine. This has involved the suspension of medical school classes globally. Medical school attachments are vital to aid the progression of students? confidence and competencies as future physicians. Since the outbreak of COVID-19, medical schools have sought ways to replace medical placements with virtual clinical teaching. Objective: The objective of this study was to review the advantages and disadvantages of virtual medical teaching for medical students during the COVID-19 pandemic based on the current emerging literature. Methods: A brief qualitative review based on the application and effectiveness of virtual teaching during the COVID-19 pandemic was conducted by referencing keywords, including medical student virtual teaching COVID-19, virtual undergraduate medical education, and virtual medical education COVID-19, in the electronic databases of PubMed and Google Scholar. A total of 201 articles were found, of which 34 were included in the study. Manual searches of the reference lists of the included articles yielded 5 additional articles. The findings were tabulated and assessed under the following headings: summary of virtual teaching offered, strengths of virtual teaching, and weaknesses of virtual teaching. Results: The strengths of virtual teaching included the variety of web-based resources available. New interactive forms of virtual teaching are being developed to enable students to interact with patients from their homes. Open-access teaching with medical experts has enabled students to remain abreast of the latest medical advancements and to reclaim knowledge lost by the suspension of university classes and clinical attachments. Peer mentoring has been proven to be a valuable tool for medical students with aims of increasing knowledge and providing psychological support. Weaknesses of virtual teaching included technical challenges, confidentiality issues, reduced student engagement, and loss of assessments. The mental well-being of students was found to be negatively affected during the pandemic. Inequalities of virtual teaching services worldwide were also noted to cause differences in medical education. Conclusions: In the unprecedented times of the COVID-19 pandemic, medical schools have a duty to provide ongoing education to medical students. The continuation of teaching is crucial to enable the graduation of future physicians into society. The evidence suggests that virtual teaching is effective, and institutions are working to further develop these resources to improve student engagement and interactivity. Moving forward, medical faculties must adopt a more holistic approach to student education and consider the mental impact of COVID-19 on students as well as improve the security and technology of virtual platforms. UR - http://mededu.jmir.org/2020/2/e20963/ UR - http://dx.doi.org/10.2196/20963 UR - http://www.ncbi.nlm.nih.gov/pubmed/33106227 ID - info:doi/10.2196/20963 ER - TY - JOUR AU - Yuliawan, Deny AU - Widyandana, Doni AU - Nur Hidayah, Rachmadya PY - 2020/11/13 TI - Utilization of Nursing Education Progressive Web Application (NEPWA) Media in an Education and Health Promotion Course Using Gagne?s Model of Instructional Design on Nursing Students: Quantitative Research and Development Study JO - JMIR Nursing SP - e19780 VL - 3 IS - 1 KW - mobile application KW - nursing students KW - blended learning KW - knowledge KW - satisfaction KW - system usability KW - mobile phone N2 - Background: Previous studies have proven that web-based learning media that offer interesting features with the learning management system concept could support the learning processes of nursing students. Nonetheless, it is still necessary to conduct further research on its potential as an information media that supports learning using 1 of the mobile learning methods. Objective: This study aims to develop and use the Nursing Education Progressive Web Application (NEPWA) media in an education and health promotion course for nursing students. Methods: This is a research and development study aimed at developing the NEPWA media using the Analyze, Design, Develop, Implement, and Evaluate approach and a quantitative research with descriptive and pre-experimental 1-group pretest-posttest design conducted in the Study Program of Nursing Sciences, Faculty of Health Sciences, Muhammadiyah University of Surakarta. A total of 39 nursing students in their second year of undergraduate studies participated in this study. A pretest-posttest design was used to measure any changes in the dependent variable, whereas a posttest design was used to measure any changes in the independent variables. Results: After using the NEPWA media, there was a significant increase in the student knowledge variable (N=39; knowledge: P<.001; 95% CI 23.88-33.14). In terms of student satisfaction with the learning process using Gagne?s model of instructional design, most of the students were satisfied, with a mean score of ?3. In addition, the results of the measurement using the System Usability Scale on the NEPWA media showed that NEPWA has good usability and it is acceptable by users, with a mean score of 72.24 (SD 8.54). Conclusions: The NEPWA media can be accepted by users and has good usability, and this media is designed to enhance student knowledge. UR - https://nursing.jmir.org/2020/1/e19780/ UR - http://dx.doi.org/10.2196/19780 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345790 ID - info:doi/10.2196/19780 ER - TY - JOUR AU - Thompson, Jessica AU - White, Simon AU - Chapman, Stephen PY - 2020/11/6 TI - Interactive Clinical Avatar Use in Pharmacist Preregistration Training: Design and Review JO - J Med Internet Res SP - e17146 VL - 22 IS - 11 KW - virtual patient KW - high-fidelity simulation training KW - patient simulation KW - pharmacy education KW - pharmacy practice education KW - virtual reality N2 - Background: Virtual patients are interactive computer-based simulations that are being increasingly used in modern health care education. They have been identified as tools that can provide experiential learning and assessment in a standardized and safe environment. However, the study of high-fidelity virtual patients such as interactive clinical avatars within pharmacy is limited. Objective: The aim of this paper is to describe the design and review of three interactive clinical avatar simulations as part of pharmacist preregistration training. Methods: A multistep design approach was taken to create interactive clinical avatar simulations on the topics of emergency hormonal contraception (EHC), calculation of renal function, and childhood illnesses. All case studies were reviewed by registered pharmacists to establish content and face validity. The EHC case study and data collection questionnaire were also reviewed by a purposive sample of preregistration trainees and newly qualified pharmacists. The questionnaire used Likert ranking statements and open-ended questions to obtain users? feedback on the design, usability, and usefulness of the interactive clinical avatars as learning tools. Descriptive statistics and content analysis were undertaken on the data. Results: Ten preregistration trainees and newly qualified pharmacists reviewed the EHC interactive clinical avatars and data collection questionnaire. The data collection questionnaire was associated with a Cronbach alpha=.95, demonstrating good reliability. All three interactive clinical avatar simulations were reported as usable and appropriately designed for preregistration training. Users perceived they were developing skills and knowledge from the simulations. The high-fidelity nature of the avatars and relevance of the simulations to real-life practice were reported as aspects that encouraged the application of theory to practice. Improvements were suggested to ensure the simulations were more user-friendly. Conclusions: The design and creation of the interactive clinical avatar simulations was successful. The multistep review process ensured validity and reliability of the simulations and data collection questionnaire. The in-depth explanation of the design process and provision of a questionnaire may help widen the use and evaluation of interactive clinical avatars or other simulation tools in pharmacy education. The interactive clinical avatars were reported as novel learning tools that promoted experiential learning and allowed users to feel like they were engaging in real-life scenarios, thus developing transferable knowledge and skills. This may be potentially beneficial for many health care training courses as a way to provide standardized experiences promoting active learning and reflection. UR - https://www.jmir.org/2020/11/e17146 UR - http://dx.doi.org/10.2196/17146 UR - http://www.ncbi.nlm.nih.gov/pubmed/33155983 ID - info:doi/10.2196/17146 ER - TY - JOUR AU - Suppan, Laurent AU - Herren, Tara AU - Taramarcaz, Victor AU - Regard, Simon AU - Martin-Achard, Sébastien AU - Zamberg, Ido AU - Larribau, Robert AU - Niquille, Marc AU - Mach, Francois AU - Suppan, Mélanie AU - Schiffer, Eduardo PY - 2020/11/6 TI - A Short Intervention Followed by an Interactive E-Learning Module to Motivate Medical Students to Enlist as First Responders: Protocol for a Prospective Implementation Study JO - JMIR Res Protoc SP - e24664 VL - 9 IS - 11 KW - basic life support KW - cardiopulmonary resuscitation KW - medical students KW - undergraduate medical education KW - out-of-hospital cardiac arrest N2 - Background: In Geneva, Switzerland, basic life support (BLS) maneuvers are provided in only 40% of out-of-hospital cardiac arrests (OHCAs) cases. As OHCA outcomes are markedly improved when BLS maneuvers are swiftly applied, a ?first-responder? system was introduced in 2019. When emergency dispatchers identify a possible OHCA, first responders receive an alert message on a specific app (Save-a-Life) installed on their smartphones. Those nearest to the victim and immediately available are sent the exact location of the intervention. First-year medical students only have limited knowledge regarding BLS procedures but might nevertheless need to take care of OHCA victims. Medical students responding to out-of-hospital emergencies are off-duty in half of these situations, and offering junior medical students the opportunity to enlist as first responders might therefore not only improve OHCA outcomes but also foster a greater recognition of the role medical students can hold in our society. Objective: Our aim is to determine whether providing first-year medical students with a short intervention followed by an interactive e-learning module can motivate them to enlist as first responders. Methods: After obtaining the approval of the regional ethics committee and of the vice-dean for undergraduate education of the University of Geneva Faculty of Medicine (UGFM), 2 senior medical students will present the project to their first-year colleagues at the beginning of a lecture. First-year students will then be provided with a link to an interactive e-learning module which has been designed according to the Swiss Resuscitation Council?s first aid guidelines. After answering a first questionnaire and completing the module, students will be able to register for practice sessions. Those attending and successfully completing these sessions will receive a training certificate which will enable them to enlist as first responders. The primary outcome will be the proportion of first-year medical students enlisting as first responders at the end of the study period. Secondary outcomes will be the proportion of first-year medical students electing to register on the platform, to begin the e-learning module, to complete the e-learning module, to register for practice sessions, to attend the practice sessions, and to obtain a certificate. The reasons given by medical students for refusing to participate will be analyzed. We will also assess how comfortable junior medical students would feel to be integrated into the first responders system at the end of the training program and whether it affects the registration rate. Results: The regional ethics committee (Req-2020-01143) and the UGFM vice-dean for undergraduate education have given their approval to the realization of this study, which is scheduled to begin in January 2021. Conclusions: This study should determine whether a short intervention followed by an interactive e-learning module can motivate first-year medical students to enlist as first responders. International Registered Report Identifier (IRRID): PRR1-10.2196/24664 UR - http://www.researchprotocols.org/2020/11/e24664/ UR - http://dx.doi.org/10.2196/24664 UR - http://www.ncbi.nlm.nih.gov/pubmed/33155574 ID - info:doi/10.2196/24664 ER - TY - JOUR AU - Kalaitzoglou, Evangelia AU - Majaliwa, Edna AU - Zacharin, Margaret AU - de Beaufort, Carine AU - Chanoine, Jean-Pierre AU - van Wijngaard-DeVugt, Conny AU - Sperla, Ervin AU - Boot, M. Annemieke AU - Drop, S. Stenvert L. PY - 2020/11/5 TI - Multilingual Global E-Learning Pediatric Endocrinology and Diabetes Curriculum for Front Line Health Care Providers in Resource-Limited Countries: Development Study JO - JMIR Form Res SP - e18555 VL - 4 IS - 11 KW - pediatric endocrinology KW - diabetes mellitus KW - e-learning KW - online learning KW - continuing education KW - resource-limited country KW - multilingual medical education N2 - Background: Electronic learning (e-learning) is a widely accessible, low-cost option for learning remotely in various settings that allows interaction between an instructor and a learner. Objective: We describe the development of a free and globally accessible multilingual e-learning module that provides education material on topics in pediatric endocrinology and diabetes and that is intended for first-line physicians and health workers but also trainees or medical specialists in resource-limited countries. Methods: As complements to concise chapters, interactive vignettes were constructed, exemplifying clinical issues and pitfalls, with specific attention to the 3 levels of medical health care in resource-limited countries. The module is part of a large e-learning portal, ESPE e-learning, which is based on ILIAS (Integriertes Lern-, Informations- und Arbeitskooperations-System), an open-source web-based learning management system. Following a review by global experts, the content was translated by native French, Spanish, Swahili, and Chinese?speaking colleagues into their respective languages using a commercial web-based translation tool (SDL Trados Studio). Results: Preliminary data suggest that the module is well received, particularly in targeted parts of the world and that active promotion to inform target users is warranted. Conclusions: The e-learning module is a free globally accessible multilingual up-to-date tool for use in resource-limited countries that has been utilized thus far with success. Widespread use will require dissemination of the tool on a global scale. UR - https://formative.jmir.org/2020/11/e18555 UR - http://dx.doi.org/10.2196/18555 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151156 ID - info:doi/10.2196/18555 ER - TY - JOUR AU - Yin, Lukas Andrew AU - Gheissari, Pargol AU - Lin, Wanyin Inna AU - Sobolev, Michael AU - Pollak, P. John AU - Cole, Curtis AU - Estrin, Deborah PY - 2020/11/3 TI - Role of Technology in Self-Assessment and Feedback Among Hospitalist Physicians: Semistructured Interviews and Thematic Analysis JO - J Med Internet Res SP - e23299 VL - 22 IS - 11 KW - feedback KW - self-assessment KW - self-learning KW - hospitalist KW - electronic medical record KW - digital health KW - assessment KW - learning N2 - Background: Lifelong learning is embedded in the culture of medicine, but there are limited tools currently available for many clinicians, including hospitalists, to help improve their own practice. Although there are requirements for continuing medical education, resources for learning new clinical guidelines, and developing fields aimed at facilitating peer-to-peer feedback, there is a gap in the availability of tools that enable clinicians to learn based on their own patients and clinical decisions. Objective: The aim of this study was to explore the technologies or modifications to existing systems that could be used to benefit hospitalist physicians in pursuing self-assessment and improvement by understanding physicians? current practices and their reactions to proposed possibilities. Methods: Semistructured interviews were conducted in two separate stages with analysis performed after each stage. In the first stage, interviews (N=12) were conducted to understand the ways in which hospitalist physicians are currently gathering feedback and assessing their practice. A thematic analysis of these interviews informed the prototype used to elicit responses in the second stage. Results: Clinicians actively look for feedback that they can apply to their practice, with the majority of the feedback obtained through self-assessment. The following three themes surrounding this aspect were identified in the first round of semistructured interviews: collaboration, self-reliance, and uncertainty, each with three related subthemes. Using a wireframe, the second round of interviews led to identifying the features that are currently challenging to use or could be made available with technology. Conclusions: Based on each theme and subtheme, we provide targeted recommendations for use by relevant stakeholders such as institutions, clinicians, and technologists. Most hospitalist self-assessments occur on a rolling basis, specifically using data in electronic medical records as their primary source. Specific objective data points or subjective patient relationships lead clinicians to review their patient cases and to assess their own performance. However, current systems are not built for these analyses or for clinicians to perform self-assessment, making this a burdensome and incomplete process. Building a platform that focuses on providing and curating the information used for self-assessment could help physicians make more accurately informed changes to their own clinical practice and decision-making. UR - http://www.jmir.org/2020/11/e23299/ UR - http://dx.doi.org/10.2196/23299 UR - http://www.ncbi.nlm.nih.gov/pubmed/33141098 ID - info:doi/10.2196/23299 ER - TY - JOUR AU - Verloo, Henk AU - Melly, Pauline AU - Hilfiker, Roger AU - Pereira, Filipa PY - 2020/11/2 TI - Effectiveness of Educational Interventions to Increase Knowledge of Evidence-Based Practice Among Nurses and Physiotherapists in Primary Health Care: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e17621 VL - 9 IS - 11 KW - evidence-based practice KW - primary healthcare KW - beliefs KW - knowledge KW - implementation KW - nurses KW - nurse practitioners KW - physiotherapists KW - interventions KW - education N2 - Background: The implementation of evidence-based practice (EBP) in daily health care practice is strongly encouraged; it is widely recognized as a means to improve the quality and safety of health care for patients and reduce avoidable costs. Primary care nurses and physiotherapists face numerous challenges in trying to ensure that they deliver effective daily care. Broadly promoted educational interventions aim to increase the integration and implementation of EBP in their daily practice. Objective: This systematic review will retrieve and evaluate publications examining the effectiveness of educational interventions to increase the integration and implementation of EBP among nurses, nurse practitioners, and physiotherapists active in primary care. Methods: We will conduct a systematic review of published articles in relevant professional, scientific journals (from their start dates) and in the following electronic databases, from inception until October 31, 2020: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb]; from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Central Register of Controlled Trials Wiley (from 1992), PsycINFO Ovid SP (from 1806), Web of Science Core collection (from 1900), PEDro (from 1999), the JBI Database of Systematic Reviews and Implementation Reports (from 1998), and the Trip Database (from 1997). We will use the predefined search terms of ?evidence-based practice,? ?nurses,? or ?physiotherapists? and combinations with other terms, such as ?educational interventions.? We will also conduct a hand search of the bibliographies of all the relevant articles and a search for unpublished studies using Google Scholar, the ProQuest Dissertations and Theses dissemination, Mednar, WorldCat, OpenGrey, and Grey Literature Report. We will consider publications in English, French, German, and Portuguese. Results: The electronic database searches were completed in October 2020. Retrieved articles are currently being screened, and the entire study is expected to be completed by March 2021. Conclusions: This systematic review will provide specific knowledge about the effectiveness of educational interventions to increase the implementation and integration of EBP in the daily practice of nurses and physiotherapists providing primary care services. Its findings will inform us about the types and frequencies of the most successful educational interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42017077309; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77309 International Registered Report Identifier (IRRID): DERR1-10.2196/17621 UR - https://www.researchprotocols.org/2020/11/e17621 UR - http://dx.doi.org/10.2196/17621 UR - http://www.ncbi.nlm.nih.gov/pubmed/33136056 ID - info:doi/10.2196/17621 ER - TY - JOUR AU - Loescher, Lois AU - Heslin, Kelly AU - Silva, Graciela AU - Muramoto, Myra PY - 2020/11/2 TI - Partnering With Massage Therapists to Communicate Information on Reducing the Risk of Skin Cancer Among Clients: Longitudinal Study JO - JMIR Form Res SP - e21309 VL - 4 IS - 11 KW - cancer prevention KW - skin cancer KW - e-training KW - electronic intervention KW - massage therapists N2 - Background: Skin cancer affects millions of Americans and is an important focus of disease prevention efforts. Partnering with non?health care practitioners such as massage therapists (MTs) can reduce the risk of skin cancer. MTs see clients? skin on a regular basis, which can allow MTs to initiate ?helping conversations? (ie, brief behavioral interventions aimed at reducing the risk of skin cancer). Objective: The purpose of this study was to evaluate (1) the feasibility of recruiting, enrolling, and retaining Arizona MTs in an online electronic training (e-training) and (2) the preliminary efficacy of e-training on knowledge, attitudes/beliefs, and practice of risk reduction for skin cancer. We explored MTs? ability to assess suspicious skin lesions. Methods: We adapted the existing educational content on skin cancer for applicability to MTs and strategies from previous research on helping conversations. We assessed the feasibility of providing such e-training, using Research Electronic Data Capture (REDCap) tools for data capture. We assessed the preliminary efficacy using established self-report surveys at baseline, immediately post training, and at 3 and 6 months post training. Results: A total of 95 participants enrolled in the study, of which 77% (73/95) completed the assessments at 6 months (overall attrition=23%). Project satisfaction and e-training acceptability were high. Knowledge, personal behaviors (skin self-examination, clinical skin examination, sun protection frequency), and practice attitudes (appropriateness and comfort with client-focused communication) of risk reduction for skin cancer improved significantly and were sustained throughout the study. Conclusions: The e-training was feasible and could be delivered online successfully to MTs. Participants were highly satisfied with and accepting of the e-training. As such, e-training has potential as an intervention in larger trials with MTs for reducing the risk of skin cancer. International Registered Report Identifier (IRRID): RR2-10.2196/13480 UR - https://formative.jmir.org/2020/11/e21309 UR - http://dx.doi.org/10.2196/21309 UR - http://www.ncbi.nlm.nih.gov/pubmed/33136054 ID - info:doi/10.2196/21309 ER - TY - JOUR AU - Pereira, Martins Alayne Larissa AU - Leon, Ponce Casandra Genoveva Rosales Martins AU - Ribeiro, Medeiros Laiane AU - Brasil, Costa Guilherme Da AU - Carneiro, Gouveia Karen Karoline AU - Vieira, Borges Géssica AU - Barbalho, Sousa Yuri Gustavo De AU - Silva, Da Izabel Cristina Rodrigues AU - Funghetto, Schwerz Silvana PY - 2020/10/21 TI - Web-Based Virtual Learning Environment for Medicine Administration in Pediatrics and Neonatology: Content Evaluation JO - JMIR Serious Games SP - e18258 VL - 8 IS - 4 KW - nursing education KW - health education KW - educational technology KW - patient safety. N2 - Background: Worldwide, patient safety has been a widely discussed topic and has currently become one of the greatest challenges for health institutions. This concern is heightened when referring to children. Objective: The goal of this study was to develop a virtual learning environment for medication administration, as a tool to facilitate the training process of undergraduate nursing students. Methods: Descriptive research and methodological development with a quantitative and qualitative approach were used with stages of design-based research as methodological strategies. For the development of the virtual environment, 5 themes were selected: rights of medication administration, medication administration steps, medication administration routes, medication calculation, and nonpharmacological actions for pain relief. After development, 2 groups?expert judges in the field of pediatrics and neonatology for environment validation and undergraduate nursing students for the assessment?were used to assess the virtual learning environment. For the validation of the virtual learning environment by expert judges, the content validity index was used, and for the evaluation of the students, the percentage of agreement was calculated. Results: The study included 13 experts who positively validated the virtual environment with a content validity index of 0.97, and 26 students who considered the content suitable for nursing students, although some adjustments are necessary. Conclusions: The results show the benefit of the virtual learning environment to the training of nursing students and professional nurses who work in health care. It is an effective educational tool for teaching medication administration in pediatrics and neonatology and converges with the conjectures of active methodologies. UR - http://games.jmir.org/2020/4/e18258/ UR - http://dx.doi.org/10.2196/18258 UR - http://www.ncbi.nlm.nih.gov/pubmed/33084579 ID - info:doi/10.2196/18258 ER - TY - JOUR AU - Mann, Simran AU - Novintan, Shonnelly AU - Hazemi-Jebelli, Yasmin AU - Faehndrich, Daniel PY - 2020/10/9 TI - Medical Students' Corner: Lessons From COVID-19 in Equity, Adaptability, and Community for the Future of Medical Education JO - JMIR Med Educ SP - e23604 VL - 6 IS - 2 KW - medical education KW - COVID-19 KW - student equity KW - community KW - adaptability KW - medical student UR - http://mededu.jmir.org/2020/2/e23604/ UR - http://dx.doi.org/10.2196/23604 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936774 ID - info:doi/10.2196/23604 ER - TY - JOUR AU - Löffler, Christin AU - Krüger, Antje AU - Daubmann, Anne AU - Iwen, Julia AU - Biedermann, Marc AU - Schulz, Maike AU - Wegscheider, Karl AU - Altiner, Attila AU - Feldmeier, Gregor AU - Wollny, Anja PY - 2020/9/30 TI - Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program JO - JMIR Res Protoc SP - e18648 VL - 9 IS - 9 KW - antibacterial agents KW - respiratory tract infection KW - upper respiratory tract infection KW - lower respiratory tract infection KW - primary care KW - primary health care KW - physician-patient relation KW - shared decision making KW - antibiotic resistance N2 - Background: The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. Objective: The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. Methods: RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. Results: RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. Conclusions: With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. Trial Registration: ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 International Registered Report Identifier (IRRID): RR1-10.2196/18648 UR - http://www.researchprotocols.org/2020/9/e18648/ UR - http://dx.doi.org/10.2196/18648 UR - http://www.ncbi.nlm.nih.gov/pubmed/32996888 ID - info:doi/10.2196/18648 ER - TY - JOUR AU - Benda, C. Natalie AU - Kellogg, M. Kathryn AU - Hoffman, J. Daniel AU - Fairbanks, J. Rollin AU - Auguste, Tamika PY - 2020/9/28 TI - Lessons Learned From an Evaluation of Serious Gaming as an Alternative to Mannequin-Based Simulation Technology: Randomized Controlled Trial JO - JMIR Serious Games SP - e21123 VL - 8 IS - 3 KW - simulation training KW - continuing medical education KW - obstetrics N2 - Background: The use of new technology like virtual reality, e-learning, and serious gaming can offer novel, more accessible options that have been demonstrated to improve learning outcomes. Objective: The aim of this study was to compare the educational effectiveness of serious game?based simulation training to traditional mannequin-based simulation training and to determine the perceptions of physicians and nurses. We used an obstetric use case, namely electronic fetal monitoring interpretation and decision making, for our assessment. Methods: This study utilized a mixed methods approach to evaluate the effectiveness of the new, serious game?based training method and assess participants? perceptions of the training. Participants were randomized to traditional simulation training in a center with mannequins or serious game training. They then participated in an obstetrical in-situ simulation scenario to assess their learning. Participants also completed a posttraining perceptions questionnaire. Results: The primary outcome measure for this study was the participants? performance in an in-situ mannequin-based simulation scenario, which occurred posttraining following a washout period. No significant statistical differences were detected between the mannequin-based and serious game?based groups in overall performance, although the study was not sufficiently powered to conclude noninferiority. The survey questions were tested for significant differences in participant perceptions of the educational method, but none were found. Qualitative participant feedback revealed important areas for improvement, with a focus on game realism. Conclusions: The serious game training tool developed has potential utility in providing education to those without access to large simulation centers; however, further validation is needed to demonstrate if this tool is as effective as mannequin-based simulation. UR - http://games.jmir.org/2020/3/e21123/ UR - http://dx.doi.org/10.2196/21123 UR - http://www.ncbi.nlm.nih.gov/pubmed/32985993 ID - info:doi/10.2196/21123 ER - TY - JOUR AU - Synnott, Jonathan AU - Harkin, Mairead AU - Horgan, Brenda AU - McKeown, Andre AU - Hamilton, David AU - McAllister, Declan AU - Trainor, Claire AU - Nugent, Chris PY - 2020/9/23 TI - The Digital Skills, Experiences and Attitudes of the Northern Ireland Social Care Workforce Toward Technology for Learning and Development: Survey Study JO - JMIR Med Educ SP - e15936 VL - 6 IS - 2 KW - social work KW - learning KW - teaching methods KW - surveys KW - health care workers KW - mobile phone KW - digital divide KW - distance education KW - educational technology N2 - Background: Continual development of the social care workforce is a key element in improving outcomes for the users of social care services. As the delivery of social care services continues to benefit from innovation in assistive technologies, it is important that the digital capabilities of the social care workforce are aligned. Policy makers have highlighted the importance of using technology to support workforce learning and development, and the need to ensure that the workforce has the necessary digital skills to fully benefit from such provisions. Objective: This study aims to identify the digital capability of the social care workforce in Northern Ireland and to explore the workforce?s appetite for and barriers to using technology for learning and development. This study is designed to answer the following research questions: (1) What is the digital capability of the social care workforce in Northern Ireland? (2) What is the workforce?s appetite to participate in digital learning and development? and (3) If there are barriers to the uptake of technology for learning and development, what are these barriers? Methods: A survey was created and distributed to the Northern Ireland social care workforce. This survey collected data on 127 metrics that described demographics, basic digital skills, technology confidence and access, factors that influence learning and development, experience with digital learning solutions, and perceived value and challenges of using technology for learning. Results: The survey was opened from December 13, 2018, to January 18, 2019. A total of 775 survey respondents completed the survey. The results indicated a workforce with a high level of self-reported basic digital skills and confidence. Face-to-face delivery of learning is still the most common method of accessing learning, which was used by 83.7% (649/775) of the respondents; however, this is closely followed by digital learning, which was used by 79.0% (612/775) of the respondents. There was a negative correlation between age and digital skills (rs=?0.262; P<.001), and a positive correlation between technology confidence and digital skills (rs=0.482; P<.001). There was also a negative correlation between age and the perceived value of technology (rs=?0.088; P=.02). The results indicated a predominantly motivated workforce in which a sizable portion is already engaged in informal digital learning. The results indicated that lower self-reported basic digital skills and confidence were associated with less interest in engaging with e-learning tools and that a portion of the workforce would benefit from additional basic digital skills training. Conclusions: These promising results provide a positive outlook for the potential of digital learning and development within the social care workforce. The findings provide clear areas of focus for the future use of technology for learning and development of the social care workforce and considerations to maximize engagement with such approaches. UR - http://mededu.jmir.org/2020/2/e15936/ UR - http://dx.doi.org/10.2196/15936 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965233 ID - info:doi/10.2196/15936 ER - TY - JOUR AU - Chen, Feng-Qin AU - Leng, Yu-Fei AU - Ge, Jian-Feng AU - Wang, Dan-Wen AU - Li, Cheng AU - Chen, Bin AU - Sun, Zhi-Ling PY - 2020/9/15 TI - Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis JO - J Med Internet Res SP - e18290 VL - 22 IS - 9 KW - virtual reality KW - nursing education KW - meta-analysis N2 - Background: Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes. Objective: The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. Methods: We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Results: A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI ?0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI ?0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI ?0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=?0.55, 95% CI ?2.04 to 0.94, P=.47, I2=97%). Conclusions: The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results. UR - http://www.jmir.org/2020/9/e18290/ UR - http://dx.doi.org/10.2196/18290 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930664 ID - info:doi/10.2196/18290 ER - TY - JOUR AU - Pimentel, Juan AU - Cockcroft, Anne AU - Andersson, Neil PY - 2020/8/31 TI - Impact of Co-Designed Game Learning on Cultural Safety in Colombian Medical Education: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e17297 VL - 9 IS - 8 KW - transformative learning KW - medical education KW - cultural safety KW - participatory research KW - game jam N2 - Background: Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients? worldviews. Lack of cultural safety in health care is linked to stigma and discrimination toward culturally diverse patients. Training in cultural safety poses considerable challenges. It is an unappealing subject for medical students and requires behavioral changes in their clinical practice. Game jams?collaborative workshops to create and play games?have recently shown effectiveness and engaging potential in university-level education. Objective: The trial aims to determine if medical students? participation in a game jam to design an educational game on cultural safety is more effective than a standard lesson on cultural safety in terms of change in the students? self-reported intended patient-oriented behavior. Methods: A parallel-group, 2-arm randomized controlled trial with a 1:1 allocation ratio will randomize 340 medical students and 60 medical interns (n=400) at the Faculty of Medicine at La Sabana University, Colombia (170 students and 30 medical interns to each arm). The intervention group will participate in an 8-hour game jam comprising (1) a preliminary lecture on cultural safety and game design, (2) a game building session where groups of students will create educational games about cultural safety, and (3) a play-test session in which students will play and learn from each other?s games. The control group will receive a standard lesson, including a 2-hour lecture on cultural safety, followed by a 6-hour workshop to create posters about cultural safety. Web-based self-administered 30-item Likert-type questionnaires will assess cultural safety self-reported intended behavior before, immediately after, and 6 months after the intervention. An intention-to-treat approach will use a t-test with 95% CIs to determine the significance of the effect of the intervention, including within- and between-group comparisons. The qualitative most significant change technique will explore the impact of the intervention on the clinical experience of the students. Results: Study enrollment began in July 2019. A total of 531 students completed the baseline survey and were randomized. Data collection is expected to be complete by July 2020, and results are expected in October 2020. The study was approved by the institutional review board of the Faculty of Medicine at McGill University (May 31, 2017) and by the Subcommittee for Research of the Faculty of Medicine at La Sabana University (approval number 445). Conclusions: The research will develop participatory methods in game-based learning co-design that might be relevant to other subjects. Ultimately, it should foster improved cultural safety skills for medical students, improve the quality of health services for diverse cultural groups, and contribute to enhanced population health. Game learning may provide an innovative solution to a long-standing and neglected problem in medical education, helping to meet the educational expectations and needs of millennial medical students. Trial Registration: ISRCTN Registry ISRCTN14261595; http://www.controlled-trials.com/ISRCTN14261595 UR - https://www.researchprotocols.org/2020/8/e17297 UR - http://dx.doi.org/10.2196/17297 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442146 ID - info:doi/10.2196/17297 ER - TY - JOUR AU - Suppan, Laurent AU - Abbas, Mohamed AU - Stuby, Loric AU - Cottet, Philippe AU - Larribau, Robert AU - Golay, Eric AU - Iten, Anne AU - Harbarth, Stephan AU - Gartner, Birgit AU - Suppan, Mélanie PY - 2020/8/21 TI - Effect of an E-Learning Module on Personal Protective Equipment Proficiency Among Prehospital Personnel: Web-Based Randomized Controlled Trial JO - J Med Internet Res SP - e21265 VL - 22 IS - 8 KW - personal protective equipment KW - COVID-19 KW - electronic learning KW - prehospital KW - randomized controlled trial KW - protection KW - equipment KW - safety KW - gamified KW - online learning KW - communication N2 - Background: To avoid misuse of personal protective equipment (PPE), ensure health care workers? safety, and avoid shortages, effective communication of up-to-date infection control guidelines is essential. As prehospital teams are particularly at risk of contamination given their challenging work environment, a specific gamified electronic learning (e-learning) module targeting this audience might provide significant advantages as it requires neither the presence of learners nor the repetitive use of equipment for demonstration. Objective: The aim of this study was to evaluate whether a gamified e-learning module could improve the rate of adequate PPE choice by prehospital personnel in the context of the coronavirus disease (COVID-19) pandemic. Methods: This was an individual-level randomized, controlled, quadruple-blind (investigators, participants, outcome assessors, and data analysts) closed web-based trial. All emergency prehospital personnel working in Geneva, Switzerland, were eligible for inclusion, and were invited to participate by email in April 2020. Participants were informed that the study aim was to assess their knowledge regarding PPE, and that they would be presented with both the guidelines and the e-learning module, though they were unaware that there were two different study paths. All participants first answered a preintervention quiz designed to establish their profile and baseline knowledge. The control group then accessed the guidelines before answering a second set of questions, and were then granted access to the e-learning module. The e-learning group was shown the e-learning module right after the guidelines and before answering the second set of questions. Results: Of the 291 randomized participants, 176 (60.5%) completed the trial. There was no significant difference in baseline knowledge between groups. Though the baseline proportion of adequate PPE choice was high (75%, IQR 50%-75%), participants? description of the donning sequence was in most cases incorrect. After either intervention, adequate choice of PPE increased significantly in both groups (P<.001). Though the median of the difference in the proportion of correct answers was slightly higher in the e-learning group (17%, IQR 8%-33% versus 8%, IQR 8%-33%), the difference was not statistically significant (P=.27). Confidence in the ability to use PPE was maintained in the e-learning group (P=.27) but significantly decreased in the control group (P=.04). Conclusions: Among prehospital personnel with an already relatively high knowledge of and experience with PPE use, both web-based study paths increased the rate of adequate choice of PPE. There was no major added value of the gamified e-learning module apart from preserving participants' confidence in their ability to correctly use PPE. UR - http://www.jmir.org/2020/8/e21265/ UR - http://dx.doi.org/10.2196/21265 UR - http://www.ncbi.nlm.nih.gov/pubmed/32747329 ID - info:doi/10.2196/21265 ER - TY - JOUR AU - Machleid, Felix AU - Kaczmarczyk, Robert AU - Johann, Doreen AU - Bal?i?nas, Justinas AU - Atienza-Carbonell, Beatriz AU - von Maltzahn, Finn AU - Mosch, Lina PY - 2020/8/14 TI - Perceptions of Digital Health Education Among European Medical Students: Mixed Methods Survey JO - J Med Internet Res SP - e19827 VL - 22 IS - 8 KW - medical students KW - medical education KW - eHealth KW - mixed method KW - health workforce KW - digital literacy KW - curriculum N2 - Background: Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. Objective: We aimed to assess European medical students? perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students? most pressing needs. Methods: The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach. Results: The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education. Conclusions: This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties. UR - http://www.jmir.org/2020/8/e19827/ UR - http://dx.doi.org/10.2196/19827 UR - http://www.ncbi.nlm.nih.gov/pubmed/32667899 ID - info:doi/10.2196/19827 ER - TY - JOUR AU - Muangpoon, Theerapat AU - Haghighi Osgouei, Reza AU - Escobar-Castillejos, David AU - Kontovounisios, Christos AU - Bello, Fernando PY - 2020/8/13 TI - Augmented Reality System for Digital Rectal Examination Training and Assessment: System Validation JO - J Med Internet Res SP - e18637 VL - 22 IS - 8 KW - Augmented Reality KW - Digital Rectal Examination (DRE) KW - Magnetic Tracker KW - Pressure Sensor KW - Medical Education KW - Usability N2 - Background: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients. Objective: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers. Methods: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system. Results: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group. Conclusions: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal organs. The initial user study proved its applicability and usefulness. UR - https://www.jmir.org/2020/8/e18637 UR - http://dx.doi.org/10.2196/18637 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788146 ID - info:doi/10.2196/18637 ER - TY - JOUR AU - Vallée, Alexandre AU - Blacher, Jacques AU - Cariou, Alain AU - Sorbets, Emmanuel PY - 2020/8/10 TI - Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e16504 VL - 22 IS - 8 KW - blended learning KW - virtual patients KW - online learning KW - computer-aided instruction KW - traditional learning KW - meta-analysis N2 - Background: Blended learning, which combines face-to-face learning and e-learning, has grown rapidly to be commonly used in education. Nevertheless, the effectiveness of this learning approach has not been completely quantitatively synthesized and evaluated using knowledge outcomes in health education. Objective: The aim of this study was to assess the effectiveness of blended learning compared to that of traditional learning in health education. Methods: We performed a systematic review of blended learning in health education in MEDLINE from January 1990 to July 2019. We independently selected studies, extracted data, assessed risk of bias, and compared overall blended learning versus traditional learning, offline blended learning versus traditional learning, online blended learning versus traditional learning, digital blended learning versus traditional learning, computer-aided instruction blended learning versus traditional learning, and virtual patient blended learning versus traditional learning. All pooled analyses were based on random-effect models, and the I2 statistic was used to quantify heterogeneity across studies. Results: A total of 56 studies (N=9943 participants) assessing several types of learning support in blended learning met our inclusion criteria; 3 studies investigated offline support, 7 studies investigated digital support, 34 studies investigated online support, 8 studies investigated computer-assisted instruction support, and 5 studies used virtual patient support for blended learning. The pooled analysis comparing all blended learning to traditional learning showed significantly better knowledge outcomes for blended learning (standardized mean difference 1.07, 95% CI 0.85 to 1.28, I2=94.3%). Similar results were observed for online (standardized mean difference 0.73, 95% CI 0.60 to 0.86, I2=94.9%), computer-assisted instruction (standardized mean difference 1.13, 95% CI 0.47 to 1.79, I2=78.0%), and virtual patient (standardized mean difference 0.62, 95% CI 0.18 to 1.06, I2=78.4%) learning support, but results for offline learning support (standardized mean difference 0.08, 95% CI ?0.63 to 0.79, I2=87.9%) and digital learning support (standardized mean difference 0.04, 95% CI ?0.45 to 0.52, I2=93.4%) were not significant. Conclusions: From this review, blended learning demonstrated consistently better effects on knowledge outcomes when compared with traditional learning in health education. Further studies are needed to confirm these results and to explore the utility of different design variants of blended learning. UR - https://www.jmir.org/2020/8/e16504 UR - http://dx.doi.org/10.2196/16504 UR - http://www.ncbi.nlm.nih.gov/pubmed/32773378 ID - info:doi/10.2196/16504 ER - TY - JOUR AU - Johnson, Grødem Susanne AU - Potrebny, Thomas AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2020/8/4 TI - Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e19072 VL - 9 IS - 8 KW - user-computer interface KW - mobile app KW - online learning KW - health education KW - students N2 - Background: E-learning technologies, including mobile apps, are used to a large extent in health care education. Mobile apps can provide extendable learning environments and motivate students for adaptive and collaborative learning outside the classroom context. Developers should design practical, effective, and easy-to-use mobile apps. Usability testing is an important part of app development in order to understand if apps meet the needs of users. Objective: The aim of this study is to perform a scoping review of usability methods and attributes reported in usability studies of mobile apps for health care education. Methods: The scoping review is guided by the methodological framework developed by Arksey & O?Malley and further developed by Levac et al and Kahlil et al. The stages we will follow are as follows: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) summarizing and reporting the results. We have developed two research questions to meet the aim of the study, which are as follows: (1) What usability methods are used to evaluate the usability of mobile apps for health care education? and (2) What usability attributes are reported in the usability studies of mobile apps for health care education? We will apply a comprehensive search of the literature, including 10 databases, a reference search, and a search for grey literature. Two review authors will independently screen articles for eligibility. Results: The initial electronic database searches were completed in March 2019. The literature search identified 14,297 unique references. Following title and abstract screening, the full texts of 369 records were obtained. The scoping review is expected to be completed in spring 2021. Conclusions: We expect the overview of usability methods and attributes reported in usability studies of mobile apps for health care education to contribute to the knowledge base for researchers and developers. It will give an overview of the research field and provide researchers and developers with relevant and important information on the usability research area, including highlighting possible research gaps. International Registered Report Identifier (IRRID): DERR1-10.2196/19072 UR - https://www.researchprotocols.org/2020/8/e19072 UR - http://dx.doi.org/10.2196/19072 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750011 ID - info:doi/10.2196/19072 ER - TY - JOUR AU - Gladman, Tehmina AU - Tylee, Grace AU - Gallagher, Steve AU - Mair, Jonathan AU - Rennie, C. Sarah AU - Grainger, Rebecca PY - 2020/7/31 TI - A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study JO - JMIR Mhealth Uhealth SP - e18015 VL - 8 IS - 7 KW - questionnaire design KW - medical education KW - health occupations students KW - just-in-time learning KW - self-directed learning KW - mobile phone KW - rubric KW - mobile learning KW - mobile apps KW - mhealth KW - digital learning N2 - Background: To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning. Objective: The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning. Methods: Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL. Results: Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (?=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66). Conclusions: MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning. UR - https://mhealth.jmir.org/2020/7/e18015 UR - http://dx.doi.org/10.2196/18015 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735228 ID - info:doi/10.2196/18015 ER - TY - JOUR AU - McLean, Allen AU - McDonald, Wade AU - Goodridge, Donna PY - 2020/7/30 TI - Simulation Modeling as a Novel and Promising Strategy for Improving Success Rates With Research Funding Applications: A Constructive Thought Experiment JO - JMIR Nursing SP - e18983 VL - 3 IS - 1 KW - simulation modeling KW - computational science KW - funding application KW - grant funding KW - grant writing KW - nursing KW - research KW - thought experiment KW - persuasive technology KW - peripheral vascular disease UR - https://nursing.jmir.org/2020/1/e18983/ UR - http://dx.doi.org/10.2196/18983 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345787 ID - info:doi/10.2196/18983 ER - TY - JOUR AU - Claflin, B. Suzi AU - Gates, Rachael AU - Maher, Maree AU - Taylor, V. Bruce PY - 2020/7/29 TI - Building a Successful Massive Open Online Course About Multiple Sclerosis: A Process Description JO - J Med Internet Res SP - e16687 VL - 22 IS - 7 KW - multiple sclerosis KW - health education N2 - Background: Over the course of a year, we developed and tested a 6-week massive open online course (MOOC) on multiple sclerosis (MS) in consultation with the MS community. The course targeted the MS community and interested laypeople and was titled Understanding MS. The primary purpose of the course was to improve MS knowledge, health literacy, and resilience among participants. The final version of the MOOC made available for open enrollment was ranked first among all MOOCs released in 2019 (n>2400) based on participant reviews. Objective: The aim of this study was to present a detailed description and assessment of the development process of the Understanding MS MOOC. Methods: The development process included a course development focus group; the creation of more than 50 content videos and related text, quizzes, activities, and discussion prompts; the creation of original images and animations; a pilot study; and collaborations with people living with MS, MS nurses, allied health care practitioners, and neurologists and researchers from 4 universities. Results: Overall, the process was efficient and effective. With a few small changes, we recommend this approach to those seeking to develop a similar course. This process led to the development of a highly reviewed MOOC with excellent user satisfaction. Conclusions: We identified 5 key lessons from this process: (1) community support is essential, (2) stakeholder involvement improves content quality, (3) plan for research from the beginning, (4) coordination between the academic lead and project manager team ensures a consistent voice, and (5) a network of collaborators is a key resource. UR - https://www.jmir.org/2020/7/e16687 UR - http://dx.doi.org/10.2196/16687 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723726 ID - info:doi/10.2196/16687 ER - TY - JOUR AU - Iancu, Magen Ariella AU - Kemp, Thomas Michael AU - Alam, Badre Hasan PY - 2020/7/20 TI - Unmuting Medical Students? Education: Utilizing Telemedicine During the COVID-19 Pandemic and Beyond JO - J Med Internet Res SP - e19667 VL - 22 IS - 7 KW - telemedicine KW - medical education KW - medical school KW - COVID-19 KW - education, medical, undergraduate KW - curriculum UR - http://www.jmir.org/2020/7/e19667/ UR - http://dx.doi.org/10.2196/19667 UR - http://www.ncbi.nlm.nih.gov/pubmed/32614776 ID - info:doi/10.2196/19667 ER - TY - JOUR AU - Remtulla, Ridhaa PY - 2020/7/17 TI - The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic JO - JMIR Med Educ SP - e20190 VL - 6 IS - 2 KW - medical education KW - technology KW - coronavirus KW - medical students KW - COVID-19 KW - pandemic KW - online lecture KW - virtual reality UR - http://mededu.jmir.org/2020/2/e20190/ UR - http://dx.doi.org/10.2196/20190 UR - http://www.ncbi.nlm.nih.gov/pubmed/32634107 ID - info:doi/10.2196/20190 ER - TY - JOUR AU - Alvarez-Lopez, Fernando AU - Maina, Fabián Marcelo AU - Saigí-Rubió, Francesc PY - 2020/7/14 TI - Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study JO - J Med Internet Res SP - e17491 VL - 22 IS - 7 KW - simulation training KW - minimally invasive surgery KW - user-computer interface KW - operating rooms KW - medical education KW - computer-assisted surgery N2 - Background: Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access. Objective: This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence. Methods: For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed. Results: A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study?s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67). Conclusions: The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained. UR - http://www.jmir.org/2020/7/e17491/ UR - http://dx.doi.org/10.2196/17491 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673217 ID - info:doi/10.2196/17491 ER - TY - JOUR AU - Blum, R. Elizabeth AU - Stenfors, Terese AU - Palmgren, J. Per PY - 2020/7/8 TI - Benefits of Massive Open Online Course Participation: Deductive Thematic Analysis JO - J Med Internet Res SP - e17318 VL - 22 IS - 7 KW - MOOC KW - MOOC evaluation KW - qualitative KW - thematic analysis KW - learner KW - online education KW - Kirkpatrick framework KW - outcomes KW - MOOC outcomes N2 - Background: Massive open online courses (MOOCs), as originally conceived, promised to provide educational access to anyone with an internet connection. However, the expansiveness of MOOC education has been found to be somewhat limited. Nonetheless, leading universities continue to offer MOOCs, including many in the health sciences, on a number of private platforms. Therefore, research on online education must include thorough understanding of the role of MOOCs. To date, studies on MOOC participants have focused mainly on learners? assessment of the course. It is known that MOOCs are not reaching the universal audiences that were predicted, and much knowledge has been gained about learners? perceptions of MOOCs. However, there is little scholarship on what learners themselves gain from participating in MOOCs. Objective: As MOOC development persists and expands, scholars and developers should be made aware of the role of MOOCs in education by examining what these courses do offer their participants. The objective of this qualitative synthesis of a set of MOOC evaluation studies was to explore outcomes for MOOC learners, that is, how the learners themselves benefit from participating in MOOCs. Methods: To explore MOOC learners? outcomes, we conducted a qualitative synthesis in the form of a deductive thematic analysis, aggregating findings from 17 individual studies selected from an existing systematic review of MOOC evaluation methods. We structured our inquiry using the Kirkpatrick model, considering Kirkpatrick levels 2, 3, and 4 as potential themes in our analysis. Results: Our analysis identified six types of Kirkpatrick outcomes in 17 studies. Five of these outcomes (learning/general knowledge, skills, attitudes, confidence, and commitment) fit into Kirkpatrick Level 2, while Kirkpatrick Level 3 outcomes concerning behavior/application were seen in four studies. Two additional themes were identified outside of the Kirkpatrick framework: culture and identity outcomes and affective/emotional outcomes. Kirkpatrick Level 4 was not represented among the outcomes we examined. Conclusions: Our findings point to some gains from MOOCs. While we can expect MOOCs to persist, how learners benefit from the experience of participating in MOOCs remains unclear. UR - https://www.jmir.org/2020/7/e17318 UR - http://dx.doi.org/10.2196/17318 UR - http://www.ncbi.nlm.nih.gov/pubmed/32672680 ID - info:doi/10.2196/17318 ER - TY - JOUR AU - Tuti, Timothy AU - Winters, Niall AU - Edgcombe, Hilary AU - Muinga, Naomi AU - Wanyama, Conrad AU - English, Mike AU - Paton, Chris PY - 2020/7/6 TI - Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers? Learning Gain: Randomized Controlled Trial JO - J Med Internet Res SP - e17100 VL - 22 IS - 7 KW - neonatal mortality KW - education KW - emergency medical services KW - global health KW - smartphone KW - feedback KW - health workforce KW - developing countries KW - mobile phone N2 - Background: Although smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with gamified approaches remains largely unexplored, despite the lack of traditional training opportunities, and high mortality rates in these settings. Objective: The primary aim of this randomized experiment is to determine the effectiveness of offering adaptive versus standard feedback, on the learning gains of clinicians, through the use of a smartphone-based game that assessed their management of a simulated medical emergency. A secondary aim is to examine the effects of learner characteristics and learning spacing with repeated use of the game on the secondary outcome of individualized normalized learning gain. Methods: The experiment is aimed at clinicians who provide bedside neonatal care in low-income settings. Data were captured through an Android app installed on the study participants? personal phones. The intervention, which was based on successful attempts at a learning task, included adaptive feedback provided within the app to the experimental arm, whereas the control arm received standardized feedback. The primary end point was completion of the second learning session. Of the 572 participants enrolled between February 2019 and July 2019, 247 (43.2%) reached the primary end point. The primary outcome was standardized relative change in learning gains between the study arms as measured by the Morris G effect size. The secondary outcomes were the participants individualized normalized learning gains. Results: The effect of adaptive feedback on care providers? learning gain was found to be g=0.09 (95% CI ?0.31 to 0.46; P=.47). In exploratory analysis, using normalized learning gains, when subject-treatment interaction and differential time effect was controlled for, this effect increased significantly to 0.644 (95% CI 0.35 to 0.94; P<.001) with immediate repetition, which is a moderate learning effect, but reduced significantly by 0.28 after a week. The overall learning change from the app use in both arms was large and may have obscured a direct effect of feedback. Conclusions: There is a considerable learning gain between the first two rounds of learning with both forms of feedback and a small added benefit of adaptive feedback after controlling for learner differences. We suggest that linking the adaptive feedback provided to care providers to how they space their repeat learning session(s) may yield higher learning gains. Future work might explore in more depth the feedback content, in particular whether or not explanatory feedback (why answers were wrong) enhances learning more than reflective feedback (information about what the right answers are). Trial Registration: Pan African Clinical Trial Registry (PACTR) 201901783811130; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5836 International Registered Report Identifier (IRRID): RR2-10.2196/13034 UR - https://www.jmir.org/2020/7/e17100 UR - http://dx.doi.org/10.2196/17100 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628115 ID - info:doi/10.2196/17100 ER - TY - JOUR AU - Suppan, Mélanie AU - Gartner, Birgit AU - Golay, Eric AU - Stuby, Loric AU - White, Marion AU - Cottet, Philippe AU - Abbas, Mohamed AU - Iten, Anne AU - Harbarth, Stephan AU - Suppan, Laurent PY - 2020/6/12 TI - Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module JO - JMIR Serious Games SP - e20173 VL - 8 IS - 2 KW - personal protective equipment KW - electronic learning KW - gamification KW - prehospital KW - COVID-19 N2 - Background: The coronavirus disease (COVID-19) pandemic has led to increased use of personal protective equipment (PPE). Adequate use of this equipment is more critical than ever because the risk of shortages must be balanced against the need to effectively protect health care workers, including prehospital personnel. Specific training is therefore necessary; however, the need for social distancing has markedly disrupted the delivery of continuing education courses. Electronic learning (e-learning) may provide significant advantages because it requires neither the physical presence of learners nor the repetitive use of equipment for demonstration. Objective: Inclusion of game mechanics, or ?gamification,? has been shown to increase knowledge and skill acquisition. The objective of this research was to develop a gamified e-learning module to interactively deliver concepts and information regarding the correct choice and handling of PPE. Methods: The SERES framework was used to define and describe the development process, including scientific and design foundations. After we defined the target audience and learning objectives by interviewing the stakeholders, we searched the scientific literature to establish relevant theoretical bases. The learning contents were validated by infection control and prehospital experts. Learning mechanics were then determined according to the learning objectives, and the content that could benefit from the inclusion of game mechanics was identified. Results: The literature search resulted in the selection and inclusion of 12 articles. In addition to gamification, pretesting, feedback, avoiding content skipping, and demonstrations using embedded videos were used as learning mechanics. Gamification was used to enhance the interactivity of the PPE donning and doffing sequences, which presented the greatest learning challenges. The module was developed with Articulate Storyline 3 to ensure that it would be compatible with a wide array of devices, as this software generates HTML5-compatible output that can be accessed on smartphones, tablets, and regular computers as long as a recent browser is available. Conclusions: A gamified e-learning module designed to promote better knowledge and understanding of PPE use among prehospital health care workers was created by following the SERES framework. The impact of this module should now be assessed by means of a randomized controlled trial. UR - http://games.jmir.org/2020/2/e20173/ UR - http://dx.doi.org/10.2196/20173 UR - http://www.ncbi.nlm.nih.gov/pubmed/32516115 ID - info:doi/10.2196/20173 ER - TY - JOUR AU - Koka, Avinash AU - Suppan, Laurent AU - Cottet, Philippe AU - Carrera, Emmanuel AU - Stuby, Loric AU - Suppan, Mélanie PY - 2020/6/9 TI - Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial JO - J Med Internet Res SP - e18358 VL - 22 IS - 6 KW - active learning KW - electronic learning KW - video KW - stroke KW - online learning KW - e-learning N2 - Background: Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition. Objective: This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics. Methods: A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a ?Declaration of no objection.? Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague. Results: The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12). Conclusions: Use of an e-learning module shows promising results in teaching the NIHSS to paramedics. UR - http://www.jmir.org/2020/6/e18358/ UR - http://dx.doi.org/10.2196/18358 UR - http://www.ncbi.nlm.nih.gov/pubmed/32299792 ID - info:doi/10.2196/18358 ER - TY - JOUR AU - Chan, SY Windy AU - Leung, YM Angela PY - 2020/6/2 TI - Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e16772 VL - 22 IS - 6 KW - dementia KW - Facebook KW - social network sites KW - continuous professional education N2 - Background: Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes. Objective: This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia. Methods: Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs. Results: Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6). Conclusions: The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants? knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings. UR - https://www.jmir.org/2020/6/e16772 UR - http://dx.doi.org/10.2196/16772 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484441 ID - info:doi/10.2196/16772 ER - TY - JOUR AU - Babini, H. Mohammad AU - Kulish, V. Vladimir AU - Namazi, Hamidreza PY - 2020/6/1 TI - Physiological State and Learning Ability of Students in Normal and Virtual Reality Conditions: Complexity-Based Analysis JO - J Med Internet Res SP - e17945 VL - 22 IS - 6 KW - virtual reality KW - learning ability KW - brain KW - facial muscle KW - fractal theory N2 - Background: Education and learning are the most important goals of all universities. For this purpose, lecturers use various tools to grab the attention of students and improve their learning ability. Virtual reality refers to the subjective sensory experience of being immersed in a computer-mediated world, and has recently been implemented in learning environments. Objective: The aim of this study was to analyze the effect of a virtual reality condition on students? learning ability and physiological state. Methods: Students were shown 6 sets of videos (3 videos in a two-dimensional condition and 3 videos in a three-dimensional condition), and their learning ability was analyzed based on a subsequent questionnaire. In addition, we analyzed the reaction of the brain and facial muscles of the students during both the two-dimensional and three-dimensional viewing conditions and used fractal theory to investigate their attention to the videos. Results: The learning ability of students was increased in the three-dimensional condition compared to that in the two-dimensional condition. In addition, analysis of physiological signals showed that students paid more attention to the three-dimensional videos. Conclusions: A virtual reality condition has a greater effect on enhancing the learning ability of students. The analytical approach of this study can be further extended to evaluate other physiological signals of subjects in a virtual reality condition. UR - https://www.jmir.org/2020/6/e17945 UR - http://dx.doi.org/10.2196/17945 UR - http://www.ncbi.nlm.nih.gov/pubmed/32478661 ID - info:doi/10.2196/17945 ER - TY - JOUR AU - Zamberg, Ido AU - Windisch, Olivier AU - Agoritsas, Thomas AU - Nendaz, Mathieu AU - Savoldelli, Georges AU - Schiffer, Eduardo PY - 2020/5/27 TI - A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study JO - JMIR Med Educ SP - e17729 VL - 6 IS - 1 KW - clinical skills KW - clinical competence KW - clinical practice guidelines KW - medical education KW - smartphone KW - innovation KW - medical guidance KW - mobile phone N2 - Background: Finding readily accessible, high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores, and other formats for the day-to-day access and use by medical students and physicians during their pre- and postgraduate education. Objective: The aim of this paper is to describe the architecture, user interface, and potential strengths and limitations of an innovative knowledge dissemination platform developed at the University of Geneva, Switzerland. We also report preliminary results from a user-experience survey and usage statistics over a selected period. Methods: The dissemination platform consists of a smartphone app. Through an administration interface, content is managed by senior university and hospital staff. The app includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; and (4) favorites section. Each content item is programmed to be available for a given duration as defined by the content?s author. Automatic notifications signal the author when the content is about to expire, hence, promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results: We launched the final version of the platform in March 2019, both at the Faculty of Medicine at the University of Geneva and at the University Hospital of Geneva in Switzerland. A total of 622 students at the university and 613 health professionals at the hospital downloaded the app. Two-thirds of users at both institutions had an iOS device. During the practical examination period (ie, May 2019) there was a significant increase in the number of active users (P=.003), user activity (P<.001), and daily usage time (P<.001) among medical students. In addition, there were 1086 clinical skills video views during this period compared to a total of 484 in the preceding months (ie, a 108% increase). On a 10-point Likert scale, students and physicians rated the app with mean scores of 8.2 (SD 1.9) for user experience, 8.1 (SD 2.0) for usefulness, and 8.5 (SD 1.8) for relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology at our institution. Conclusions: HeadToToe is an educator-driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given high ratings for user experience, usefulness, and content quality and was used more often during the exam period. This suggests that the platform could be used as tool for exam preparation. UR - http://mededu.jmir.org/2020/1/e17729/ UR - http://dx.doi.org/10.2196/17729 UR - http://www.ncbi.nlm.nih.gov/pubmed/32249758 ID - info:doi/10.2196/17729 ER - TY - JOUR AU - Lozano-Lozano, Mario AU - Fernández-Lao, Carolina AU - Cantarero-Villanueva, Irene AU - Noguerol, Ignacio AU - Álvarez-Salvago, Francisco AU - Cruz-Fernández, Mayra AU - Arroyo-Morales, Manuel AU - Galiano-Castillo, Noelia PY - 2020/5/22 TI - A Blended Learning System to Improve Motivation, Mood State, and Satisfaction in Undergraduate Students: Randomized Controlled Trial JO - J Med Internet Res SP - e17101 VL - 22 IS - 5 KW - learning KW - teaching KW - students, health occupations KW - mobile apps KW - education N2 - Background: Smartphone-based learning, or mobile learning (m-learning), has become a popular learning-and-teaching strategy in educational environments. Blended learning combines strategies such as m-learning with conventional learning to offer continuous training, anytime and anywhere, via innovative learning activities. Objective: The main aim of this work was to examine the short-term (ie, 2-week) effects of a blended learning method using traditional materials plus a mobile app?the iPOT mobile learning app?on knowledge, motivation, mood state, and satisfaction among undergraduate students enrolled in a health science first-degree program. Methods: The study was designed as a two-armed, prospective, single-blind, randomized controlled trial. Subjects who met the inclusion criteria were randomly assigned to either the intervention group (ie, blended learning involving traditional lectures plus m-learning via the use of the iPOT app) or the control group (ie, traditional on-site learning). For both groups, the educational program involved 13 lessons on basic health science. The iPOT app is a hybrid, multiplatform (ie, iOS and Android) smartphone app with an interactive teacher-student interface. Outcomes were measured via multiple-choice questions (ie, knowledge), the Instructional Materials Motivation Survey (ie, motivation), the Profile of Mood States scale (ie, mood state), and Likert-type questionnaires (ie, satisfaction and linguistic competence). Results: A total of 99 students were enrolled, with 49 (49%) in the intervention group and 50 (51%) in the control group. No difference was seen between the two groups in terms of theoretical knowledge gain (P=.92). However, the intervention group subjects returned significantly higher scores than the control group subjects for all postintervention assessed items via the motivation questionnaire (all P<.001). Analysis of covariance (ANCOVA) revealed a significant difference in the confusion and bewilderment component in favor of the intervention group (P=.01), but only a trend toward significance in anger and hostility as well as total score. The intervention group subjects were more satisfied than the members of the control group with respect to five out of the six items evaluated: general satisfaction (P<.001), clarity of the instructions (P<.01), clarity with the use of the learning method (P<.001), enough time to complete the proposed exercises (P<.01), and improvement in the capacity to learn content (P<.001). Finally, the intervention group subjects who were frequent users of the app showed stronger motivation, as well as increased perception of greater gains in their English-language competence, than did infrequent users. Conclusions: The blended learning method led to significant improvements in motivation, mood state, and satisfaction compared to traditional teaching, and elicited statements of subjective improvement in terms of competence in English. Trial Registration: ClinicalTrials.gov NCT03335397; https://clinicaltrials.gov/ct2/show/NCT03335397 UR - http://www.jmir.org/2020/5/e17101/ UR - http://dx.doi.org/10.2196/17101 UR - http://www.ncbi.nlm.nih.gov/pubmed/32441655 ID - info:doi/10.2196/17101 ER - TY - JOUR AU - Lara, Sebastian Juan AU - Braga, Minatel Mariana AU - Zagatto, Gustavo Carlos AU - Wen, Lung Chao AU - Mendes, Medeiros Fausto AU - Murisi, Uribe Pedroza AU - Haddad, Estela Ana PY - 2020/5/22 TI - A Virtual 3D Dynamic Model of Caries Lesion Progression as a Learning Object for Caries Detection Training and Teaching: Video Development Study JO - JMIR Med Educ SP - e14140 VL - 6 IS - 1 KW - 3d virtual models KW - dental education KW - e-learning KW - learning object KW - caries KW - cariology N2 - Background: In the last decade, 3D virtual models have been used for educational purposes in the health sciences, specifically for teaching human anatomy and pathology. These models provide an opportunity to didactically visualize key spatial relations that can be poorly understood when taught by traditional educational approaches. Caries lesion detection is a crucial process in dentistry that has been reported to be difficult to learn. One especially difficult aspect is linking clinical characteristics of the different severity stages with their histological features, which is fundamental for treatment decision-making. Objective: This project was designed to develop a virtual 3D digital model of caries lesion formation and progression to aid the detection of lesions at different severity stages as a potential complement to traditional lectures. Methods: Pedagogical planning, including identification of objectives, exploration of the degree of difficulty of caries diagnosis?associated topics perceived by dental students and lecturers, review of the literature regarding key concepts, and consultation of experts, was performed prior to constructing the model. An educational script strategy was created based on the topics to be addressed (dental tissues, biofilm stagnation areas, the demineralization process, caries lesion progression on occlusal surfaces, clinical characteristics related to different stages of caries progression, and histological correlations). Virtual 3D models were developed using the Virtual Man Project and refined using multiple 3D software applications. In the next phase, computer graphic modelling and previsualization were executed. After that, the video was revised and edited based on suggestions. Finally, explanatory subtitles were generated, the models were textured and rendered, and voiceovers in 3 languages were implemented. Results: We developed a 6-minute virtual 3D dynamic video in 3 languages (English, Spanish, and Brazilian Portuguese) intended for dentists and dental students to support teaching and learning of caries lesion detection. The videos were made available on YouTube; to date, they have received more than 100,000 views. Conclusions: Complementary pedagogical tools are valuable to support cariology education. This tool will be further tested in terms of utility and usability as well as user satisfaction in achieving the proposed objectives in specific contexts. UR - http://mededu.jmir.org/2020/1/e14140/ UR - http://dx.doi.org/10.2196/14140 UR - http://www.ncbi.nlm.nih.gov/pubmed/32441661 ID - info:doi/10.2196/14140 ER - TY - JOUR AU - Hong, Zhen AU - Li, Nian AU - Li, Dajiang AU - Li, Junhua AU - Li, Bing AU - Xiong, Weixi AU - Lu, Lu AU - Li, Weimin AU - Zhou, Dong PY - 2020/5/8 TI - Telemedicine During the COVID-19 Pandemic: Experiences From Western China JO - J Med Internet Res SP - e19577 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus disease KW - medical education KW - pandemics KW - teleteaching KW - tele-education KW - telemedicine UR - http://www.jmir.org/2020/5/e19577/ UR - http://dx.doi.org/10.2196/19577 UR - http://www.ncbi.nlm.nih.gov/pubmed/32349962 ID - info:doi/10.2196/19577 ER - TY - JOUR AU - Alturkistani, Abrar AU - Lam, Ching AU - Foley, Kimberley AU - Stenfors, Terese AU - Blum, R. Elizabeth AU - Van Velthoven, Helena Michelle AU - Meinert, Edward PY - 2020/4/27 TI - Massive Open Online Course Evaluation Methods: Systematic Review JO - J Med Internet Res SP - e13851 VL - 22 IS - 4 KW - online learning KW - learning KW - computer-assisted instruction N2 - Background: Massive open online courses (MOOCs) have the potential to make a broader educational impact because many learners undertake these courses. Despite their reach, there is a lack of knowledge about which methods are used for evaluating these courses. Objective: The aim of this review was to identify current MOOC evaluation methods to inform future study designs. Methods: We systematically searched the following databases for studies published from January 2008 to October 2018: (1) Scopus, (2) Education Resources Information Center, (3) IEEE (Institute of Electrical and Electronic Engineers) Xplore, (4) PubMed, (5) Web of Science, (6) British Education Index, and (7) Google Scholar search engine. Two reviewers independently screened the abstracts and titles of the studies. Published studies in the English language that evaluated MOOCs were included. The study design of the evaluations, the underlying motivation for the evaluation studies, data collection, and data analysis methods were quantitatively and qualitatively analyzed. The quality of the included studies was appraised using the Cochrane Collaboration Risk of Bias Tool for randomized controlled trials (RCTs) and the National Institutes of Health?National Heart, Lung, and Blood Institute quality assessment tool for cohort observational studies and for before-after (pre-post) studies with no control group. Results: The initial search resulted in 3275 studies, and 33 eligible studies were included in this review. In total, 16 studies used a quantitative study design, 11 used a qualitative design, and 6 used a mixed methods study design. In all, 16 studies evaluated learner characteristics and behavior, and 20 studies evaluated learning outcomes and experiences. A total of 12 studies used 1 data source, 11 used 2 data sources, 7 used 3 data sources, 4 used 2 data sources, and 1 used 5 data sources. Overall, 3 studies used more than 3 data sources in their evaluation. In terms of the data analysis methods, quantitative methods were most prominent with descriptive and inferential statistics, which were the top 2 preferred methods. In all, 26 studies with a cross-sectional design had a low-quality assessment, whereas RCTs and quasi-experimental studies received a high-quality assessment. Conclusions: The MOOC evaluation data collection and data analysis methods should be determined carefully on the basis of the aim of the evaluation. The MOOC evaluations are subject to bias, which could be reduced using pre-MOOC measures for comparison or by controlling for confounding variables. Future MOOC evaluations should consider using more diverse data sources and data analysis methods. International Registered Report Identifier (IRRID): RR2-10.2196/12087 UR - https://www.jmir.org/2020/4/e13851 UR - http://dx.doi.org/10.2196/13851 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338618 ID - info:doi/10.2196/13851 ER - TY - JOUR AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Piroux, Corentin AU - George, Richelle AU - Attias, Melissa AU - Gamhewage, Gaya PY - 2020/4/27 TI - Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data JO - J Med Internet Res SP - e19076 VL - 22 IS - 4 KW - online learning KW - OpenWHO KW - novel coronavirus KW - COVID-19 KW - coronavirus KW - pandemic KW - WHO KW - e-learning KW - MOOC KW - public health N2 - Background: At the onset of the coronavirus outbreak, the World Health Organization?s (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO?s health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID?19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users? professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses? statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform?s own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99%) of all course enrollments, and the English language course was comprised of 38.21% (n=88,988) of enrollments. The WHO?s Region of the Americas accounted for most of the course enrollments, with more than 72.47% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10% enrollment for each. A total of 32.43% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as ?Other.? With the COVID-19 introductory course, the largest number of users selected ?Other? (16,527/52,214, 31.65%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO?s technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform?s aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. UR - https://www.jmir.org/2020/4/e19076 UR - http://dx.doi.org/10.2196/19076 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293580 ID - info:doi/10.2196/19076 ER - TY - JOUR AU - Wu, Vivien Xi AU - Chi, Yuchen AU - Panneer Selvam, Umadevi AU - Devi, Kamala M. AU - Wang, Wenru AU - Chan, Shih Yah AU - Wee, Chi Fong AU - Zhao, Shengdong AU - Sehgal, Vibhor AU - Ang, Emily Neo Kim PY - 2020/4/24 TI - A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors? Teaching Competencies: Pretest and Posttest Study JO - J Med Internet Res SP - e18604 VL - 22 IS - 4 KW - blended learning KW - case-based learning KW - clinical pedagogy KW - clinical teaching competency KW - web-based program KW - nurse preceptor N2 - Background: Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students? clinical learning to enhance their clinical competencies. Objective: This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors? clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods: A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. Results: Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. Conclusions: The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education. UR - http://www.jmir.org/2020/4/e18604/ UR - http://dx.doi.org/10.2196/18604 UR - http://www.ncbi.nlm.nih.gov/pubmed/32329743 ID - info:doi/10.2196/18604 ER - TY - JOUR AU - Hsiao, Cheng-Ting AU - Chou, ChihChen Fremen AU - Hsieh, Chih-Cheng AU - Chang, Chun Li AU - Hsu, Chih-Ming PY - 2020/4/14 TI - Developing a Competency-Based Learning and Assessment System for Residency Training: Analysis Study of User Requirements and Acceptance JO - J Med Internet Res SP - e15655 VL - 22 IS - 4 KW - competency-based learning KW - milestones KW - entrustable professional activities KW - assessment KW - learning platform N2 - Background: The increasingly complex medical environment highlights the importance of milestones and entrustable professional activities (EPAs) to realize the ideals of competency-based medical education (CBME). However, if enormous amounts of assessment results need to be compiled, the development of a digital system to manage, integrate, and synthesize learning and assessment data will be necessary. Furthermore, this system should be able to facilitate real-time assessment with feedback and therefore enhance users? learning through coaching in the moment in the clinical workplace. Objective: The main purpose of this study was to develop a competency-based electronic platform system to provide resident physicians with clinical assessments and learning in order to enhance the learning of trainees and reduce the burden of assessments. Methods: A competency-based learning and assessment system (CBLAS) for residency training was designed, developed, and evaluated in this study. Opinion interviews and a focus group consensus meeting of key users, including trainees, clinical teachers, and administrative staff, were conducted as needs assessments. The structure of the CBLAS was designed according to the thematic analysis of needs assessments. Clinical teachers? acceptance of using CBME assessments, according to the constructs of attitude, perceived usefulness, and perceived ease of use, was surveyed in the beginning and half a year after implementation of the CBLAS. Additionally, the satisfaction of using the CBLAS, according to information, system, and service qualities, was surveyed after implementation. Results: The main functions of the CBLAS, including milestones, EPAs, learning portfolios, teacher/student feedback, e-books, learning materials, assessment progress tracking, and statistical analysis of assessment results, were designed and developed for responding to nine themes, which emerged from the needs assessments of the three user groups. Twenty clinical teachers responded to the CBME assessment acceptance surveys before and after CBLAS implementation, which revealed a significant improvement in the factor of ?attitude? (P=.02) but no significant differences in the two factors of ?usefulness? (P=.09) and ?ease of use? (P=.58) for CBME assessments. Furthermore, satisfaction surveys were performed in 117 users, and 87.2% (102/117) were satisfied with the CBLAS in terms of information, system, and service qualities. There was no significant difference in satisfaction among different user groups. Conclusions: The CBLAS is a user-centered platform that supports clinical teachers? assessment exercises and residents? learning, as well as administrative work for staff according to users? needs assessments and operationalized features of CBME assessments. With the system, clinical teachers had a more positive attitude to conduct the assessment activities of milestones and EPAs and learners could arrange their study schedules to enhance their learning effectiveness. The CBLAS sheds light on how to effectively design and develop a digital system to execute milestone- and EPA-based assessments for enhancing competency-based education among residents, according to our experiences in Taiwan. UR - https://www.jmir.org/2020/4/e15655 UR - http://dx.doi.org/10.2196/15655 UR - http://www.ncbi.nlm.nih.gov/pubmed/32286233 ID - info:doi/10.2196/15655 ER - TY - JOUR AU - Li, Shuang AU - Li, Guoqing AU - Liu, Ying AU - Xu, Wanying AU - Yang, Ningning AU - Chen, Haoyuan AU - Li, Ning AU - Luo, Kunpeng AU - Jin, Shizhu PY - 2020/3/23 TI - Development and Assessment of a Gastroscopy Electronic Learning System for Primary Learners: Randomized Controlled Trial JO - J Med Internet Res SP - e16233 VL - 22 IS - 3 KW - e-learning KW - gastroscopy KW - endoscopy KW - randomized controlled trial N2 - Background: Endoscopic examination is a popular and routine procedure for the diagnosis and treatment of gastrointestinal (GI) diseases. Skilled endoscopists are in great demand in clinical practice, but the training process for beginners to become endoscopy specialists is fairly long. Convenience and a self-paced, learner-centered approach make electronic learning (e-learning) an excellent instructional prospect. Objective: This study aimed to develop and apply an e-learning system in gastroscopy teaching and learning and to evaluate its effectiveness and user satisfaction. Methods: The e-learning software Gastroscope Roaming System was developed for primary learners. The system simulates the real structure of the upper gastrointestinal (UGI) tract to teach the main characteristics of gastroscopy under both normal conditions and conditions of common UGI tract diseases. A randomized controlled trial was conducted. Participants were randomly allocated to an e-learning group (EG)or a non?e-learning control group after a pretest. On completing the training, participants undertook a posttest and gastroscopy examination. In addition, the EG completed a satisfaction questionnaire. Results: Of the 44 volunteers, 41 (93%) completed the gastroscopy learning and testing components. No significant pretest differences were found between the intervention and control groups (mean 50.86, SD 6.12 vs mean 50.76, SD 6.88; P=.96). After 1 month of learning, the EG?s posttest scores were higher (mean 83.70, SD 5.99 vs mean 78.76, SD 7.58; P=.03) and improved more (P=.01) than those of the control group, with better performance in the gastroscopy examination (mean 91.05, SD 4.58 vs mean 84.38, SD 5.19; P<.001). Overall, 85% (17/20) of the participants were satisfied with the e-learning system, and 95% (19/20) of the participants considered it successful. Conclusions: E-learning is an effective educational strategy for primary learners to acquire skills in gastroscopy examination and endoscopic imaging of the GI tract. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17013091; http://www.chictr.org.cn/showproj.aspx?proj=22142 UR - http://www.jmir.org/2020/3/e16233/ UR - http://dx.doi.org/10.2196/16233 UR - http://www.ncbi.nlm.nih.gov/pubmed/32202507 ID - info:doi/10.2196/16233 ER - TY - JOUR AU - Setrakian, Jean AU - Gauthier, Geneviève AU - Bergeron, Linda AU - Chamberland, Martine AU - St-Onge, Christina PY - 2020/3/12 TI - Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study JO - JMIR Med Educ SP - e14428 VL - 6 IS - 1 KW - virtual patients KW - medical history taking KW - automated scoring KW - simulation training KW - medical education KW - medical students KW - educational assessment KW - computer software KW - medical history?taking skills KW - medical history?taking skills assessment N2 - Background: A virtual patient (VP) can be a useful tool to foster the development of medical history?taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students? skills, documenting and assessing skills acquired through a VP is a challenge. Objective: We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs). Methods: We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains. Results: The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores. Conclusions: Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment. UR - http://mededu.jmir.org/2020/1/e14428/ UR - http://dx.doi.org/10.2196/14428 UR - http://www.ncbi.nlm.nih.gov/pubmed/32163036 ID - info:doi/10.2196/14428 ER - TY - JOUR AU - Lozano-Lozano, Mario AU - Galiano-Castillo, Noelia AU - Fernández-Lao, Carolina AU - Postigo-Martin, Paula AU - Álvarez-Salvago, Francisco AU - Arroyo-Morales, Manuel AU - Cantarero-Villanueva, Irene PY - 2020/3/10 TI - The Ecofisio Mobile App for Assessment and Diagnosis Using Ultrasound Imaging for Undergraduate Health Science Students: Multicenter Randomized Controlled Trial JO - J Med Internet Res SP - e16258 VL - 22 IS - 3 KW - undergraduate KW - OSCE KW - mHealth KW - teaching and learning strategies N2 - Background: Generation Z is starting to reach college age. They have adopted technology from an early age and have a deep dependence on it; therefore, they have become more drawn to the virtual world. M-learning has experienced huge growth in recent years, both in the medical context and in medical and health sciences education. Ultrasound imaging is an important diagnosis technique in physiotherapy, especially in sports pathology. M-learning systems could be useful tools for improving the comprehension of ultrasound concepts and the acquisition of professional competencies. Objective: The purpose of this study was to evaluate the efficacy and use of an interactive platform accessible through mobile devices?Ecofisio?using ultrasound imaging for the development of professional competencies in the evaluation and diagnosis of sports pathologies. Methods: Participants included 110 undergraduate students who were placed into one of two groups of a randomized controlled multicenter study: control group (ie, traditional learning) and experimental group (ie, Ecofisio mobile app). Participants? theoretical knowledge was assessed using a multiple-choice questionnaire (MCQ); students were also assessed by means of the Objective Structured Clinical Examination (OSCE). Moreover, a satisfaction survey was completed by the students. Results: The statistical analyses revealed that Ecofisio was effective in most of the processes evaluated when compared with the traditional learning method: all OSCE stations, P<.001; MCQ, 43 versus 15 students passed in the Ecofisio and control groups, respectively, P<.001. Moreover, the results revealed that the students found the app to be attractive and useful. Conclusions: The Ecofisio mobile app may be an effective way for physiotherapy students to obtain adequate professional competencies regarding evaluation and diagnosis of sports pathologies. Trial Registration: ClinicalTrials.gov NCT04138511; https://clinicaltrials.gov/ct2/show/NCT04138511 UR - https://www.jmir.org/2020/3/e16258 UR - http://dx.doi.org/10.2196/16258 UR - http://www.ncbi.nlm.nih.gov/pubmed/32154784 ID - info:doi/10.2196/16258 ER - TY - JOUR AU - Phungoen, Pariwat AU - Promto, Songwoot AU - Chanthawatthanarak, Sivit AU - Maneepong, Sawitree AU - Apiratwarakul, Korakot AU - Kotruchin, Praew AU - Mitsungnern, Thapanawong PY - 2020/3/9 TI - Precourse Preparation Using a Serious Smartphone Game on Advanced Life Support Knowledge and Skills: Randomized Controlled Trial JO - J Med Internet Res SP - e16987 VL - 22 IS - 3 KW - CPR training KW - gamified learning KW - medical education KW - serious game learning N2 - Background: In the past several years, gamified learning has been growing in popularity in various medical educational contexts including cardiopulmonary resuscitation (CPR) training. Furthermore, prior work in Basic Life Support (BLS) training has demonstrated the benefits of serious games as a method for pretraining among medical students. However, there is little evidence to support these benefits with regard to Advanced Life Support (ALS) training. Objective: We compare the effects of a brief precourse ALS preparation using a serious smartphone game on student knowledge, skills, and perceptions in this area with those of conventional ALS training alone. Methods: A serious game (Resus Days) was developed by a Thai physician based on global ALS clinical practice guidelines. Fifth-year medical students were enrolled and randomized to either the game group or the control group. Participants in both groups attended a traditional ALS lecture, but the game group was assigned to play Resus Days for 1 hour before attending the lecture and were allowed to play as much as they wished during the training course. All students underwent conventional ALS training, and their abilities were evaluated using multiple-choice questions and with hands-on practice on a mannequin. Subject attitudes and perceptions about the game were evaluated using a questionnaire. Results: A total of 105 students participated in the study and were randomly assigned to either the game group (n=52) or the control group (n=53). Students in the game group performed better on the ALS algorithm knowledge posttest than those in the control group (17.22 [SD 1.93] vs 16.60 [SD 1.97], P=.01; adjusted mean difference [AMD] 0.93; 95% CI 0.21-1.66). The game group?s pass rate on the skill test was also higher but not to a statistically significant extent (79% vs 66%, P=.09; adjusted odds ratio [AOR] 2.22; 95% CI 0.89-5.51). Students indicated high satisfaction with the game (9.02 [SD 1.11] out of 10). Conclusions: Engaging in game-based preparation prior to an ALS training course resulted in better algorithm knowledge scores for medical students than attending the course alone. Trial Registration: Thai Clinical Trials Registry HE611533; https://tinyurl.com/wmbp3q7 UR - http://www.jmir.org/2020/3/e16987/ UR - http://dx.doi.org/10.2196/16987 UR - http://www.ncbi.nlm.nih.gov/pubmed/32149711 ID - info:doi/10.2196/16987 ER - TY - JOUR AU - Sharifzadeh, Nahid AU - Kharrazi, Hadi AU - Nazari, Elham AU - Tabesh, Hamed AU - Edalati Khodabandeh, Maryam AU - Heidari, Somayeh AU - Tara, Mahmood PY - 2020/3/5 TI - Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review JO - JMIR Serious Games SP - e13459 VL - 8 IS - 1 KW - serious games KW - health education KW - health games KW - game-based learning N2 - Background: Serious educational games have shown effectiveness in improving various health outcomes. Previous reviews of health education games have focused on specific diseases, certain medical subjects, fixed target groups, or limited outcomes of interest. Given the recent surge in health game studies, a scoping review of health education games is needed to provide an updated overview of various aspects of such serious games. Objective: This study aimed to conduct a scoping review of the design and evaluation of serious educational games for health targeting health care providers, patients, and public (health) users. Methods: We identified 2313 studies using a unique combination of keywords in the PubMed and ScienceDirect databases. A total of 161 studies were included in this review after removing duplicates (n=55) and excluding studies not meeting our inclusion criteria (1917 based on title and abstract and 180 after reviewing the full text). The results were stratified based on games targeting health care providers, patients, and public users. Results: Most health education games were developed and evaluated in America (82/161, 50.9%) and Europe (64/161, 39.8%), with a considerable number of studies published after 2012. We discovered 58.4% (94/161) of studies aiming to improve knowledge learning and 41.6% (67/161) to enhance skill development. The studies targeted various categories of end users: health care providers (42/161, 26.1%), patients (38/161, 23.6%), public users (75/161, 46.6%), and a mix of users (6/161, 3.7%). Among games targeting patients, only 13% (6/44) targeted a specific disease, whereas a growing majority targeted lifestyle behaviors, social interactions, cognition, and generic health issues (eg, safety and nutrition). Among 101 studies reporting gameplay specifications, the most common gameplay duration was 30 to 45 min. Of the 61 studies reporting game repetition, only 14% (9/61) of the games allowed the users to play the game with unlimited repetitions. From 32 studies that measured follow-up duration after the game intervention, only 1 study reported a 2-year postintervention follow-up. More than 57.7% (93/161) of the games did not have a multidisciplinary team to design, develop, or assess the game. Conclusions: Serious games are increasingly used for health education targeting a variety of end users. This study offers an updated scoping review of the studies assessing the value of serious games in improving health education. The results showed a promising trend in diversifying the application of health education games that go beyond a specific medical condition. However, our findings indicate the need for health education game development and adoption in developing countries and the need to focus on multidisciplinary teamwork in designing effective health education games. Furthermore, future health games should expand the duration and repetition of games and increase the length of the follow-up assessments to provide evidence on long-term effectiveness. UR - https://games.jmir.org/2020/1/e13459 UR - http://dx.doi.org/10.2196/13459 UR - http://www.ncbi.nlm.nih.gov/pubmed/32134391 ID - info:doi/10.2196/13459 ER - TY - JOUR AU - Tyagi, Hanu AU - Sabharwal, Manisha AU - Dixit, Nishi AU - Pal, Arnab AU - Deo, Sarang PY - 2020/3/3 TI - Leveraging Providers? Preferences to Customize Instructional Content in Information and Communications Technology?Based Training Interventions: Retrospective Analysis of a Mobile Phone?Based Intervention in India JO - JMIR Mhealth Uhealth SP - e15998 VL - 8 IS - 3 KW - public health KW - mobile health KW - health care providers KW - health care workers KW - instructional technology KW - information technology KW - infectious diseases KW - provider training KW - learning preferences N2 - Background: Many public health programs and interventions across the world increasingly rely on using information and communications technology (ICT) tools to train and sensitize health professionals. However, the effects of such programs on provider knowledge, practice, and patient health outcomes have been inconsistent. One of the reasons for the varied effectiveness of these programs is the low and varying levels of provider engagement, which, in turn, could be because of the form and mode of content used. Tailoring instructional content could improve engagement, but it is expensive and logistically demanding to do so with traditional training Objective: This study aimed to discover preferences among providers on the form (articles or videos), mode (featuring peers or experts), and length (short or long) of the instructional content; to quantify the extent to which differences in these preferences can explain variation in provider engagement with ICT-based training interventions; and to compare the power of content preferences to explain provider engagement against that of demographic variables. Methods: We used data from a mobile phone?based intervention focused on improving tuberculosis diagnostic practices among 24,949 private providers from 5 specialties and 1734 cities over 1 year. Engagement time was used as the primary outcome to assess provider engagement. K-means clustering was used to segment providers based on the proportion of engagement time spent on content formats, modes, and lengths to discover their content preferences. The identified clusters were used to predict engagement time using a linear regression model. Subsequently, we compared the accuracy of the cluster-based prediction model with one based on demographic variables of providers (eg, specialty and geographic location). Results: The average engagement time across all providers was 7.5 min (median 0, IQR 0-1.58). A total of 69.75% (17,401/24,949) of providers did not consume any content. The average engagement time for providers with nonzero engagement time was 24.8 min (median 4.9, IQR 2.2-10.1). We identified 4 clusters of providers with distinct preferences for form, mode, and length of content. These clusters explained a substantially higher proportion of the variation in engagement time compared with demographic variables (32.9% vs 1.0%) and yielded a more accurate prediction for the engagement time (root mean square error: 4.29 vs 5.21 and mean absolute error: 3.30 vs 4.26). Conclusions: Providers participating in a mobile phone?based digital campaign have inherent preferences for instructional content. Targeting providers based on individual content preferences could result in higher provider engagement as compared to targeting providers based on demographic variables. UR - https://mhealth.jmir.org/2020/3/e15998 UR - http://dx.doi.org/10.2196/15998 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130191 ID - info:doi/10.2196/15998 ER - TY - JOUR AU - Loda, Teresa AU - Erschens, Rebecca AU - Junne, Florian AU - Stengel, Andreas AU - Zipfel, Stephan AU - Herrmann-Werner, Anne PY - 2020/3/2 TI - Undergraduate Medical Students? Search for Health Information Online: Explanatory Cross-Sectional Study JO - JMIR Med Inform SP - e16279 VL - 8 IS - 3 KW - digital health literacy KW - medical education KW - evidence-based online information KW - digital native KW - trustworthy webpages N2 - Background: Previous research shows that being a ?digital native? or growing up in a digital environment does not necessarily lead to increased digital competencies, such as digital health literacy or evaluation of webpage quality. Objective: This study showed how medical students searched for health information online, specifically the recommended testing for histamine intolerance, by comparing the use of various search engines (Google, Medisuch, and a website of the student?s choice) to find out more about search strategies in future health professionals. As Medisuch presents a qualitatively better search engine, we assumed that medical students using this search engine might find valid information faster on more reliable webpages, and might recommend the correct diagnostic steps for histamine intolerance to their patients more often than students using a generic search engine like Google. Methods: Medical students in their third year of study were asked to find the relevant diagnostic steps of histamine intolerance online. They were randomly assigned to use one search engine: Google, their personal choice, or Medisuch. Their process of seeking information online was video recorded. Results: In total, 140 medical students participated in this study. The total number of webpages found did not differ among the groups (P=.52). Students using Medisuch (P=.02) correctly identified the elimination diet as a relevant diagnostic step more frequently. The provocation test was reported by almost half of the students independent of the search engine used. In general, medical students commonly identified trustworthy webpages in all three groups (Google: 36/44, 82%; free choice: 31/36; 86%; and Medisuch: 35/45, 78%). Conclusions: The results indicate that medical students were able to find trustworthy health-related information online independent of the search engine used. Medical students that are digital natives seem to have proper internet skills and a knowledge of how to use them. They entered specific medical terms (evidence-based diagnostic steps) or names of reliable webpages (DocCheck) in the search engines to gain correct information. However, it remains to be seen if this behavior can be called true ?digital literacy?. UR - https://medinform.jmir.org/2020/3/e16279 UR - http://dx.doi.org/10.2196/16279 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130146 ID - info:doi/10.2196/16279 ER - TY - JOUR AU - Blakemore, M. Louise AU - Meek, M. Sarah E. AU - Marks, K. Leah PY - 2020/2/26 TI - Equipping Learners to Evaluate Online Health Care Resources: Longitudinal Study of Learning Design Strategies in a Health Care Massive Open Online Course JO - J Med Internet Res SP - e15177 VL - 22 IS - 2 KW - health care education KW - learning analytics KW - MOOC KW - plagiarism KW - ehealth KW - eHealth literacy KW - digital health literacy KW - misinformation KW - assessment KW - digital literacy N2 - Background: The digital revolution has led to a boom in the number of available online health care resources. To navigate these resources successfully, digital literacy education is required. Learners who can evaluate the reliability and validity of online health care information are likely to be more effective at avoiding potentially dangerous misinformation. In addition to providing health care education, massive open online courses (MOOCs) are well positioned to play a role in providing digital literacy education in this context. Objective: This study focused on learners enrolled in a MOOC on cancer genomics. The aim of this study was to evaluate the efficacy of a series of digital literacy?related activities within this course. This was an iterative study, with changes made to digital literacy?related activities in 4 of the 8 runs of the course. Methods: This mixed methods study focused on learner engagement with the digital literacy?related activities, including the final course written assignment. Quantitative data including the number of references listed in each written assignment were compared between successive runs. Qualitative data in the form of learner comments on discussion forums for digital literacy?related tasks were evaluated to determine the impact of these educational activities. Results: Using the number of references included for each final course assignment as an indicator of digital literacy skills, the digital literacy?related activities in the final 2 runs were judged to be the most successful. We found a statistically significant increase in the number of references cited by learners in their final written assignments. The average number of references cited in Run 8 was significantly higher (3.5) than in Run 1 (1.8) of the MOOC (P=.001). Learner comments in Runs 7 and 8 showed that a poll in which learners were asked to select which of 4 online resources was reliable was effective in stimulating learner discussion about how to evaluate resource reliability. Conclusions: Similar to many health care MOOCs, the course studied here had a heterogeneous group of learners, including patients (and their families), the public, health care students, and practitioners. Carefully designing a range of digital literacy?related activities that would be beneficial to this heterogenous group of learners enabled learners to become more effective at evaluating and citing appropriate online resources within their written assignments. UR - http://www.jmir.org/2020/2/e15177/ UR - http://dx.doi.org/10.2196/15177 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130120 ID - info:doi/10.2196/15177 ER - TY - JOUR AU - Glover, Kevin AU - Bodzin, Alec PY - 2020/2/6 TI - Learner Analysis to Inform the Design and Development of a Serious Game for Nongaming Female Emerging Health Care Preprofessionals: Qualitative Sample Study JO - JMIR Serious Games SP - e16003 VL - 8 IS - 1 KW - games KW - health care KW - education KW - females KW - motivation KW - instructional design N2 - Background: Overall, 75% of health care practitioners are women, but half of all females do not play digital games of any kind. There is no consensus in the literature regarding optimal design elements to maximize the efficacy of serious games. To capitalize on the promise of serious games in health care education, it is important for instructional designers to understand the underlying learners? values, attitudes, and beliefs that might motivate nongaming female health care preprofessional students to independently choose to persistently play serious games to mastery. Objective: Specifically, the aim of this study was to seek answers to 2 questions. First, what values, attitudes, and beliefs contribute to the nongaming behaviors of 12th-grade female emerging health care preprofessionals? Second, how do the values, attitudes, and beliefs of 12th-grade female emerging health care preprofessionals align with important design features of serious games? Methods: In this study, a learner analysis was conducted using semistructured interviews with 8 12th-grade college-bound female health science students to better understand learners? values, attitudes, and beliefs to inform the design and development of a serious game. These interviewees represented a diverse subset of the female emerging health care preprofessionals who self-identified themselves as not playing games at all, not very often, or infrequently. Results: The findings suggest that the study participants exhibited a complex fusion of desire for both accomplishment and affiliation. The participants were all independent, competitive, and prosocial leaders. They thought strategically and consciously self-limited their leisure time to achieve personally meaningful long-term goals. They embraced overcoming expected failures and aimed to achieve relevant high-stakes wins in all academic, athletic, extracurricular, and leisure activities they valued while consciously avoiding what they considered to be non?goal-oriented activities. Conclusions: The results of this study reinforce the need for a robust learner analysis to identify the multifaceted behavioral characteristics of targeted learners before the design and development of serious games. The common characteristics of the 12th-grade female health science students in this study suggest that they will choose to invest their limited leisure time playing a personally meaningful, preprofessionally authentic serious game if the collective design elements are aligned with the students? self-conceptualization of their present or future selves. UR - https://games.jmir.org/2020/1/e16003 UR - http://dx.doi.org/10.2196/16003 UR - http://www.ncbi.nlm.nih.gov/pubmed/32027312 ID - info:doi/10.2196/16003 ER - TY - JOUR AU - Moehead, Anne AU - DeSouza, Kathryn AU - Walsh, Karen AU - Pit, W. Sabrina PY - 2020/1/22 TI - A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review JO - J Med Internet Res SP - e16808 VL - 22 IS - 1 KW - education KW - workforce KW - online learning KW - Web-based learning KW - distance education KW - dementia KW - nursing KW - facilitated learning KW - competency KW - training KW - network KW - capability KW - skills KW - person-centered N2 - Background: Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia. Objective: This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program?an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice?and (2) determine how these features correlate with the DCC&TN. Methods: Six electronic databases?Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar?were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick?s model for the evaluation of training were used to ensure quality and rigor of the analysis. Results: A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick?s four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick?s model. Features were then correlated against the DCC&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC&TN. Conclusions: A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick?s salient elements of the model?reaction, learning, behavior, and results?in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick?s levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training. UR - http://www.jmir.org/2020/1/e16808/ UR - http://dx.doi.org/10.2196/16808 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012077 ID - info:doi/10.2196/16808 ER - TY - JOUR AU - Kullberg, J. Marie-Louise AU - Mouthaan, Joanne AU - Schoorl, Maartje AU - de Beurs, Derek AU - Kenter, Francisca Robin Maria AU - Kerkhof, JFM Ad PY - 2020/1/22 TI - E-Learning to Improve Suicide Prevention Practice Skills Among Undergraduate Psychology Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e14623 VL - 7 IS - 1 KW - e-learning KW - suicide prevention KW - digital learning KW - skills training KW - randomized controlled trial KW - undergraduate students N2 - Background: Despite increasing evidence of the effectiveness of digital learning solutions in higher vocational education, including the training of allied health professionals, the impact of Web-based training on the development of practical skills in psychiatry and psychology, in general, and in suicide prevention, specifically, remains largely understudied. Objective: This study aimed to determine the effectiveness of an electronic learning (e-learning) module on the adherence to suicide prevention guidelines, knowledge of practical skills, and provider?s confidence to have a conversation about suicidal behavior with undergraduate psychology students. Methods: The e-learning module, comprising video recordings of therapist-patient interactions, was designed with the aim of transferring knowledge about suicide prevention guideline recommendations. The program?s effects on guideline adherence, self-evaluated knowledge, and provider?s confidence were assessed using online questionnaires before the program (baseline and at 1 month [T1] and 3 months after baseline). The eligible third- and fourth-year undergraduate psychology students were randomly allocated to the e-learning (n=211) or to a waitlist control condition (n=187), with access to the intervention after T1. Results: Overall, the students evaluated e-learning in a fairly positive manner. The intention-to-treat analysis showed that the students in the intervention condition (n=211) reported higher levels of self-evaluated knowledge, provider?s confidence, and guideline adherence than those in the waitlist control condition (n=187) after receiving the e-learning module (all P values<.001). When comparing the scores at the 1- and 3-month follow-up, after both groups had received access to the e-learning module, the completers-only analysis showed that the levels of knowledge, guideline adherence, and confidence remained constant (all P values>.05) within the intervention group, whereas a significant improvement was observed in the waitlist control group (all P values<.05). Conclusions: An e-learning intervention on suicide prevention could be an effective first step toward improved knowledge of clinical skills. The learning outcomes of a stand-alone module were found to be similar to those of a training that combined e-learning with a face-to-face training, with the advantages of flexibility and low costs. UR - http://mental.jmir.org/2020/1/e14623/ UR - http://dx.doi.org/10.2196/14623 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012076 ID - info:doi/10.2196/14623 ER - TY - JOUR AU - Zulkiewicz, A. Brittany AU - Boudewyns, Vanessa AU - Gupta, Catherine AU - Kirschenbaum, Ari AU - Lewis, A. Megan PY - 2020/1/6 TI - Using 360-Degree Video as a Research Stimulus in Digital Health Studies: Lessons Learned JO - JMIR Serious Games SP - e15422 VL - 8 IS - 1 KW - virtual reality KW - 360-degree video KW - empathy KW - migraine disorders KW - health personnel KW - medical education UR - https://games.jmir.org/2020/1/e15422 UR - http://dx.doi.org/10.2196/15422 UR - http://www.ncbi.nlm.nih.gov/pubmed/31904577 ID - info:doi/10.2196/15422 ER - TY - JOUR AU - Hughes, Charmayne AU - Musselman, A. Elaine AU - Walsh, Lilia AU - Mariscal, Tatiana AU - Warner, Sam AU - Hintze, Amy AU - Rashidi, Neela AU - Gordon-Murer, Chloe AU - Tanha, Tiana AU - Licudo, Fahrial AU - Ng, Rachel AU - Tran, Jenna PY - 2020/1/3 TI - The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study JO - JMIR Nursing SP - e15828 VL - 3 IS - 1 KW - intimate partner violence KW - domestic violence KW - nursing education KW - learning N2 - Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. UR - https://nursing.jmir.org/2020/1/e15828 UR - http://dx.doi.org/10.2196/15828 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345778 ID - info:doi/10.2196/15828 ER - TY - JOUR AU - Guetterman, C. Timothy AU - Sakakibara, Rae AU - Baireddy, Srikar AU - Kron, W. Frederick AU - Scerbo, W. Mark AU - Cleary, F. James AU - Fetters, D. Michael PY - 2019/11/27 TI - Medical Students? Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study JO - J Med Internet Res SP - e15459 VL - 21 IS - 11 KW - cancer KW - virtual reality KW - health communication KW - interprofessional relations KW - informatics KW - nonverbal communication KW - computer simulation KW - physician-nurse relations KW - empathy N2 - Background: Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)?based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. Objective: This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. Methods: We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures?MPathic-VR?calculated scores and the objective structured clinical exam (OSCE) scores?with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. Results: OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. Conclusions: VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills. UR - http://www.jmir.org/2019/11/e15459/ UR - http://dx.doi.org/10.2196/15459 UR - http://www.ncbi.nlm.nih.gov/pubmed/31774400 ID - info:doi/10.2196/15459 ER - TY - JOUR AU - Murad, Abdulaziz AU - Hyde, Natalie AU - Chang, Shanton AU - Lederman, Reeva AU - Bosua, Rachelle AU - Pirotta, Marie AU - Audehm, Ralph AU - Yates, J. Christopher AU - Briggs, M. Andrew AU - Gorelik, Alexandra AU - Chiang, Cherie AU - Wark, D. John PY - 2019/11/27 TI - Quantifying Use of a Health Virtual Community of Practice for General Practitioners? Continuing Professional Development: A Novel Methodology and Pilot Evaluation JO - J Med Internet Res SP - e14545 VL - 21 IS - 11 KW - online systems KW - online social networking KW - general practitioners KW - online learning KW - continuing education KW - professional education KW - evaluation methodology KW - use-effectiveness KW - quantitative evaluation KW - knowledgebases KW - information sharing N2 - Background: Health care practitioners (HPs), in particular general practitioners (GPs), are increasingly adopting Web-based social media platforms for continuing professional development (CPD). As GPs are restricted by time, distance, and demanding workloads, a health virtual community of practice (HVCoP) is an ideal solution to replace face-to-face CPD with Web-based CPD. However, barriers such as time and work schedules may limit participation in an HVCoP. Furthermore, it is difficult to gauge whether GPs engage actively or passively in HVCoP knowledge-acquisition for Web-based CPD, as GPs? competencies are usually measured with pre- and posttests. Objective: This study investigated a method for measuring the engagement features needed for an HVCoP (the Community Fracture Capture [CFC] Learning Hub) for learning and knowledge sharing among GPs for their CPD activity. Methods: A prototype CFC Learning Hub was developed using an Igloo Web-based social media software platform and involved a convenience sample of GPs interested in bone health topics. This Hub, a secure Web-based community site, included 2 key components: an online discussion forum and a knowledge repository (the Knowledge Hub). The discussion forum contained anonymized case studies (contributed by GP participants) and topical discussions (topics that were not case studies). Using 2 complementary tools (Google Analytics and Igloo Statistical Tool), we characterized individual participating GPs? engagement with the Hub. We measured the GP participants? behavior by quantifying the number of online sessions of the participants, activities undertaken within these online sessions, written posts made per learning topic, and their time spent per topic. We calculated time spent in both active and passive engagement for each topic. Results: Seven GPs participated in the CFC Learning Hub HVCoP from September to November 2017. The complementary tools successfully captured the GP participants? engagement in the Hub. GPs were more active in topics in the discussion forum that had direct clinical application as opposed to didactic, evidence-based discussion topics (ie, topical discussions). From our knowledge hub, About Osteoporosis and Prevention were the most engaging topics, whereas shared decision making was the least active topic. Conclusions: We showcased a novel complementary analysis method that allowed us to quantify the CFC Learning Hub?s usage data into (1) sessions, (2) activities, (3) active or passive time spent, and (4) posts made to evaluate the potential engagement features needed for an HVCoP focused on GP participants? CPD process. Our design and evaluation methods for ongoing use and engagement in this Hub may be useful to evaluate future learning and knowledge-sharing projects for GPs and may allow for extension to other HPs? environments. However, owing to the limited number of GP participants in this study, we suggest that further research with a larger cohort should be performed to validate and extend these findings. UR - http://www.jmir.org/2019/11/e14545/ UR - http://dx.doi.org/10.2196/14545 UR - http://www.ncbi.nlm.nih.gov/pubmed/31774401 ID - info:doi/10.2196/14545 ER - TY - JOUR AU - Jaunay, Louis-Baptiste AU - Zerr, Philippe AU - Peguin, Lino AU - Renouard, Léandre AU - Ivanoff, Anne-Sophie AU - Picard, Hervé AU - Griffith, James AU - Chassany, Olivier AU - Duracinsky, Martin PY - 2019/11/20 TI - Development and Evaluation of a New Serious Game for Continuing Medical Education of General Practitioners (Hygie): Double-Blinded Randomized Controlled Trial JO - J Med Internet Res SP - e12669 VL - 21 IS - 11 KW - general practice KW - continuing medical education KW - evidence-based medicine KW - video games KW - randomized controlled trial KW - pedagogy N2 - Background: Continuing medical education is important but time-consuming for general practitioners (GPs). Current learning approaches are limited and lack the ability to engage some practitioners. Serious games are new learning approaches that use video games as engaging teaching material. They have significant advantages in terms of efficiency and dissemination. Objective: The aim of this study was to create a serious game and to evaluate it in terms of effectiveness and satisfaction, comparing it with a traditional method of continuing education?article reading. Methods: We produced a prototype video game called Hygie on the 5 most common reasons of consultation in general practice using 9 articles from independent evidence-based medicine journals (reviews from Prescrire and Minerva). We created 51 clinical cases. We then conducted a double-blinded randomized trial comparing the learning provided by a week of access to the game versus source articles. Participants were GPs involved as resident supervisors in 14 French university departments of family practice, recruited by email. Primary outcomes were (1) mean final knowledge score completed 3 to 5 weeks after the end of the intervention and (2) mean difference between knowledge pretest (before intervention) and posttest (3 to 5 weeks after intervention) scores, both scaled on 10 points. Secondary outcomes were transfer of knowledge learned to practice, satisfaction, and time spent playing. Results: A total of 269 GPs agreed to participate in the study. Characteristics of participants were similar between learning groups. There was no difference between groups on the mean score of the final knowledge test, with scores of 4.9 (95% CI 4.6-5.2) in the Hygie group and 4.6 (95% CI 4.2-4.9) in the reading group (P=.21). There was a mean difference score between knowledge pre- and posttests, with significantly superior performance for Hygie (mean gain of 1.6 in the Hygie group and 0.9 in the reading group; P=.02), demonstrating a more efficient and persistent learning with Hygie. The rate of participants that reported to have used the knowledge they learned through the teaching material was significantly superior in the Hygie group: 77% (47/61) in the Hygie group and 53% (25/47) in the reading group; odds ratio 2.9, 95% CI 1.2-7.4. Moreover, 87% of the opinions were favorable, indicating that Hygie is of interest for updating medical knowledge. Qualitative data showed that learners enjoyed Hygie especially for its playful, interactive, and stimulating aspects. Conclusions: We conclude that Hygie can diversify the offering for continuing education for GPs in an effective, pleasant, and evidence-based way. Trial Registration: ClinicalTrials.gov NCT03486275; https://clinicaltrials.gov/ct2/show/NCT03486275 UR - http://www.jmir.org/2019/11/e12669/ UR - http://dx.doi.org/10.2196/12669 UR - http://www.ncbi.nlm.nih.gov/pubmed/31746775 ID - info:doi/10.2196/12669 ER - TY - JOUR AU - Herrmann-Werner, Anne AU - Holderried, Martin AU - Loda, Teresa AU - Malek, Nisar AU - Zipfel, Stephan AU - Holderried, Friederike PY - 2019/11/12 TI - Navigating Through Electronic Health Records: Survey Study on Medical Students? Perspectives in General and With Regard to a Specific Training JO - JMIR Med Inform SP - e12648 VL - 7 IS - 4 KW - medical students KW - electronic health records KW - eHealth KW - simulation N2 - Background: An electronic health record (EHR) is the state-of-the-art method for ensuring all data concerning a given patient are up to date for use by multidisciplinary hospital teams. Therefore, medical students need to be trained to use health information technologies within this environment from the early stages of their education. Objective: As little is known about the effects of specific training within the medical curriculum, this study aimed to develop a course module and evaluate it to offer best practice teaching for today?s students. Moreover, we looked at the acceptance of new technologies such as EHRs. Methods: Fifth-year medical students (N=104) at the University of Tübingen took part in a standardized two-day training procedure about the advantages and risks of EHR use. After the training, students performed their own EHR entries on hypothetical patient cases in a safe practice environment. In addition, questionnaires?standardized and with open-ended questions?were administered to assess students? experiences with a new teaching module, a newly developed EHR simulator, the acceptance of the health technology, and their attitudes toward it before and after training. Results: After the teaching, students rated the benefit of EHR training for medical knowledge significantly higher than before the session (mean 3.74, SD 1.05). However, they also had doubts about the long-term benefit of EHRs for multidisciplinary coworking after training (mean 1.96, SD 0.65). The special training with simulation software was rated as helpful for preparing students (88/102, 86.2%), but they still did not feel safe in all aspects of EHR. Conclusions: A specific simulated training on using EHRs helped students improve their knowledge and become more aware of the risks and challenges of such a system. Overall, students welcomed the new training module and supported the integration of EHR teaching into the medical curriculum. Further studies are needed to optimize training modules and make use of long-term feedback opportunities a simulated system offers. UR - http://medinform.jmir.org/2019/4/e12648/ UR - http://dx.doi.org/10.2196/12648 UR - http://www.ncbi.nlm.nih.gov/pubmed/31714247 ID - info:doi/10.2196/12648 ER - TY - JOUR AU - Shorey, Shefaly AU - Ang, Emily AU - Yap, John AU - Ng, Debby Esperanza AU - Lau, Tiang Siew AU - Chui, Kong Chee PY - 2019/10/29 TI - A Virtual Counseling Application Using Artificial Intelligence for Communication Skills Training in Nursing Education: Development Study JO - J Med Internet Res SP - e14658 VL - 21 IS - 10 KW - artificial intelligence KW - communication KW - learning KW - nursing education KW - patients KW - technology KW - virtual reality N2 - Background: The ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings. Objective: The aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings. Methods: The stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud?s Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D. Results: The VPs included four case scenarios that were congruent with the nursing undergraduates? semesters? learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training. Conclusions: The creation of VPs to assist in nursing students? communication skills training may provide authentic learning environments that enhance students? perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation. UR - https://www.jmir.org/2019/10/e14658 UR - http://dx.doi.org/10.2196/14658 UR - http://www.ncbi.nlm.nih.gov/pubmed/31663857 ID - info:doi/10.2196/14658 ER - TY - JOUR AU - Rouleau, Geneviève AU - Gagnon, Marie-Pierre AU - Côté, José AU - Payne-Gagnon, Julie AU - Hudson, Emilie AU - Dubois, Carl-Ardy AU - Bouix-Picasso, Julien PY - 2019/10/2 TI - Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews JO - J Med Internet Res SP - e15118 VL - 21 IS - 10 KW - continuing education KW - e-learning KW - nurses KW - nursing care KW - systematic review of systematic reviews N2 - Background: E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses? continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context. Objective: We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context. Methods: We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results). Results: We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick?s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration. Conclusions: The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714 UR - https://www.jmir.org/2019/10/e15118 UR - http://dx.doi.org/10.2196/15118 UR - http://www.ncbi.nlm.nih.gov/pubmed/31579016 ID - info:doi/10.2196/15118 ER - TY - JOUR AU - Alyami, Hussain AU - Alawami, Mohammed AU - Lyndon, Mataroria AU - Alyami, Mohsen AU - Coomarasamy, Christin AU - Henning, Marcus AU - Hill, Andrew AU - Sundram, Frederick PY - 2019/9/26 TI - Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study JO - JMIR Serious Games SP - e13748 VL - 7 IS - 3 KW - video games KW - instructional technology KW - memory KW - retention KW - metaphor KW - learning KW - clinical competence N2 - Background: History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors. Objective: The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac). Methods: In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later.Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection. Results: Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file. Conclusions: Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students. UR - https://games.jmir.org/2019/3/e13748 UR - http://dx.doi.org/10.2196/13748 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573895 ID - info:doi/10.2196/13748 ER - TY - JOUR AU - Brusamento, Serena AU - Kyaw, Myint Bhone AU - Whiting, Penny AU - Li, Li AU - Tudor Car, Lorainne PY - 2019/09/25 TI - Digital Health Professions Education in the Field of Pediatrics: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration JO - J Med Internet Res SP - e14231 VL - 21 IS - 9 KW - digital education KW - randomized controlled trials KW - pediatrics KW - systematic review KW - meta-analysis KW - traditional learning KW - high-fidelity mannequins N2 - Background: Reducing childhood morbidity and mortality is challenging, particularly in countries with a shortage of qualified health care workers. Lack of trainers makes it difficult to provide the necessary continuing education in pediatrics for postregistration health professionals. Digital education, teaching and learning by means of digital technologies, has the potential to deliver medical education to a large audience while limiting the number of trainers needed. Objective: The goal of the research was to evaluate whether digital education can replace traditional learning to improve postregistration health professionals? knowledge, skills, attitudes, and satisfaction and foster behavior change in the field of pediatrics. Methods: We completed a systematic review of the literature by following the Cochrane methodology. We searched 7 major electronic databases for articles published from January 1990 to August 2017. No language restrictions were applied. We independently selected studies, extracted data, and assessed risk of bias, and pairs of authors compared information. We contacted authors of studies for additional information if necessary. All pooled analyses were based on random effects models. We included individually or cluster randomized controlled trials that compared digital education with traditional learning, no intervention, or other forms of digital education. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. Results: Twenty studies (1382 participants) were included. Participants included pediatricians, physicians, nurses, and midwives. Digital education technologies were assessed including high-fidelity mannequins (6 studies), computer-based education (12 studies), mobile learning (1 study), and virtual reality (1 study). Most studies reported that digital education was either as effective as or more effective than the control intervention for outcomes including skill, knowledge, attitude, and satisfaction. High-fidelity mannequins were associated with higher postintervention skill scores compared with low-fidelity mannequins (standardized mean difference 0.62; 95% CI 0.17-1.06; moderate effect size, low-quality evidence). One study reported physician change in practicing behavior and found similar effects between offline plus online digital education and no intervention. The only study that assessed impact on patient outcome found no difference between intervention and control groups. None of the included studies reported adverse or untoward effects or economic outcomes of the digital education interventions. The risk of bias was mainly unclear or high. The quality of evidence was low due to study inconsistencies, limitations, or imprecision across the studies. Conclusions: Digital education for postregistration health professions education in pediatrics is at least as effective as traditional learning and more effective than no learning. High-fidelity mannequins were found to be more effective at improving skills than traditional learning with low-fidelity mannequins. Computer-based offline/online digital education was better than no intervention for knowledge and skill outcomes and as good as traditional face-to-face learning. This review highlights evidence gaps calling for more methodologically rigorous randomized controlled trials on the topic. Trial Registration: PROSPERO CRD42017057793; https://tinyurl.com/y5q9q5o6 UR - https://www.jmir.org/2019/9/e14231 UR - http://dx.doi.org/10.2196/14231 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573906 ID - info:doi/10.2196/14231 ER - TY - JOUR AU - Kyaw, Myint Bhone AU - Tudor Car, Lorainne AU - van Galen, Sandra Louise AU - van Agtmael, A. Michiel AU - Costelloe, E. Céire AU - Ajuebor, Onyema AU - Campbell, James AU - Car, Josip PY - 2019/09/12 TI - Health Professions Digital Education on Antibiotic Management: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration JO - J Med Internet Res SP - e14984 VL - 21 IS - 9 KW - digital education KW - antibiotic management KW - systematic review KW - meta-analysis KW - randomized controlled trial N2 - Background: Inappropriate antibiotic prescription is one of the key contributors to antibiotic resistance, which is managed with a range of interventions including education. Objective: We aimed to summarize evidence on the effectiveness of digital education of antibiotic management compared to traditional education for improving health care professionals? knowledge, skills, attitudes, and clinical practice. Methods: Seven electronic databases and two trial registries were searched for randomized controlled trials (RCTs) and cluster RCTs published between January 1, 1990, and September 20, 2018. There were no language restrictions. We also searched the International Clinical Trials Registry Platform Search Portal and metaRegister of Controlled Trials to identify unpublished trials and checked the reference lists of included studies and relevant systematic reviews for study eligibility. We followed Cochrane methods to select studies, extract data, and appraise and synthesize eligible studies. We used random-effect models for the pooled analysis and assessed statistical heterogeneity by visual inspection of a forest plot and calculation of the I2 statistic. Results: Six cluster RCTs and two RCTs with 655 primary care practices, 1392 primary care physicians, and 485,632 patients were included. The interventions included personal digital assistants; short text messages; online digital education including emails and websites; and online blended education, which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed postintervention change in clinical practice. The majority of the studies (4/6) reported greater reduction in antibiotic prescription or dispensing rate with digital education than with traditional education. Two studies showed significant differences in postintervention knowledge scores in favor of mobile education over traditional education (standardized mean difference=1.09, 95% CI 0.90-1.28; I2=0%; large effect size; 491 participants [2 studies]). The findings for health care professionals? attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction, or potential adverse effects. Conclusions: Findings from studies deploying mobile or online modalities of digital education on antibiotic management were complementary and found to be more cost-effective than traditional education in improving clinical practice and postintervention knowledge, particularly in postregistration settings. There is a lack of evidence on the effectiveness of other digital education modalities such as virtual reality or serious games. Future studies should also include health care professionals working in settings other than primary care and low- and middle-income countries. Clinical Trial: PROSPERO CRD42018109742; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=109742 UR - http://www.jmir.org/2019/9/e14984/ UR - http://dx.doi.org/10.2196/14984 UR - http://www.ncbi.nlm.nih.gov/pubmed/31516125 ID - info:doi/10.2196/14984 ER - TY - JOUR AU - Yang, Xiaoxian AU - Xie, Ri-Hua AU - Chen, Si AU - Yu, Wei AU - Liao, Yan AU - Krewski, Daniel AU - Wen, Wu Shi PY - 2019/09/05 TI - Using Video Feedback Through Smartphone Instant Messaging in Fundamental Nursing Skills Teaching: Observational Study JO - JMIR Mhealth Uhealth SP - e15386 VL - 7 IS - 9 KW - video feedback KW - smartphone KW - mobile phone KW - student nurses KW - fundamental nursing skill KW - teaching N2 - Background: Video feedback has been shown to be an effective teaching tool that can improve student learning when having them view their own performance. However, the literature on the effect of integrating smartphones with video feedback in fundamental nursing skills teaching is sparse. Objective: This study aimed to explore the potential effects of video feedback through smartphone-based instant messaging on teaching undergraduate nursing students fundamental nursing skills. Methods: We conducted a study on teaching fundamental nursing skills to 6 classes of second-year undergraduate nursing students. In 2 classes (the intervention group), the instructor elected to use smartphone-based video feedback to facilitate teaching; instructors in the other 4 classes (the control group) elected to use routine methods of teaching without video feedback. Scores from the final examination, in-class assignments, and the General Self-Efficacy Scale questionnaire were collected and compared between the two groups. Multiple linear regression analysis was performed to estimate the independent effect of video feedback after adjusting for gender, age, and prior experience in the use of WeChat/QQ in learning applications. An ad hoc questionnaire was used for student evaluation of the novel smartphone-based video feedback teaching method. Results: A total of 195 nursing students (65 in the video feedback group and 130 in the control group) completed the study and were included in the final analysis. Mean and standard deviation of scores on the final examination, bed making, aseptic procedure, vital signs measurement, and oxygen therapy were 91.29 (SD 2.36), 90.52 (SD 3.18), 93.23 (SD 3.16), 91.65 (SD 4.21), and 92.06 (SD 3.58), respectively, in the video feedback group and 89.99 (SD 3.12), 81.71 (SD 8.63), 87.12 (SD 5.50), 87.45 (SD 8.00), and 90.37 (SD 6.36), respectively, in the control group (differences were statistically significant). The mean and standard deviation of scores for assignments in catheterization and enema and General Self-Efficacy Scale were 89.69 (SD 3.22), 91.14 (SD 3.15), and 24.52 (SD 5.35), respectively, in the video feedback group and 88.82 (SD 7.48), 90.79 (SD 6.08), and 24.50 (SD 6.16), respectively, in the control group (differences were not statistically significant). The majority (over 98%) of nursing students were satisfied with this smartphone-based video feedback teaching method. Conclusions: Video feedback through smartphone-based instant messaging may be an effective way to improve nursing students? academic performance and professional skills. UR - https://mhealth.jmir.org/2019/9/e15386 UR - http://dx.doi.org/10.2196/15386 UR - http://www.ncbi.nlm.nih.gov/pubmed/31489839 ID - info:doi/10.2196/15386 ER - TY - JOUR AU - Bientzle, Martina AU - Hircin, Emrah AU - Kimmerle, Joachim AU - Knipfer, Christian AU - Smeets, Ralf AU - Gaudin, Robert AU - Holtz, Peter PY - 2019/08/21 TI - Association of Online Learning Behavior and Learning Outcomes for Medical Students: Large-Scale Usage Data Analysis JO - JMIR Med Educ SP - e13529 VL - 5 IS - 2 KW - learning engagement KW - medical online learning platform KW - big data analytics KW - writing notes KW - learning outcomes N2 - Background: Digital learning environments have become very common in the training of medical professionals, and students often use such platforms for exam preparation. Multiple choice questions (MCQs) are a common format in medical exams and are used by students to prepare for said exams. Objective: We aimed to examine whether particular learning activities contributed more strongly than others to users? exam performance. Methods: We analyzed data from users of an online platform that provides learning materials for medical students in preparation for their final exams. We analyzed whether the number of learning cards viewed and the number of MCQs taken were positively related to learning outcomes. We also examined whether viewing learning cards or answering MCQs was more effective. Finally, we tested whether taking individual notes predicted learning outcomes, and whether taking notes had an effect after controlling for the effects of learning cards and MCQs. Our analyses from the online platform Amboss are based on user activity data, which supplied the number of learning cards studied and test questions answered. We also included the number of notes from each of those 23,633 users who had studied at least 200 learning cards and had answered at least 1000 test exam questions in the 180 days before their state exam. The activity data for this analysis was collected retrospectively, using Amboss archival usage data from April 2014 to April 2017. Learning outcomes were measured using the final state exam scores that were calculated by using the answers voluntarily entered by the participants. Results: We found correlations between the number of cards studied (r=.22; P<.001) and the number of test questions that had been answered (r=.23; P<.001) with the percentage of correct answers in the learners? medical exams. The number of test questions answered still yielded a significant effect, even after controlling for the number of learning cards studied using a hierarchical regression analysis (?=.14; P<.001; ?R2=.017; P<.001). We found a negative interaction between the number of learning cards and MCQs, indicating that users with high scores for learning cards and MCQs had the highest exam scores. Those 8040 participants who had taken at least one note had a higher percentage of correct answers (80.94%; SD=7.44) than those who had not taken any notes (78.73%; SD=7.80; t23631=20.95; P<.001). In a stepwise regression, the number of notes the participants had taken predicted the percentage of correct answers over and above the effect of the number of learning cards studied and of the number of test questions entered in step one (?=.06; P<.001; ?R2=.004; P<.001). Conclusions: These results show that online learning platforms are particularly helpful whenever learners engage in active elaboration in learning material, such as by answering MCQs or taking notes. UR - http://mededu.jmir.org/2019/2/e13529/ UR - http://dx.doi.org/10.2196/13529 UR - http://www.ncbi.nlm.nih.gov/pubmed/31436166 ID - info:doi/10.2196/13529 ER - TY - JOUR AU - Zupanic, Michaela AU - Rebacz, Patrick AU - Ehlers, P. Jan PY - 2019/08/19 TI - Media Use Among Students From Different Health Curricula: Survey Study JO - JMIR Med Educ SP - e12809 VL - 5 IS - 2 KW - social media KW - medical education KW - computers KW - interprofessional relations KW - distance education KW - health occupations N2 - Background: Mobile devices such as smartphones, tablets, and laptop computers enable users to search for information and communicate with others at any place and any time. Such devices are increasingly being used at universities for teaching and learning. The use of mobile devices by students depends, among others, on the individual media literacy level and the curricular framework. Objective: The objective of this study was to explore whether there were differences in media use in students from various curricula at the Faculty of Health, Witten/Herdecke University. Methods: During the 2015-16 winter term, a survey was conducted at the Faculty of Health, Witten/Herdecke University, in which a total of 705 students (out of 1091 students; response rate: 705/1091, 64.61%) from 4 schools participated voluntarily: medicine (346/598), dentistry (171/204), psychology (142/243), and nursing science (46/46). The questionnaire developed for the study included 132 questions on 4 topics: (1) electronic and mobile devices (19 questions), (2) communication and organization of learning (45 questions), (3) apps/programs/websites/media (34 questions), and (4) media literacy (34 questions). The questionnaire was distributed and anonymously completed during in-class courses. Results: Students from all 4 schools had at least two electronic devices, with smartphones (97.4%, 687/705) and laptops (94.8%, 669/705) being the most common ones. Students agreed that electronic devices enabled them to effectively structure the learning process (mean 3.16, SD 0.62) and shared the opinion that university teaching should include imparting media literacy (mean 2.84, SD 0.84). Electronic device ownership was the highest among medical students (mean 2.68, SD 0.86) and medical students were the only ones to use a tutorial (36.1%, 125/346). Dental students most widely used text messages (mean 3.41, SD 0.49) and social media (mean 2.57, SD 1.10) to organize learning. Psychology students considered mobile devices to be most ineffective (mean 2.81, SD 0.83). Nursing science students used emails (mean 3.47, SD 0.73) and desktop computers (39%, 18/46) most widely. Conclusions: The results show that almost all students use electronic learning (e-learning) tools. At the same time, different profiles for different degree programs become apparent, which are to be attributed to not only the varying curricula and courses but also to the life circumstances of different age groups. Universities should, therefore, pay attention to the diverse user patterns and media literacy levels of students when planning courses to enable successful use of e-learning methods. UR - http://mededu.jmir.org/2019/2/e12809/ UR - http://dx.doi.org/10.2196/12809 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429412 ID - info:doi/10.2196/12809 ER - TY - JOUR AU - de Leeuw, Adrianus Robert AU - Westerman, Michiel AU - Walsh, Kieran AU - Scheele, Fedde PY - 2019/08/09 TI - Development of an Instructional Design Evaluation Survey for Postgraduate Medical E-Learning: Content Validation Study JO - J Med Internet Res SP - e13921 VL - 21 IS - 8 KW - postgraduate medical education KW - continuing medical education KW - e-learning KW - distance education KW - survey KW - evaluation N2 - Background: E-Learning has taken a firm place in postgraduate medical education. Whereas 10 years ago it was promising, it now has a definite niche and is clearly here to stay. However, evaluating the effect of postgraduate medical e-learning (PGMeL) and improving upon it can be complicated. While the learning aims of e-learning are evaluated, there are no instruments to evaluate the instructional design of PGMeL. Such an evaluation instrument may be developed by following the Association for Medical Education in Europe (AMEE) 7-step process. The first 5 steps of this process were previously performed by literature reviews, focus group discussion, and an international Delphi study. Objective: This study will continue with steps 6 and 7 and answer the research question: Is a content-validated PGMeL evaluation survey useful, understandable, and of added value for creators of e-learning? Methods: There are five phases in this study: creating a survey from 37 items (phase A); testing readability and question interpretation (phase B); adjusting, rewriting, and translating surveys (phase C); gathering completed surveys from three PGMeL modules (phase D); and holding focus group discussions with the e-learning authors (phase E). Phase E was carried out by presenting the results of the evaluations from phase D, followed by a group discussion. There are four groups of participants in this study. Groups A and B are experienced end users of PGMeL and participated in phase B. Group C are users who undertook e-learning and were asked to complete the survey in phase D. Group D are the authors of the e-learning modules described above. Results: From a list of 36 items, we developed a postgraduate Medical E-Learning Evaluation Survey (MEES). Seven residents participated in the phase B group discussion: 4 items were interpreted differently, 3 were not readable, and 2 items were double. The items from phase B were rewritten and, after adjustment, understood correctly. The MEES was translated into Dutch and again pilot-tested. All items were clear and were understood correctly. The MEES version used for the evaluation contained 3 positive domains (motivation, learning enhancers, and real-world translation) and 2 negative domains (barriers and learning discouragers), with 36 items in those domains, 5 Likert scale questions of 1 to 10, and 5 open questions asking participants to give their own comments in each domain. Three e-learning modules were evaluated from July to November 2018. There were a total of 158 responses from a Dutch module, a European OB/GYN (obstetrics and gynecology) module, and a surgical module offered worldwide. Finally, 3 focus group discussions took place with a total of 10 participants. Usefulness was much appreciated, understandability was good, and added value was high. Four items needed additional explanation by the authors, and a Creators? Manual was written at their request. Conclusions: The MEES is the first survey to evaluate the instructional design of PGMeL and was constructed following all 7 steps of the AMEE. This study completes the design of the survey and shows its usefulness and added value to the authors. It finishes with a final, publicly available survey that includes a Creators? Manual. We briefly discuss the number of responses needed and conclude that more is better; in the end, however, one has to work with what is available. The next steps would be to see whether improvement can be measured by using the MEES and continue to work on the end understandability in different languages and cultural groups. UR - https://www.jmir.org/2019/8/e13921/ UR - http://dx.doi.org/10.2196/13921 UR - http://www.ncbi.nlm.nih.gov/pubmed/31400102 ID - info:doi/10.2196/13921 ER - TY - JOUR AU - Jewer, Jennifer AU - Parsons, H. Michael AU - Dunne, Cody AU - Smith, Andrew AU - Dubrowski, Adam PY - 2019/8/6 TI - Evaluation of a Mobile Telesimulation Unit to Train Rural and Remote Practitioners on High-Acuity Low-Occurrence Procedures: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e14587 VL - 21 IS - 8 KW - medical education KW - distributed medical education KW - simulation training KW - emergency medicine KW - rural health KW - remote-facilitation KW - assessment KW - chest tubes N2 - Background: The provision of acute medical care in rural and remote areas presents unique challenges for practitioners. Therefore, a tailored approach to training providers would prove beneficial. Although simulation-based medical education (SBME) has been shown to be effective, access to such training can be difficult and costly in rural and remote areas. Objective: The aim of this study was to evaluate the educational efficacy of simulation-based training of an acute care procedure delivered remotely, using a portable, self-contained unit outfitted with off-the-shelf and low-cost telecommunications equipment (mobile telesimulation unit, MTU), versus the traditional face-to-face approach. A conceptual framework based on a combination of Kirkpatrick?s Learning Evaluation Model and Miller?s Clinical Assessment Framework was used. Methods: A written procedural skills test was used to assess Miller?s learning level? knows ?at 3 points in time: preinstruction, immediately postinstruction, and 1 week later. To assess procedural performance (shows how), participants were video recorded performing chest tube insertion before and after hands-on supervised training. A modified Objective Structured Assessment of Technical Skills (OSATS) checklist and a Global Rating Scale (GRS) of operative performance were used by a blinded rater to assess participants? performance. Kirkpatrick?s reaction was measured through subject completion of a survey on satisfaction with the learning experiences and an evaluation of training. Results: A total of 69 medical students participated in the study. Students were randomly assigned to 1 of the following 3 groups: comparison (25/69, 36%), intervention (23/69, 33%), or control (21/69, 31%). For knows, as expected, no significant differences were found between the groups on written knowledge (posttest, P=.13). For shows how, no significant differences were found between the comparison and intervention groups on the procedural skills learning outcomes immediately after the training (OSATS checklist and GRS, P=1.00). However, significant differences were found for the control versus comparison groups (OSATS checklist, P<.001; GRS, P=.02) and the control versus intervention groups (OSATS checklist, P<.001; GRS, P=.01) on the pre- and postprocedural performance. For reaction, there were no statistically significant differences between the intervention and comparison groups on the satisfaction with learning items (P=.65 and P=.79) or the evaluation of the training (P=.79, P=.45, and P=.31). Conclusions: Our results demonstrate that simulation-based training delivered remotely, applying our MTU concept, can be an effective way to teach procedural skills. Participants trained remotely in the MTU had comparable learning outcomes (shows how) to those trained face-to-face. Both groups received statistically significant higher procedural performance scores than those in the control group. Participants in both instruction groups were equally satisfied with their learning and training (reaction). We believe that mobile telesimulation could be an effective way of providing expert mentorship and overcoming a number of barriers to delivering SBME in rural and remote locations. UR - http://www.jmir.org/2019/8/e14587/ UR - http://dx.doi.org/10.2196/14587 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/14587 ER - TY - JOUR AU - Schuelper, Nikolai AU - Ludwig, Sascha AU - Anders, Sven AU - Raupach, Tobias PY - 2019/07/22 TI - The Impact of Medical Students? Individual Teaching Format Choice on the Learning Outcome Related to Clinical Reasoning JO - JMIR Med Educ SP - e13386 VL - 5 IS - 2 KW - undergraduate medical education KW - case histories N2 - Background: Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences. Objective: The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own. Methods: In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories. Results: Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2% [SD 12.6] vs 70.0% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3% [SD 16.6] vs 63.4% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams. Conclusions: Despite students? overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods. UR - http://mededu.jmir.org/2019/2/e13386/ UR - http://dx.doi.org/10.2196/13386 UR - http://www.ncbi.nlm.nih.gov/pubmed/31333193 ID - info:doi/10.2196/13386 ER - TY - JOUR AU - de Leeuw, Robert AU - Scheele, Fedde AU - Walsh, Kieran AU - Westerman, Michiel PY - 2019/07/22 TI - A 9-Step Theory- and Evidence-Based Postgraduate Medical Digital Education Development Model: Empirical Development and Validation JO - JMIR Med Educ SP - e13004 VL - 5 IS - 2 KW - postgraduate medical e-learning KW - instructional design KW - e-learning KW - distance education KW - design model KW - education, medical KW - education, distance KW - models, educational N2 - Background: Digital education tools (e-learning, technology-enhanced learning) can be defined as any educational intervention that is electronically mediated. Decveloping and applying such tools and interventions for postgraduate medical professionals who work and learn after graduation can be called postgraduate medical digital education (PGMDE), which is increasingly being used and evaluated. However, evaluation has focused mainly on reaching the learning goals and little on the design. Design models for digital education (instructional design models) help educators create a digital education curriculum, but none have been aimed at PGMDE. Studies show the need for efficient, motivating, useful, and satisfactory digital education. Objective: Our objective was (1) to create an empirical instructional design model for PGMDE founded in evidence and theory, with postgraduate medical professionals who work and learn after graduation as the target audience, and (2) to compare our model with existing models used to evaluate and create PGMDE. Methods: Previously we performed an integrative literature review, focus group discussions, and a Delphi procedure to determine which building blocks for such a model would be relevant according to experts and users. This resulted in 37 relevant items. We then used those 37 items and arranged them into chronological steps. After we created the initial 9-step plan, we compared these steps with other models reported in the literature. Results: The final 9 steps were (1) describe who, why, what, (2) select educational strategies, (3) translate to the real world, (4) choose the technology, (5) complete the team, (6) plan the budget, (7) plan the timing and timeline, (8) implement the project, and (9) evaluate continuously. On comparing this 9-step model with other models, we found that no other was as complete, nor were any of the other models aimed at PGMDE. Conclusions: Our 9-step model is the first, to our knowledge, to be based on evidence and theory building blocks aimed at PGMDE. We have described a complete set of evidence-based steps, expanding a 3-domain model (motivate, learn, and apply) to an instructional design model that can help every educator in creating efficient, motivating, useful, and satisfactory PGMDE. Although certain steps are more robust and have a deeper theoretical background in current research (such as education), others (such as budget) have been barely touched upon and should be investigated more thoroughly in order that proper guidelines may also be provided for them. UR - http://mededu.jmir.org/2019/2/e13004/ UR - http://dx.doi.org/10.2196/13004 UR - http://www.ncbi.nlm.nih.gov/pubmed/31333194 ID - info:doi/10.2196/13004 ER - TY - JOUR AU - ?ilar, Jan AU - Polák, David AU - Mládek, Arno?t AU - Je?ek, Filip AU - Kurtz, W. Theodore AU - DiCarlo, E. Stephen AU - ?ivný, Jan AU - Kofranek, Jiri PY - 2019/07/03 TI - Development of In-Browser Simulators for Medical Education: Introduction of a Novel Software Toolchain JO - J Med Internet Res SP - e14160 VL - 21 IS - 7 KW - education KW - physiology KW - computer simulation KW - modeling KW - Web browser KW - Web technologies N2 - Background: Simulators used in teaching are interactive applications comprising a mathematical model of the system under study and a graphical user interface (GUI) that allows the user to control the model inputs and visualize the model results in an intuitive and educational way. Well-designed simulators promote active learning, enhance problem-solving skills, and encourage collaboration and small group discussion. However, creating simulators for teaching purposes is a challenging process that requires many contributors including educators, modelers, graphic designers, and programmers. The availability of a toolchain of user-friendly software tools for building simulators can facilitate this complex task. Objective: This paper aimed to describe an open-source software toolchain termed Bodylight.js that facilitates the creation of browser-based client-side simulators for teaching purposes, which are platform independent, do not require any installation, and can work offline. The toolchain interconnects state-of-the-art modeling tools with current Web technologies and is designed to be resilient to future changes in the software ecosystem. Methods: We used several open-source Web technologies, namely, WebAssembly and JavaScript, combined with the power of the Modelica modeling language and deployed them on the internet with interactive animations built using Adobe Animate. Results: Models are implemented in the Modelica language using either OpenModelica or Dassault Systèmes Dymola and exported to a standardized Functional Mock-up Unit (FMU) to ensure future compatibility. The C code from the FMU is further compiled to WebAssembly using Emscripten. Industry-standard Adobe Animate is used to create interactive animations. A new tool called Bodylight.js Composer was developed for the toolchain that enables one to create the final simulator by composing the GUI using animations, plots, and control elements in a drag-and-drop style and binding them to the model variables. The resulting simulators are stand-alone HyperText Markup Language files including JavaScript and WebAssembly. Several simulators for physiology education were created using the Bodylight.js toolchain and have been received with general acclaim by teachers and students alike, thus validating our approach. The Nephron, Circulation, and Pressure-Volume Loop simulators are presented in this paper. Bodylight.js is licensed under General Public License 3.0 and is free for anyone to use. Conclusions: Bodylight.js enables us to effectively develop teaching simulators. Armed with this technology, we intend to focus on the development of new simulators and interactive textbooks for medical education. Bodylight.js usage is not limited to developing simulators for medical education and can facilitate the development of simulators for teaching complex topics in a variety of different fields. UR - https://www.jmir.org/2019/7/e14160 UR - http://dx.doi.org/10.2196/14160 UR - http://www.ncbi.nlm.nih.gov/pubmed/31271154 ID - info:doi/10.2196/14160 ER - TY - JOUR AU - Meinert, Edward AU - Alturkistani, Abrar AU - Foley, A. Kimberley AU - Brindley, David AU - Car, Josip PY - 2019/06/04 TI - Examining Cost Measurements in Production and Delivery of Three Case Studies Using E-Learning for Applied Health Sciences: Cross-Case Synthesis JO - J Med Internet Res SP - e13574 VL - 21 IS - 6 KW - education KW - distance education KW - professional education KW - online education KW - online learning KW - costs and cost analysis KW - economics N2 - Background: The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs. Objective: To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses. Methods: This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course. Results: A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task estimation, lack of contingency planning, challenges in third-party resource management, and the need to update health-related materials that became outdated during course production. The third study reported a positive budget variance because of the cost efficiency derived from previous implementation, the strong working relationship of the course project team, and the use of iterative project management methods. Conclusions: This research suggests that the delivery costs of an e-Learning course could be underestimated or underreported and identifies factors that could be used to better control budgets. Through consistent management of factors affecting the cost of course production, further research could be undertaken using standard economic evaluation methods to evaluate the advantages of using e-Learning. UR - https://www.jmir.org/2019/6/e13574/ UR - http://dx.doi.org/10.2196/13574 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165718 ID - info:doi/10.2196/13574 ER - TY - JOUR AU - Liaw, Ying Sok AU - Tan, Kiat Khoon AU - Wu, Ting Ling AU - Tan, Chee Seng AU - Choo, Hyekyung AU - Yap, John AU - Lim, Mui Sok AU - Wong, Lilian AU - Ignacio, Jeanette PY - 2019/05/28 TI - Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning JO - J Med Internet Res SP - e12537 VL - 21 IS - 5 KW - blended learning KW - constructivism KW - instructional sequence KW - interprofessional learning KW - simulation KW - technologically-enhanced learning KW - virtual reality KW - web-based instruction N2 - Background: With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes. Objective: The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students? learning outcomes on interprofessional competencies. Methods: A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities?Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)?after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students? learning outcomes on interprofessional competencies. Results: A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence ?WI-VR-SE? as their top preference. Conclusions: This study shows that the instructional sequence of a blended learning approach can have a significant impact on students? learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students? learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments. UR - http://www.jmir.org/2019/5/e12537/ UR - http://dx.doi.org/10.2196/12537 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140432 ID - info:doi/10.2196/12537 ER - TY - JOUR AU - Loescher, J. Lois AU - Heslin, M. Kelly AU - Szalacha, A. Laura AU - Silva, E. Graciela AU - Muramoto, L. Myra PY - 2019/05/15 TI - Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study JO - JMIR Res Protoc SP - e13480 VL - 8 IS - 5 KW - skin cancer KW - primary prevention KW - secondary prevention KW - health education KW - e-learning KW - massage KW - web-based learning KW - massage therapists N2 - Background: Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients? skin and are amenable to performing skin cancer risk reduction activities during massage appointments. Objective: The objective of this study is to describe the Massage Therapists Skin Health Awareness, Referral, and Education protocol, presenting an overview of our systematic approach to developing rigorous e-training for MTs to enable them to be partners in skin cancer risk reduction. We also describe procedures for usability and feasibility testing of the training. Methods: We developed an integrated electronic learning system that includes electronic training (e-training) technology, simulated client interactions, online data collection instruments, and in-person assessment of MTs? application of their training. Results: A total of 20 participants nationally scored the e-training as high for usability and satisfaction. We have screened an additional 77 MTs in Arizona for interest and eligibility, and currently have 37 enrolled participants, of whom 32 have completed the Web-based training. Conclusions: The structured and rigorous development approach for this skin cancer risk reduction and brief behavioral intervention e-training for MTs begins to fill a gap in skin cancer risk reduction research. Iterative usability testing of our asynchronous Web-based training resulted in positive participant response. Our e-training approach offers greater learner accessibility, increased convenience, and greater scalability than the few existing programs and has the potential to reach many MTs nationally. International Registered Report Identifier (IRRID): DERR1-10.2196/13480 UR - http://www.researchprotocols.org/2019/5/e13480/ UR - http://dx.doi.org/10.2196/13480 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094348 ID - info:doi/10.2196/13480 ER - TY - JOUR AU - Thew, R. Graham AU - Powell, LYM Candice AU - Kwok, PL Amy AU - Lissillour Chan, H. Mandy AU - Wild, Jennifer AU - Warnock-Parkes, Emma AU - Leung, WL Patrick AU - Clark, M. David PY - 2019/05/15 TI - Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series JO - JMIR Form Res SP - e13446 VL - 3 IS - 2 KW - anxiety KW - social phobia KW - internet KW - cognitive therapy KW - clinical competence KW - cross-cultural comparison KW - Hong Kong KW - benchmarking KW - psychology, clinical KW - mental health N2 - Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists? iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients? clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. UR - http://formative.jmir.org/2019/2/e13446/ UR - http://dx.doi.org/10.2196/13446 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094320 ID - info:doi/10.2196/13446 ER - TY - JOUR AU - Ray, E. Anne AU - Greene, Kathryn AU - Hecht, L. Michael AU - Barriage, C. Sarah AU - Miller-Day, Michelle AU - Glenn, D. Shannon AU - Banerjee, C. Smita PY - 2019/05/09 TI - An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media JO - JMIR Form Res SP - e12132 VL - 3 IS - 2 KW - substance use KW - prevention KW - media literacy KW - e-learning KW - adaptation N2 - Background: There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. Objective: Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. Methods: An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. Results: Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. Conclusions: The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations. UR - http://formative.jmir.org/2019/2/e12132/ UR - http://dx.doi.org/10.2196/12132 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094328 ID - info:doi/10.2196/12132 ER - TY - JOUR AU - Lukaschek, Karoline AU - Schneider, Nico AU - Schelle, Mercedes AU - Kirk, Bak Ulrik AU - Eriksson, Tina AU - Kunnamo, Ilkka AU - Rochfort, Andrée AU - Collins, Claire AU - Gensichen, Jochen PY - 2019/04/29 TI - Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study JO - JMIR Ment Health SP - e12540 VL - 6 IS - 4 KW - motivational interviewing KW - e-learning KW - web-based learning KW - primary care KW - health behavior change KW - disease management N2 - Background: Motivational interviewing (MI) is an established communication method for enhancing intrinsic motivation for changing health behavior. E-learning can reduce the cost and time involved in providing continuing education and can be easily integrated into individual working arrangements and the daily routines of medical professionals. Thus, a Web-based course was devised to familiarize health professionals with different levels of education and expertise with MI techniques for patients with chronic conditions. Objective: The aim of this study was to report participants? opinion on the practicality of MI (as learned in the course) in daily practice, stratified by the level of education. Methods: Participants (N=607) of the MI Web-based training course evaluated the course over 18 months, using a self-administered questionnaire. The evaluation was analyzed descriptively and stratified for the level of education (medical students, physicians in specialist training [PSTs], and general practitioners [GPs]). Results: Participants rated the applicability of the skills and knowledge gained by the course as positive (medical students: 94% [79/84] good; PSTs: 88.6% [109/123] excellent; and GPs: 51.3% [182/355] excellent). When asked whether they envisage the use of MI in the future, 79% (67/84) of the students stated to a certain extent, 88.6% (109/123) of the PSTs stated to a great extent, and 38.6% (137/355) of GPs stated to a great extent. Participants acknowledged an improvement of communication skills such as inviting (medical students: 85% [72/84]; PSTs: 90.2% [111/123]; GPs: 37.2% [132/355]) and encouraging (medical students: 81% [68/84]; PSTs: 45.5% [56/123]; GPs: 36.3% [129/355]) patients to talk about behavior change and conveying respect for patient?s choices (medical students: 72% [61/84]; PSTs: 50.0% [61/123]; GPs: 23.4% [83/355]). Conclusions: Participants confirmed the practicality of MI. However, the extent to which the practicality of MI was acknowledged as well as its expected benefits depended on the individual?s level of education/expertise. UR - http://mental.jmir.org/2019/4/e12540/ UR - http://dx.doi.org/10.2196/12540 UR - http://www.ncbi.nlm.nih.gov/pubmed/31033446 ID - info:doi/10.2196/12540 ER - TY - JOUR AU - Goffard, Anne AU - Odou, Pascal AU - Aliouat, Moukhtar El AU - Aliouat-Denis, Cécile-Marie AU - Carnoy, Christophe AU - Décaudin, Bertrand AU - Damien, Cuny AU - Hamoudi, Mounira AU - Pinçon, Claire AU - Quelennec, Katia AU - Zanetti, Sebastien AU - Ravaux, Pierre AU - Standaert, Annie PY - 2019/04/11 TI - Development and Evaluation of a Hybrid Course in Clinical Virology at a Faculty of Pharmacy in Lille, France JO - JMIR Med Educ SP - e10766 VL - 5 IS - 1 KW - virology KW - pharmacy KW - education, distance KW - e-learning N2 - Background: During their studies, pharmacy students must acquire the specific skills in clinical virology required for their subsequent professional practice. Recent experiments on teaching and learning in higher education have shown that hybrid courses strengthen the students? commitment to learning and enable high-quality knowledge acquisition. Objective: This study concerned the design and deployment of a hybrid course that combines face-to-face and Web-based instruction in clinical virology for fourth-year pharmacy students. The study?s objectives were to (1) measure the students? level of involvement in the course, (2) gauge their interest in this type of learning, and (3) highlight any associated difficulties. Methods: The study included 194 fourth-year pharmacy students from the Lille Faculty of Pharmacy (University of Lille, Lille, France) between January and June 2017. The students followed a hybrid course comprising an online learning module and 5 tutorial sessions in which professional situations were simulated. The learning module and 3 online evaluation sessions were delivered via the Moodle learning management system. Each tutorial session ended with an evaluation. The number of Moodle log-ins, the number of views of learning resources, and the evaluation marks were recorded. The coefficient for the correlation between the marks in the online evaluation and those in the tutorials was calculated. The students? opinions and level of satisfaction were evaluated via a course questionnaire. Results: The course?s learning resources and Web pages were viewed 21,446 and 3413 times, respectively. Of the 194 students, 188 (96.9%) passed the course (ie, marks of at least 10 out of 20). There was a satisfactory correlation between the marks obtained in the online evaluations and those obtained after the tutorials. The course met the students? expectations in 53.2% of cases, and 57.4% of the students stated that they were able to work at their own pace. Finally, 26.6% of the students stated that they had difficulty organizing their work around this hybrid course. Conclusions: Our results showed that pharmacy students were strongly in favor of a hybrid course. The levels of attendance and participation were high. However, teachers must be aware that some students will encounter organizational difficulties. UR - http://mededu.jmir.org/2019/1/e10766/ UR - http://dx.doi.org/10.2196/10766 UR - http://www.ncbi.nlm.nih.gov/pubmed/30973341 ID - info:doi/10.2196/10766 ER - TY - JOUR AU - Clavier, Thomas AU - Ramen, Julie AU - Dureuil, Bertrand AU - Veber, Benoit AU - Hanouz, Jean-Luc AU - Dupont, Hervé AU - Lebuffe, Gilles AU - Besnier, Emmanuel AU - Compere, Vincent PY - 2019/04/09 TI - Use of the Smartphone App WhatsApp as an E-Learning Method for Medical Residents: Multicenter Controlled Randomized Trial JO - JMIR Mhealth Uhealth SP - e12825 VL - 7 IS - 4 KW - education, medical, graduate/methods KW - educational measurement KW - anesthesiology KW - internship and residency KW - trauma KW - hemorrhage KW - mobile applications KW - WhatsApp KW - smartphone KW - teaching materials KW - mobile phone N2 - Background: The WhatsApp smartphone app is the most widely used instant messaging app in the world. Recent studies reported the use of WhatsApp for educational purposes, but there is no prospective study comparing WhatsApp?s pedagogical effectiveness to that of any other teaching modality. Objective: The main objective of this study was to measure the impact of a learning program via WhatsApp on clinical reasoning in medical residents. Methods: This prospective, randomized, multicenter study was conducted among first- and second-year anesthesiology residents (offline recruitment) from four university hospitals in France. Residents were randomized in two groups of online teaching (WhatsApp and control). The WhatsApp group benefited from daily delivery of teaching documents on the WhatsApp app and a weekly clinical case supervised by a senior physician. In the control group, residents had access to the same documents via a traditional computer electronic learning (e-learning) platform. Medical reasoning was self-assessed online by a script concordance test (SCT; primary parameter), and medical knowledge was assessed using multiple-choice questions (MCQs). The residents also completed an online satisfaction questionnaire. Results: In this study, 62 residents were randomized (32 to the WhatsApp group and 30 to the control group) and 22 residents in each group answered the online final evaluation. We found a difference between the WhatsApp and control groups for SCTs (60% [SD 9%] vs 68% [SD 11%]; P=.006) but no difference for MCQs (18/30 [SD 4] vs 16/30 [SD 4]; P=.22). Concerning satisfaction, there was a better global satisfaction rate in the WhatsApp group than in the control group (8/10 [interquartile range 8-9] vs 8/10 [interquartile range 8-8]; P=.049). Conclusions: Compared to traditional e-learning, the use of WhatsApp for teaching residents was associated with worse clinical reasoning despite better global appreciation. The use of WhatsApp probably contributes to the dispersion of attention linked to the use of the smartphone. The impact of smartphones on clinical reasoning should be studied further. UR - http://mhealth.jmir.org/2019/4/e12825/ UR - http://dx.doi.org/10.2196/12825 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964435 ID - info:doi/10.2196/12825 ER - TY - JOUR AU - Aylwin, Christopher PY - 2019/4/4 TI - Faculty and Student Interaction in an Online Master?s Course: Survey and Content Analysis JO - JMIR Med Educ SP - e10464 VL - 5 IS - 1 KW - online learning KW - faculty & student interaction KW - Community of Inquiry KW - medicine N2 - Background: The provision of online educational courses has soared since the creation of the World Wide Web, with most universities offering some degree of distance-based programs. The social constructivist pedagogy is widely accepted as the framework to provide education, but it largely relies on the face-to-face presence of students and faculty to foster a learning environment. The concern with online courses is that this physical interaction is removed, and therefore learning may be diminished. Objective: The Community of Inquiry (CoI) is a framework designed to support the educational experience of such courses. This study aims to examine the characteristics of the CoI across the whole of an entirely online master?s course. Methods: This research used a case study method, using a convergent parallel design to study the interactions described by the CoI model in an online master?s program. The MSc program studied is a postgraduate medical degree for doctors or allied health professionals. Different data sources were used to corroborate this dataset including content analysis of both asynchronous and synchronous discussion forums. Results: This study found that a CoI can be created within the different learning activities of the course. The discussion forums integral to online courses are a rich source of interaction, with the ability to promote social interaction, teaching presence, and cognitive learning. Conclusions: The results show that meaningful interaction between faculty and student can be achieved in online courses, which is important to ensure deep learning and reflection. UR - http://mededu.jmir.org/2019/1/e10464/ UR - http://dx.doi.org/10.2196/10464 UR - http://www.ncbi.nlm.nih.gov/pubmed/30958274 ID - info:doi/10.2196/10464 ER - TY - JOUR AU - de Leeuw, Robert AU - de Soet, Anneloes AU - van der Horst, Sabine AU - Walsh, Kieran AU - Westerman, Michiel AU - Scheele, Fedde PY - 2019/04/05 TI - How We Evaluate Postgraduate Medical E-Learning: Systematic Review JO - JMIR Med Educ SP - e13128 VL - 5 IS - 1 KW - distance education KW - learning KW - professional education N2 - Background: Electronic learning (e-learning) in postgraduate medical education has seen a rapid evolution; however, we tend to evaluate it only on its primary outcome or learning aim, whereas its effectiveness also depends on its instructional design. We believe it is important to have an overview of all the methods currently used to evaluate e-learning design so that the preferred method may be identified and the next steps needed to continue to evaluate postgraduate medical e-learning may be outlined. Objective: This study aimed to identify and compare the outcomes and methods used to evaluate postgraduate medical e-learning. Methods: We performed a systematic literature review using the Web of Science, PubMed, Education Resources Information Center, and Cumulative Index of Nursing and Allied Health Literature databases. Studies that used postgraduates as participants and evaluated any form of e-learning were included. Studies without any evaluation outcome (eg, just a description of e-learning) were excluded. Results: The initial search identified 5973 articles, of which we used 418 for our analysis. The types of studies were trials, prospective cohorts, case reports, and reviews. The primary outcomes of the included studies were knowledge, skills, and attitude. A total of 12 instruments were used to evaluate a specific primary outcome, such as laparoscopic skills or stress related to training. The secondary outcomes mainly evaluated satisfaction, motivation, efficiency, and usefulness. We found 13 e-learning design methods across 19 studies (4% 19/418). The methods evaluated usability, motivational characteristics, and the use of learning styles or were based on instructional design theories, such as Gagne?s instructional design, the Heidelberg inventory, Kern?s curriculum development steps, and a scale based on the cognitive load theory. Finally, 2 instruments attempted to evaluate several aspects of a design, based on the experience of creating e-learning. Conclusions: Evaluating the effect of e-learning design is complicated. Given the diversity of e-learning methods, there are many ways to carry out such an evaluation, and probably, many ways to do so correctly. However, the current literature shows us that we have yet to reach any form of consensus about which indicators to evaluate. There is a great need for an evaluation tool that is properly constructed, validated, and tested. This could be a more homogeneous way to compare the effects of e-learning and for the authors of e-learning to continue to improve their product. UR - http://mededu.jmir.org/2019/1/e13128/ UR - http://dx.doi.org/10.2196/13128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30950805 ID - info:doi/10.2196/13128 ER - TY - JOUR AU - Alturkistani, Abrar AU - Majeed, Azeem AU - Car, Josip AU - Brindley, David AU - Wells, Glenn AU - Meinert, Edward PY - 2019/04/02 TI - Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study JO - JMIR Med Educ SP - e10982 VL - 5 IS - 1 KW - education, distance KW - education KW - teaching KW - online learning KW - online education KW - MOOC KW - massive open online course N2 - Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark?s method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners? experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology. UR - http://mededu.jmir.org/2019/1/e10982/ UR - http://dx.doi.org/10.2196/10982 UR - http://www.ncbi.nlm.nih.gov/pubmed/30938683 ID - info:doi/10.2196/10982 ER - TY - JOUR AU - Wang, Dongwen AU - Abrams, Meredith PY - 2019/03/28 TI - Health Care Providers? Profiles and Evaluations of a Statewide Online Education Program for Dissemination of Clinical Evidence on HIV, Hepatitis C Virus, and Sexually Transmitted Disease: Cross-Sectional Study JO - JMIR Med Educ SP - e10722 VL - 5 IS - 1 KW - information dissemination KW - online systems KW - continuing education KW - HIV KW - hepatitis C KW - sexually transmitted diseases KW - multimedia N2 - Background: Timely and effective dissemination of the latest clinical evidence to health care providers is essential for translating biomedical research into routine patient care. Online platforms offer unique opportunities for dissemination of medical knowledge. Objective: In this study, we report the profiles of health care providers participating in the New York State HIV-HCV-STD Clinical Education Initiative online program and their evaluations of the online continuing professional development courses. Methods: We compiled professional and personal background information of the clinicians who completed at least one online course. We collected their self-reported program evaluation data with regard to the course content, format, knowledge increase, and impact on clinical practice. Results: We recorded a total of 4363 completions of 88 online courses by 1976 unique clinicians during a 12-month study period. The clinicians? background was diverse in terms of demographics, education levels, professional disciplines, practice years, employment settings, caseloads, and clinical services. The evaluation of online courses was very positive (usefulness/relevance, 91.08%; easy comprehension, 89.09%; knowledgeable trainer, 92.00%; appropriate format, 84.35%; knowledge increase, 48.52%; intention to use knowledge, 85.26%; and plan to change practice, 21.98%). Comparison with the reference data indicated that the online program successfully reached out to the primary care communities. Both the younger generation and the senior health care providers were attracted to the online program. High-quality multimedia resources, flexibility of access, ease of use, and provision of continuing professional development credits contributed to the initial success of this online clinical education program. Conclusions: We have successfully characterized a diverse group of clinicians participating in a statewide online continuing professional development program. The evaluation has shown effective use of online resources to disseminate clinical evidence on HIV, hepatitis C virus, and sexually transmitted disease to primary care clinicians. UR - http://mededu.jmir.org/2019/1/e10722/ UR - http://dx.doi.org/10.2196/10722 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920374 ID - info:doi/10.2196/10722 ER - TY - JOUR AU - Kyaw, Myint Bhone AU - Posadzki, Pawel AU - Dunleavy, Gerard AU - Semwal, Monika AU - Divakar, Ushashree AU - Hervatis, Vasilis AU - Tudor Car, Lorainne PY - 2019/03/25 TI - Offline Digital Education for Medical Students: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration JO - J Med Internet Res SP - e13165 VL - 21 IS - 3 KW - medical education KW - systematic review KW - meta-analysis KW - randomized controlled trials KW - students, medical N2 - Background: Medical schools in low- and middle-income countries are facing a shortage of staff, limited infrastructure, and restricted access to fast and reliable internet. Offline digital education may be an alternative solution for these issues, allowing medical students to learn at their own time and pace, without the need for a network connection. Objective: The primary objective of this systematic review was to assess the effectiveness of offline digital education compared with traditional learning or a different form of offline digital education such as CD-ROM or PowerPoint presentations in improving knowledge, skills, attitudes, and satisfaction of medical students. The secondary objective was to assess the cost-effectiveness of offline digital education, changes in its accessibility or availability, and its unintended/adverse effects on students. Methods: We carried out a systematic review of the literature by following the Cochrane methodology. We searched seven major electronic databases from January 1990 to August 2017 for randomized controlled trials (RCTs) or cluster RCTs. Two authors independently screened studies, extracted data, and assessed the risk of bias. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations criteria. Results: We included 36 studies with 3325 medical students, of which 33 were RCTs and three were cluster RCTs. The interventions consisted of software programs, CD-ROMs, PowerPoint presentations, computer-based videos, and other computer-based interventions. The pooled estimate of 19 studies (1717 participants) showed no significant difference between offline digital education and traditional learning groups in terms of students? postintervention knowledge scores (standardized mean difference=0.11, 95% CI ?0.11 to 0.32; small effect size; low-quality evidence). Meta-analysis of four studies found that, compared with traditional learning, offline digital education improved medical students? postintervention skills (standardized mean difference=1.05, 95% CI 0.15-1.95; large effect size; low-quality evidence). We are uncertain about the effects of offline digital education on students? attitudes and satisfaction due to missing or incomplete outcome data. Only four studies estimated the costs of offline digital education, and none reported changes in accessibility or availability of such education or in the adverse effects. The risk of bias was predominantly high in more than half of the included studies. The overall quality of the evidence was low (for knowledge, skills, attitudes, and satisfaction) due to the study limitations and inconsistency across the studies. Conclusions: Our findings suggest that offline digital education is as effective as traditional learning in terms of medical students? knowledge and may be more effective than traditional learning in terms of medical students? skills. However, there is a need to further investigate students? attitudes and satisfaction with offline digital education as well as its cost-effectiveness, changes in its accessibility or availability, and any resulting unintended/adverse effects. UR - http://www.jmir.org/2019/3/e13165/ UR - http://dx.doi.org/10.2196/13165 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907731 ID - info:doi/10.2196/13165 ER - TY - JOUR AU - Martinengo, Laura AU - Yeo, Ying Natalie Jia AU - Tang, Qiang Zheng AU - Markandran, D/O Kasturi AU - Kyaw, Myint Bhone AU - Tudor Car, Lorainne PY - 2019/03/25 TI - Digital Education for the Management of Chronic Wounds in Health Care Professionals: Protocol for a Systematic Review by the Digital Health Education Collaboration JO - JMIR Res Protoc SP - e12488 VL - 8 IS - 3 KW - distance education KW - digital education KW - e-learning KW - continuous medical education KW - health professions KW - health personnel KW - leg ulcers KW - pressure ulcers KW - systematic review N2 - Background: Digital education is ?the act of teaching and learning by means of digital technologies.? Digital education comprises a wide range of interventions that can be broadly divided into offline digital education, online digital education, digital game-based learning, massive open online courses (MOOCs), psychomotor skills trainers, virtual reality environments, virtual patient simulations, and m-learning. Chronic wounds pose an immense economic and psychosocial burden to patients and the health care system, as caring for them require highly specialized personnel. Current training strategies face significant barriers, such as lack of time due to work commitments, distance from provider centers, and costs. Therefore, there is an increased need to synthesize evidence on the effectiveness of digital education interventions on chronic wounds management in health care professionals. Objective: Our main objective is to assess the effectiveness of digital education as a stand-alone approach or as part of a blended-learning approach in improving pre- and postregistration health care professionals? knowledge, attitudes, practical skills, and behavior in the management of chronic wounds, as well as their satisfaction with the intervention. Secondary objectives are to evaluate patient-related outcomes, cost-effectiveness of the interventions, and any unfavorable or undesirable outcomes that may arise. Methods: This systematic review will follow the methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions. As our systematic review is one of a series of reviews on digital education for health professionals? education, we will use a previously developed search strategy. This search includes the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library), MEDLINE (Ovid), Embase (Ovid), Web of Science, the Educational Resource Information Centre (ERIC) (Ovid), PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), the ProQuest Dissertation and Theses database, and trial registries. Databases will be searched for studies published from January 1990 to August 2018. Two independent reviewers will screen the library for included studies. We will describe the screening process using a flowchart as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will extract the data using a previously developed, structured data extraction form. Included studies will be quality-assessed using the Risk of Bias tool from Cochrane. We will narratively summarize the data and, if possible, we will conduct a meta-analysis. We will use Cochrane?s RevMan 5.3 software for data analysis. Results: We have completed the screening of titles and abstracts for this systematic review and are currently selecting papers against our inclusion and exclusion criteria through full-text revision. We are expecting to complete our review by the end of April 2019. Conclusions: This systematic review will provide an in-depth analysis of digital education strategies to train health care providers in the management of chronic wounds. We consider this topic particularly relevant given the current challenges facing health care systems worldwide, including shortages of skilled personnel and a steep increase in the population of older adults as a result of a prolonged life expectancy. Trial Registration: PROSPERO CRD42018109971; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=109971 International Registered Report Identifier (IRRID): DERR1-10.2196/12488 UR - http://www.researchprotocols.org/2019/3/e12488/ UR - http://dx.doi.org/10.2196/12488 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907743 ID - info:doi/10.2196/12488 ER - TY - JOUR AU - Zhang, Wei AU - Li, Zheng-Rong AU - Li, Zhi PY - 2019/03/19 TI - WeChat as a Platform for Problem-Based Learning in a Dental Practical Clerkship: Feasibility Study JO - J Med Internet Res SP - e12127 VL - 21 IS - 3 KW - PBL KW - app KW - WeChat KW - clerkship KW - dental medicine N2 - Background: Problem-Based-Learning (PBL) has been widely accepted in student-centered medical education. Since WeChat is the most popular communication app in China, we have chosen to use WeChat as new platform for online PBL in order to reduce the limitations of traditional PBL in dental practical clerkships. Objective: This study aims to demonstrate the feasibility and acceptability of online PBL using WeChat (WeChat-PBL) in a dental practical clerkship. Methods: A total of 72 students in a dental practical clerkship and 10 tutors participated in this study from June to August 2017. We created 10 WeChat groups to provide a communication platform for the PBL teaching, in which the students selected the PBL cases themselves from their practical clerkship. After each individual PBL case, group members were required to complete an evaluation on the PBL process itself. A final questionnaire survey was completed by the participants to summarize the long-term evaluation of the whole WeChat-PBL experience after the 3-month clerkship. Data from the PBL cases, WeChat messages, periodic evaluations, and long-term evaluations were collected for analysis. Results: There were 45 cases presented in the WeChat-PBL within the 3-month clerkship. All students had positive reactions to the communication within the PBL groups. The results of the periodic evaluation showed that the students and tutors were quite satisfied with the process of WeChat-PBL and appreciated the group members? contributions and performance. The final questionnaire results indicated that the WeChat-PBL had achieved positive effects. Conclusions: The results of this study indicate the feasibility and acceptability of the app, WeChat, for problem-based learning in a dental practical clerkship. UR - http://www.jmir.org/2019/3/e12127/ UR - http://dx.doi.org/10.2196/12127 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888328 ID - info:doi/10.2196/12127 ER - TY - JOUR AU - Padilha, Miguel José AU - Machado, Puga Paulo AU - Ribeiro, Ana AU - Ramos, José AU - Costa, Patrício PY - 2019/03/18 TI - Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial JO - J Med Internet Res SP - e11529 VL - 21 IS - 3 KW - clinical virtual simulation KW - nursing education KW - virtual patient KW - user-computer interface N2 - Background: In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students? intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple ?lecturers? and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods: A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students? levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results: The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students. UR - http://www.jmir.org/2019/3/e11529/ UR - http://dx.doi.org/10.2196/11529 UR - http://www.ncbi.nlm.nih.gov/pubmed/30882355 ID - info:doi/10.2196/11529 ER - TY - JOUR AU - Bajpai, Shweta AU - Semwal, Monika AU - Bajpai, Ram AU - Car, Josip AU - Ho, Yan Andy Hau PY - 2019/03/12 TI - Health Professions? Digital Education: Review of Learning Theories in Randomized Controlled Trials by the Digital Health Education Collaboration JO - J Med Internet Res SP - e12912 VL - 21 IS - 3 KW - learning theory KW - health professions KW - digital education KW - digital health education KW - digital education interventions N2 - Background: Learning theory is an essential component for designing an effective educational curriculum. Reviews of existing literature consistently lack sufficient evidence to support the effectiveness of digital interventions for health professions? education, which may reflect disconnections among learning theories, curriculum design, use of technology, and outcome evaluation. Objective: The aim of this review was to identify, map, and evaluate the use of learning theories in designing and implementing intervention trials of health professions? digital education, as well as highlight areas for future research on technology-enhanced education via the establishment of a development framework for practice and research. Methods: We performed a systematic search of Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cochrane Central Register of Controlled Trials (Cochrane Library), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, and Web of Science for randomized controlled trials (RCTs) published between 2007 and 2016. Results: A total of 874 RCTs on digital health education were identified and categorized into online-offline, mobile digital education, and simulation-based modalities for pre and postregistration health professions? education. Of these, 242 studies were randomly selected for methodological review and thematic analysis. Data were extracted by one author using a standardized form, with a (48/242, 20%) random sample extracted by a second author, in duplicate. One-third (81/242, 33.4%) of the studies reported single or multiple learning theories in design, assessment, conceptualization, or interpretation of outcomes of the digital education interventions. Commonly reported learning theories were problem-based learning (16/81, 20%), social learning theory (11/81, 14%), and cognitive theory of multimedia learning (10/81, 12%). Most of these studies assessed knowledge (118/242, 48.8%), skills (62/242, 25.6%), and performance (59/242, 24.3%) as primary outcomes with nonvalidated assessment tools (151/242, 62.4%). Studies with reported learning theories (?21=8.2; P=.002) and validated instruments (?21=12.6; P=.006) have shown effective acquisition of learning outcomes. Conclusions: We proposed a Theory-Technology Alignment Framework to safeguard the robustness and integrity of the design and implementation of future digital education programs for the training of health professionals. UR - http://www.jmir.org/2019/3/e12912/ UR - http://dx.doi.org/10.2196/12912 UR - http://www.ncbi.nlm.nih.gov/pubmed/30860483 ID - info:doi/10.2196/12912 ER - TY - JOUR AU - Hurley, A. Deirdre AU - Keogh, Alison AU - Mc Ardle, Danielle AU - Hall, M. Amanda AU - Richmond, Helen AU - Guerin, Suzanne AU - Magdalinski, Tara AU - Matthews, James PY - 2019/03/07 TI - Evaluation of an E-Learning Training Program to Support Implementation of a Group-Based, Theory-Driven, Self-Management Intervention For Osteoarthritis and Low-Back Pain: Pre-Post Study JO - J Med Internet Res SP - e11123 VL - 21 IS - 3 KW - technology-enhanced learning KW - evaluation KW - e-learning KW - digital learning KW - program evaluation KW - effectiveness KW - physiotherapy KW - implementation KW - osteoarthritis KW - low-back pain N2 - Background: By adaptation of the face-to-face physiotherapist-training program previously used in the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) feasibility trial, an asynchronous, interactive, Web-based, e-learning training program (E-SOLAS) underpinned by behavior and learning theories was developed. Objective: This study investigated the effect of the E-SOLAS training program on relevant outcomes of effective training and implementation. Methods: Thirteen physiotherapists from across Ireland were trained via E-SOLAS by using mixed methods, and seven physiotherapists progressed to implementation of the 6-week group-based SOLAS intervention. The effectiveness of E-SOLAS was evaluated using the Kirkpatrick model at the levels of reaction (physiotherapist engagement and satisfaction with E-SOLAS training methods and content), learning (pre- to posttraining changes in physiotherapists? confidence and knowledge in delivering SOLAS content and self-determination theory-based communication strategies, administered via a SurveyMonkey questionnaire), and behavior (fidelity to delivery of SOLAS content using physiotherapist-completed weekly checklists). During implementation, five physiotherapists audio recorded delivery of one class, and the communication between physiotherapists and clients was assessed using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behaviour Scale (CCBS), and an intervention-specific measure (ISM; 7-point Likert scale). A range of implementation outcomes were evaluated during training and delivery (ie, acceptability, appropriateness, feasibility, fidelity, and sustainability of E-SOLAS) using a posttraining feedback questionnaire and individual semistructured telephone interviews. Results: With regard to their reaction, physiotherapists (n=13) were very satisfied with E-SOLAS posttraining (median 5.0; interquartile range 1.0; min-max 4.0-5.0) and completed training within 3-4 weeks. With regard to learning, there were significant increases in physiotherapists? confidence and knowledge in delivery of all SOLAS intervention components (P<.05). Physiotherapists? confidence in 7 of 10 self-determination theory-based communication strategies increased (P<.05), whereas physiotherapists? knowledge of self-determination theory-based strategies remained high posttraining (P>.05). In terms of behavior, physiotherapists delivered SOLAS in a needs supportive manner (HCCQ: median 5.2, interquartile range 1.3, min-max 3.7-5.8; CCBS: median 6.6, interquartile range 1.0, min-max 5.6-7.0; ISM: median 4.5, interquartile range 1.2, min-max 2.8-4.8). Fidelity scores were high for SOLAS content delivery (total %mean fidelity score 93.5%; SD 4.9%). The posttraining questionnaire and postdelivery qualitative interviews showed that physiotherapists found E-SOLAS acceptable, appropriate, feasible, and sustainable within primary care services to support the implementation of the SOLAS intervention. Conclusions: This study provides preliminary evidence of the effectiveness, acceptability, and feasibility of an e-learning program to train physiotherapists to deliver a group-based self-management complex intervention in primary care settings, which is equivalent to face-to-face training outcomes and would support inclusion of physiotherapists in a definitive trial of SOLAS. UR - https://www.jmir.org/2019/3/e11123/ UR - http://dx.doi.org/10.2196/11123 UR - http://www.ncbi.nlm.nih.gov/pubmed/30843863 ID - info:doi/10.2196/11123 ER - TY - JOUR AU - Laine, Anna AU - Välimäki, Maritta AU - Löyttyniemi, Eliisa AU - Pekurinen, Virve AU - Marttunen, Mauri AU - Anttila, Minna PY - 2019/03/01 TI - The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study JO - J Med Internet Res SP - e11198 VL - 21 IS - 3 KW - internet KW - online education KW - mental health KW - continuing education N2 - Background: Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments. Objective: We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described. Methods: The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course. Results: Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages. Conclusions: Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed. UR - https://www.jmir.org/2019/3/e11198/ UR - http://dx.doi.org/10.2196/11198 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821697 ID - info:doi/10.2196/11198 ER - TY - JOUR AU - Wahabi, Abdelmageed Hayfaa AU - Esmaeil, Ahmed Samia AU - Bahkali, Hassan Khawater AU - Titi, Abdelraheim Maher AU - Amer, Sami Yasser AU - Fayed, Ahmed Amel AU - Jamal, Amr AU - Zakaria, Nasriah AU - Siddiqui, Rehana Amna AU - Semwal, Monika AU - Car, Tudor Lorainne AU - Posadzki, Paul AU - Car, Josip PY - 2019/03/01 TI - Medical Doctors? Offline Computer-Assisted Digital Education: Systematic Review by the Digital Health Education Collaboration JO - J Med Internet Res SP - e12998 VL - 21 IS - 3 KW - systematic review KW - medical education, digital education N2 - Background: The widening gap between innovations in the medical field and the dissemination of such information to doctors may affect the quality of care. Offline computer-based digital education (OCDE) may be a potential solution to overcoming the geographical, financial, and temporal obstacles faced by doctors. Objective: The objectives of this systematic review were to evaluate the effectiveness of OCDE compared with face-to-face learning, no intervention, or other types of digital learning for improving medical doctors? knowledge, cognitive skills, and patient-related outcomes. Secondary objectives were to assess the cost-effectiveness (CE) of OCDE and any adverse effects. Methods: We searched major bibliographic databases from 1990 to August 2017 to identify relevant articles and followed the Cochrane methodology for systematic reviews of intervention. Results: Overall, 27 randomized controlled trials (RCTs), 1 cluster RCT (cRCT), and 1 quasi-RCT were included in this review. The total number of participants was 1690 in addition to the cRCT, which included 24 practices. Due to the heterogeneity of the participants, interventions, and outcomes, meta-analysis was not feasible, and the results were presented as narrative summary. Compared with face-to-face learning, the effect of OCDE on knowledge gain is uncertain (ratio of the means [RM] range 0.95-1.17; 8 studies, 495 participants; very low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 0.1-0.9; 8 studies, 375 participants; very low grade of evidence). OCDE may have little or no effect on patients? outcome compared with face-to-face education (2 studies, 62 participants; low grade of evidence). Compared with no intervention, OCDE may improve knowledge gain (RM range 1.36-0.98; 4 studies, 401 participants; low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 1.1-1.15; 4 trials, 495 participants; very low grade of evidence). One cRCT, involving 24 practices, investigated patients? outcome in this comparison and showed no difference between the 2 groups with low-grade evidence. Compared with text-based learning, the effect of OCDE on cognitive skills gain is uncertain (RM range 0.91-1.46; 3 trials with 4 interventions; 68 participants; very low-grade evidence). No study in this comparison investigated knowledge gain or patients? outcomes. One study assessed the CE and showed that OCDE was cost-effective when compared with face-to-face learning if the cost is less than or equal to Can $200. No trial evaluated the adverse effect of OCDE. Conclusions: The effect of OCDE compared with other methods of education on medical doctors? knowledge and cognitive skill gain is uncertain. OCDE may improve doctors? knowledge compared with no intervention but its effect on doctors? cognitive skills is uncertain. OCDE may have little or no effect in improving patients? outcome. UR - https://www.jmir.org/2019/3/e12998/ UR - http://dx.doi.org/10.2196/12998 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821689 ID - info:doi/10.2196/12998 ER - TY - JOUR AU - Tudor Car, Lorainne AU - Kyaw, Myint Bhone AU - Dunleavy, Gerard AU - Smart, A. Neil AU - Semwal, Monika AU - Rotgans, I. Jerome AU - Low-Beer, Naomi AU - Campbell, James PY - 2019/02/28 TI - Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration JO - J Med Internet Res SP - e12945 VL - 21 IS - 2 KW - randomized controlled trials KW - effectiveness KW - systematic review KW - problem-based learning KW - medical education N2 - Background: The use of digital education in problem-based learning, or digital problem-based learning (DPBL), is increasingly employed in health professions education. DPBL includes purely digitally delivered as well as blended problem-based learning, wherein digital and face-to-face learning are combined. Objective: The aim of this review is to evaluate the effectiveness of DPBL in improving health professionals? knowledge, skills, attitudes, and satisfaction. Methods: We used the gold-standard Cochrane methods to conduct a systematic review of randomized controlled trials (RCTs). We included studies that compared the effectiveness of DPBL with traditional learning methods or other forms of digital education in improving health professionals? knowledge, skills, attitudes, and satisfaction. Two authors independently screened studies, extracted data, and assessed the risk of bias. We contacted study authors for additional information, if necessary. We used the random-effects model in the meta-analyses. Results: Nine RCTs involving 890 preregistration health professionals were included. Digital technology was mostly employed for presentation of problems. In three studies, PBL was delivered fully online. Digital technology modalities spanned online learning, offline learning, virtual reality, and virtual patients. The control groups consisted of traditional PBL and traditional learning. The pooled analysis of seven studies comparing the effect of DPBL and traditional PBL reported little or no difference in postintervention knowledge outcomes (standardized mean difference [SMD] 0.19, 95% CI 0.00-0.38). The pooled analysis of three studies comparing the effect of DPBL to traditional learning on postintervention knowledge outcomes favored DPBL (SMD 0.67, 95% CI 0.14-1.19). For skill development, the pooled analysis of two studies comparing DPBL to traditional PBL favored DPBL (SMD 0.30, 95% CI 0.07-0.54). Findings on attitudes and satisfaction outcomes were mixed. The included studies mostly had an unclear risk of bias. Conclusions: Our findings suggest that DPBL is as effective as traditional PBL and more effective than traditional learning in improving knowledge. DPBL may be more effective than traditional learning or traditional PBL in improving skills. Further studies should evaluate the use of digital technology for the delivery of other PBL components as well as PBL overall. UR - https://www.jmir.org/2019/2/e12945/ UR - http://dx.doi.org/10.2196/12945 UR - http://www.ncbi.nlm.nih.gov/pubmed/30816846 ID - info:doi/10.2196/12945 ER - TY - JOUR AU - George, Paul Pradeep AU - Zhabenko, Olena AU - Kyaw, Myint Bhone AU - Antoniou, Panagiotis AU - Posadzki, Pawel AU - Saxena, Nakul AU - Semwal, Monika AU - Tudor Car, Lorainne AU - Zary, Nabil AU - Lockwood, Craig AU - Car, Josip PY - 2019/02/25 TI - Online Digital Education for Postregistration Training of Medical Doctors: Systematic Review by the Digital Health Education Collaboration JO - J Med Internet Res SP - e13269 VL - 21 IS - 2 KW - randomized controlled trials KW - effectiveness KW - systematic review KW - medical education KW - internet N2 - Background: Globally, online and local area network?based (LAN) digital education (ODE) has grown in popularity. Blended learning is used by ODE along with traditional learning. Studies have shown the increasing potential of these technologies in training medical doctors; however, the evidence for its effectiveness and cost-effectiveness is unclear. Objective: This systematic review evaluated the effectiveness of online and LAN-based ODE in improving practicing medical doctors? knowledge, skills, attitude, satisfaction (primary outcomes), practice or behavior change, patient outcomes, and cost-effectiveness (secondary outcomes). Methods: We searched seven electronic databased for randomized controlled trials, cluster-randomized trials, and quasi-randomized trials from January 1990 to March 2017. Two review authors independently extracted data and assessed the risk of bias. We have presented the findings narratively. We mainly compared ODE with self-directed/face-to-face learning and blended learning with self-directed/face-to-face learning. Results: A total of 93 studies (N=16,895) were included, of which 76 compared ODE (including blended) and self-directed/face-to-face learning. Overall, the effect of ODE (including blended) on postintervention knowledge, skills, attitude, satisfaction, practice or behavior change, and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher postintervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge scores (small to large effect size and very low quality) for the intervention, while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size and low quality), while 13 studies reported no difference in the skill scores between the groups. One study reported a higher attitude score for the intervention (very low quality), while four studies reported no difference in the attitude score between the groups. Four studies reported higher postintervention physician satisfaction with the intervention (large effect size and low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher postintervention practice or behavior change for the ODE group (small to moderate effect size and low quality), while five studies reported no difference in practice or behavior change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects or cost-effectiveness of the interventions. Conclusions: Empiric evidence showed that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training practicing physicians. Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning. The quality of the evidence in these studies was found to be very low for knowledge. Further high-quality randomized controlled trials are required to confirm these findings. UR - http://www.jmir.org/2019/2/e13269/ UR - http://dx.doi.org/10.2196/13269 UR - http://www.ncbi.nlm.nih.gov/pubmed/30801252 ID - info:doi/10.2196/13269 ER - TY - JOUR AU - Huang, Zhilian AU - Semwal, Monika AU - Lee, Yee Shuen AU - Tee, Mervin AU - Ong, William AU - Tan, Shin Woan AU - Bajpai, Ram AU - Tudor Car, Lorainne PY - 2019/02/21 TI - Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration JO - J Med Internet Res SP - e12997 VL - 21 IS - 2 KW - evidence-based practice KW - health personnel KW - learning KW - systematic review KW - diabetes mellitus N2 - Background: There is a shortage of health care professionals competent in diabetes management worldwide. Digital education is increasingly used in educating health professionals on diabetes. Digital diabetes self-management education for patients has been shown to improve patients? knowledge and outcomes. However, the effectiveness of digital education on diabetes management for health care professionals is still unknown. Objective: The objective of this study was to assess the effectiveness and economic impact of digital education in improving health care professionals? knowledge, skills, attitudes, satisfaction, and competencies. We also assessed its impact on patient outcomes and health care professionals? behavior. Methods: We included randomized controlled trials evaluating the impact of digitalized diabetes management education for health care professionals pre- and postregistration. Publications from 1990 to 2017 were searched in MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, ERIC, and Web of Science. Screening, data extraction and risk of bias assessment were conducted independently by 2 authors. Results: A total of 12 studies met the inclusion criteria. Studies were heterogeneous in terms of digital education modality, comparators, outcome measures, and intervention duration. Most studies comparing digital or blended education to traditional education reported significantly higher knowledge and skills scores in the intervention group. There was little or no between-group difference in patient outcomes or economic impact. Most studies were judged at a high or unclear risk of bias. Conclusions: Digital education seems to be more effective than traditional education in improving diabetes management?related knowledge and skills. The paucity and low quality of the available evidence call for urgent and well-designed studies focusing on important outcomes such as health care professionals? behavior, patient outcomes, and cost-effectiveness as well as its impact in diverse settings, including developing countries. UR - http://www.jmir.org/2019/2/e12997/ UR - http://dx.doi.org/10.2196/12997 UR - http://www.ncbi.nlm.nih.gov/pubmed/30789348 ID - info:doi/10.2196/12997 ER - TY - JOUR AU - Chan, KM Albert AU - Botelho, G. Michael AU - Lam, LT Otto PY - 2019/02/13 TI - Use of Learning Analytics Data in Health Care?Related Educational Disciplines: Systematic Review JO - J Med Internet Res SP - e11241 VL - 21 IS - 2 KW - education KW - e-learning KW - learning analytics KW - learning management systems KW - online learning KW - systematic review N2 - Background: While the application of learning analytics in tertiary education has received increasing attention in recent years, a much smaller number have explored its use in health care-related educational studies. Objective: This systematic review aims to examine the use of e-learning analytics data in health care studies with regards to how the analytics is reported and if there is a relationship between e-learning analytics and learning outcomes. Methods: We performed comprehensive searches of papers from 4 electronic databases (MEDLINE, EBSCOhost, Web of Science, and ERIC) to identify relevant papers. Qualitative studies were excluded from this review. Papers were screened by 2 independent reviewers. We selected qualified studies for further investigation. Results: A total of 537 papers were screened, and 19 papers were identified. With regards to analytics undertaken, 11 studies reported the number of connections and time spent on e-learning. Learning outcome measures were defined by summative final assessment marks or grades. In addition, significant statistical results of the relationships between e-learning usage and learning outcomes were reported in 12 of the identified papers. In general, students who engaged more in e-learning resources would get better academic attainments. However, 2 papers reported otherwise with better performing students consuming less e-learning videos. A total of 14 papers utilized satisfaction questionnaires for students, and all were positive in their attitude toward e-learning. Furthermore, 6 of 19 papers reported descriptive statistics only, with no statistical analysis. Conclusions: The nature of e-learning activities reported in this review was varied and not detailed well. In addition, there appeared to be inadequate reporting of learning analytics data observed in over half of the selected papers with regards to definitions and lack of detailed information of what the analytic was recording. Although learning analytics data capture is popular, a lack of detail is apparent with regards to the capturing of meaningful and comparable data. In particular, most analytics record access to a management system or particular e-learning materials, which may not necessarily detail meaningful learning time or interaction. Hence, learning analytics data should be designed to record the time spent on learning and focus on key learning activities. Finally, recommendations are made for future studies. UR - http://www.jmir.org/2019/2/e11241/ UR - http://dx.doi.org/10.2196/11241 UR - http://www.ncbi.nlm.nih.gov/pubmed/30758291 ID - info:doi/10.2196/11241 ER - TY - JOUR AU - Adam, Maya AU - McMahon, A. Shannon AU - Prober, Charles AU - Bärnighausen, Till PY - 2019/01/30 TI - Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach JO - J Med Internet Res SP - e12128 VL - 21 IS - 1 KW - human-centered design KW - health promotion KW - health behavior KW - health knowledge, attitudes, practice KW - community health workers KW - telemedicine KW - eHealth KW - mHealth UR - http://www.jmir.org/2019/1/e12128/ UR - http://dx.doi.org/10.2196/12128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698531 ID - info:doi/10.2196/12128 ER - TY - JOUR AU - Barteit, Sandra AU - Neuhann, Florian AU - Bärnighausen, Till AU - Bowa, Annel AU - Lüders, Sigrid AU - Malunga, Gregory AU - Chileshe, Geoffrey AU - Marimo, Clemence AU - Jahn, Albrecht PY - 2019/1/15 TI - Perspectives of Nonphysician Clinical Students and Medical Lecturers on Tablet-Based Health Care Practice Support for Medical Education in Zambia, Africa: Qualitative Study JO - JMIR Mhealth Uhealth SP - e12637 VL - 7 IS - 1 KW - educational technology KW - computers, handheld KW - computer-assisted decision making KW - mobile apps KW - information dissemination KW - education KW - allied health occupations KW - Africa, Southern KW - Zambia N2 - Background: Zambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access. Objective: This study aimed to explore MLP students? and medical lecturers? perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation. Methods: We conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding. Results: The eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given. Conclusions: To address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support. UR - http://mhealth.jmir.org/2019/1/e12637/ UR - http://dx.doi.org/10.2196/12637 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/12637 ER - TY - JOUR AU - Rankin, Audra AU - Truskey, Maria AU - Chisolm, S. Margaret PY - 2019/01/11 TI - The Use of Social Media in Interprofessional Education: Systematic Review JO - JMIR Med Educ SP - e11328 VL - 5 IS - 1 KW - interprofessional education KW - interprofessional learning KW - medicine KW - nursing KW - social media, social networking N2 - Background: The implementation of interprofessional education (IPE) activities into health care education is a challenge for many training programs owing to time and location constraints of both faculty and learners. The integration of social media into these IPE activities may provide a solution to these problems. Objective: This review of the published literature aims to identify health care IPE activities using social media. Methods: The authors searched 5 databases (from the beginning coverage date to May 27, 2017) using keywords related to IPE and social media. Teams of 2 authors independently reviewed the search results to identify peer-reviewed, English language papers reporting on IPE activities using social media. They assessed the study quality of identified papers using the Medical Education Research Study Quality Instrument. Results: A total of 8 studies met the review?s inclusion criteria. Of these 8 papers, 3 had single-group, posttest-only study design; 4 had single-group, pre- and posttest design; and 1 had nonrandomized 3-group design. Qualitative and quantitative outcome measures showed mixed results with the majority of student feedback being positive. Conclusions: Despite a need for additional research, this review suggests that the use of social media may aid the implementation of health care IPE. UR - https://mededu.jmir.org/2019/1/e11328/ UR - http://dx.doi.org/10.2196/11328 UR - http://www.ncbi.nlm.nih.gov/pubmed/30632967 ID - info:doi/10.2196/11328 ER - TY - JOUR AU - Barteit, Sandra AU - Jahn, Albrecht AU - Banda, S. Sekelani AU - Bärnighausen, Till AU - Bowa, Annel AU - Chileshe, Geoffrey AU - Guzek, Dorota AU - Jorge, Mendes Margarida AU - Lüders, Sigrid AU - Malunga, Gregory AU - Neuhann, Florian PY - 2019/01/09 TI - E-Learning for Medical Education in Sub-Saharan Africa and Low-Resource Settings: Viewpoint JO - J Med Internet Res SP - e12449 VL - 21 IS - 1 KW - medical e-learning KW - technology-enhanced learning KW - blended learning KW - health workers KW - health system strengthening KW - universal health coverage KW - medical education KW - mHealth KW - eHealth KW - developing countries KW - sub-Saharan Africa KW - low-resource countries UR - http://www.jmir.org/2019/1/e12449/ UR - http://dx.doi.org/10.2196/12449 UR - http://www.ncbi.nlm.nih.gov/pubmed/30626565 ID - info:doi/10.2196/12449 ER - TY - JOUR AU - Barteit, Sandra AU - Jahn, Albrecht AU - Bowa, Annel AU - Lüders, Sigrid AU - Malunga, Gregory AU - Marimo, Clemence AU - Wolter, Sigrid AU - Neuhann, Florian PY - 2018/11/27 TI - How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study JO - JMIR Med Educ SP - e10222 VL - 4 IS - 2 KW - evaluation KW - medical e-learning KW - intervention KW - sustainability KW - effectiveness KW - adoption KW - health care workers KW - rural health KW - sub-Saharan Africa N2 - Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials. Objective: Our aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training. Methods: The pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data?s adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills. Results: In total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80%) and high agreement (>75%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized. Conclusions: The pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes. UR - http://mededu.jmir.org/2018/2/e10222/ UR - http://dx.doi.org/10.2196/10222 UR - http://www.ncbi.nlm.nih.gov/pubmed/30482744 ID - info:doi/10.2196/10222 ER - TY - JOUR AU - Sheng, Y. Alexander AU - Chu, Andrew AU - Biancarelli, Dea AU - Drainoni, Mari-Lynn AU - Sullivan, Ryan AU - Schneider, I. Jeffrey PY - 2018/10/17 TI - A Novel Web-Based Experiential Learning Platform for Medical Students (Learning Moment): Qualitative Study JO - JMIR Med Educ SP - e10657 VL - 4 IS - 2 KW - experiential learning KW - reflection KW - shared learning N2 - Background: Experiential learning plays a critical role in learner development. Kolb?s 4-part experiential learning model consists of concrete experience, reflective observation, abstract conceptualization, and active experimentation in a recurring cycle. Most clinical environments provide opportunities for experiences and active experimentation but rarely offer structured means for reflection and abstract conceptualization that are crucial for learners to learn through experience. We created Learning Moment, a novel Web-based educational tool that integrates principles of asynchronous learning and learning portfolios to fulfill the reflection and abstract conceptualization aspects of Kolb?s learning cycle in the modern clinical learning environment. Medical students log concise clinical ?pearls? in the form of ?learning moments? for reflection, review, and sharing with peers in a community of practice. Objective: We sought to evaluate learners? experiences with Learning Moment via a qualitative study. Methods: We employed purposive sampling to recruit medical students who used Learning Moment during their rotation. We conducted 13 semistructured interviews (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. Results: A total of 13 students (five in their third year of medical school and eight in their fourth year) voluntarily participated in our qualitative interviews. Five of the 13 (38%) students intended to pursue emergency medicine as their chosen field of specialty. The median number of ?learning moments? logged by these students is 6. From our analysis, three key themes emerged relating to the perceived impact of Learning Moment on student learning: (1) logging ?learning moments? enhanced memorization, (2) improved learning through reflection, and (3) sharing of knowledge and experiences in a community of practice. Conclusions: Learning Moment was successfully implemented into the educational infrastructure in our department. Students identified three mechanisms by which the application optimizes experiential learning, including enabling the logging of ?learning moments? to promote memorization, encouraging reflection to facilitate learning, and fostering the sharing of knowledge and experiences within a community of practice. The Learning Moment concept is potentially scalable to other departments, disciplines, and institutions as we seek to optimize experiential learning ecosystems for all trainees. UR - http://mededu.jmir.org/2018/2/e10657/ UR - http://dx.doi.org/10.2196/10657 UR - http://www.ncbi.nlm.nih.gov/pubmed/30333094 ID - info:doi/10.2196/10657 ER - TY - JOUR AU - Choi, Sunhea AU - Yuen, Ming Ho AU - Annan, Reginald AU - Pickup, Trevor AU - Pulman, Andy AU - Monroy-Valle, Michele AU - Aduku, Linda Nana Esi AU - Kyei-Boateng, Samuel AU - Velásquez Monzón, Isabel Carmen AU - Portillo Sermeño, Elisa Carmen AU - Penn, Andrew AU - Ashworth, Ann AU - Jackson, A. Alan PY - 2018/10/03 TI - Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study JO - J Med Internet Res SP - e10396 VL - 20 IS - 10 KW - eLearning KW - severe acute malnutrition KW - WHO guidelines for malnutrition KW - capacity building KW - staff development KW - quality improvement KW - nutrition training and education N2 - Background: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. Objective: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. Methods: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. Results: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)?a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. Conclusions: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course. UR - http://www.jmir.org/2018/10/e10396/ UR - http://dx.doi.org/10.2196/10396 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10396 ER - TY - JOUR AU - Fischer, Quentin AU - Sbissa, Yannis AU - Nhan, Pascal AU - Adjedj, Julien AU - Picard, Fabien AU - Mignon, Alexandre AU - Varenne, Olivier PY - 2018/9/24 TI - Use of Simulator-Based Teaching to Improve Medical Students? Knowledge and Competencies: Randomized Controlled Trial JO - J Med Internet Res SP - e261 VL - 20 IS - 9 KW - education KW - coronary angiography KW - high fidelity simulation training N2 - Background: Simulator-based teaching for coronary angiography (CA) is an attractive educational tool for medical students to improve their knowledge and skills. Its pedagogical impact has not been fully evaluated yet. Objective: The aim of this study was to compare traditional face-to-face teaching with a simulator-based teaching for the acquisition of coronary anatomy knowledge and CAs interpretation. Methods: A total of 118 medical school students in their fourth to sixth year were prospectively randomized in 2 groups: (1) a control teaching group (n=59, CONT group) and (2) a simulator group (using the Mentice VIST-Lab CA simulator; n=59, SIM group). The CONT group received a PowerPoint-based course, whereas the SIM group received a simulator-based course including the same information. After the course, all students were evaluated by 40 multiple choice questions (maximum of 100 points), including questions on coronary anatomy (part 1), angiographic projections (part 2), and real CAs interpretation (part 3). Satisfaction of the students was also evaluated by a simple questionnaire. Results: Student characteristics were identical in both the groups: 62/118 (52.5%) were female and age was 22.6 (SD 1.4) years. Moreover, 35.6% (42/118) were in their fourth year, 35.6% (42/118) were in the fifth year, and 28.8% (34/118) in the sixth year. During the evaluation, SIM students had higher global scores compared with CONT students, irrespective of their year of medical school (59.5 [SD 10.8] points vs 43.7 [SD 11.3] points, P<.001). The same observations were noted for each part of the test (36.9 [SD 6.6] points vs 29.6 [SD 6.9] points, P<.001; 5.9 [SD 3.0] points vs 3.1 [SD 2.8] points, P<.001; and 16.8 [SD 6.9] points vs 10.9 [SD 6.5] points, P<.001; for parts 1, 2, and 3, respectively). Student satisfaction was higher in the SIM group compared with the CONT group (98% vs 75%, P<.001). Conclusions: This study suggests that simulator-based teaching could potentially improve students? knowledge of coronary anatomy, angiography projections, and interpretation of real clinical cases, suggesting better clinical skills. These results should encourage further evaluation of simulator-based teaching in other medical specialties and how they can translate into clinical practice. UR - http://www.jmir.org/2018/9/e261/ UR - http://dx.doi.org/10.2196/jmir.9634 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249587 ID - info:doi/10.2196/jmir.9634 ER - TY - JOUR AU - Rat, Anne-Christine AU - Ricci, Laetitia AU - Guillemin, Francis AU - Ricatte, Camille AU - Pongy, Manon AU - Vieux, Rachel AU - Spitz, Elisabeth AU - Muller, Laurent PY - 2018/07/19 TI - Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET) JO - JMIR Med Educ SP - e17 VL - 4 IS - 2 KW - bad news disclosure KW - health communication KW - physician-patient relationship KW - distance e-learning N2 - Background: Although most physicians in medical settings have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and nonverbal skills, the ability to recognize and respond to patients? emotions and the importance of considering the patient?s environment such as culture and social status. How bad news is delivered can have consequences that may affect patients, sometimes over the long term. Objective: This project aimed to develop a Web-based formative self-assessment tool for physicians to practice delivering bad news to minimize the deleterious effects of poor way of breaking bad news about a disease, whatever the disease. Methods: BReaking bAD NEws Tool (BRADNET) items were developed by reviewing existing protocols and recommendations for delivering bad news. We also examined instruments for assessing patient-physician communications and conducted semistructured interviews with patients and physicians. From this step, we selected specific themes and then pooled these themes before consensus was achieved on a good practices communication framework list. Items were then created from this list. To ensure that physicians found BRADNET acceptable, understandable, and relevant to their patients? condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was used to explore the impact of the items and messages and why and how these messages could change physicians? relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). Results: The good practices communication framework list comprised 70 specific issues related to breaking bad news pooled into 8 main domains: opening, preparing for the delivery of bad news, communication techniques, consultation content, attention, physician emotional management, shared decision making, and the relationship between the physician and the medical team. After constructing the items from this list, the items were extensively refined to make them more useful to the target audience, and one item was added. BRADNET contains 71 items, each including a question, response options, and a corresponding message, which were divided into 8 domains and assessed with 12 self-assessment sessions. The BRADNET Web-based platform was developed according to the cognitive load theory and the cognitive theory of multimedia learning. Conclusions: The objective of this Web-based assessment tool was to create a ?space? for reflection. It contained items leading to self-reflection and messages that introduced recommended communication behaviors. Our approach was innovative as it provided an inexpensive distance-learning self-assessment tool that was manageable and less time-consuming for physicians with often overwhelming schedules. UR - http://mededu.jmir.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/mededu.9551 UR - http://www.ncbi.nlm.nih.gov/pubmed/30026180 ID - info:doi/10.2196/mededu.9551 ER - TY - JOUR AU - Hartnup, Becky AU - Dong, Lin AU - Eisingerich, Benedikt Andreas PY - 2018/07/13 TI - How an Environment of Stress and Social Risk Shapes Student Engagement With Social Media as Potential Digital Learning Platforms: Qualitative Study JO - JMIR Med Educ SP - e10069 VL - 4 IS - 2 KW - social media KW - online learning KW - digital engagement KW - stress KW - social risk KW - digital platforms KW - education KW - university adjustment N2 - Background: Social media has been increasingly used as a learning tool in medical education. Specifically, when joining university, students often go through a phase of adjustment, and they need to cope with various challenges such as leaving their families and friends and trying to fit into a new environment. Research has shown that social media helps students to connect with old friends and to establish new relationships. However, managing friendships on social media might intertwine with the new learning environment that shapes students? online behaviors. Especially, when students perceive high levels of social risks when using social media, they may struggle to take advantage of the benefits that social media can provide for learning. Objective: This study aimed to develop a model that explores the drivers and inhibitors of student engagement with social media during their university adjustment phase. Methods: We used a qualitative method by interviewing 78 undergraduate students studying medical courses at UK research-focused universities. In addition, we interviewed 6 digital technology experts to provide additional insights into students? learning behaviors on social media. Results: Students? changing relationships and new academic environment in the university adjustment phase led to various factors that affected their social media engagement. The main drivers of social media engagement were maintaining existing relationships, building new relationships, and seeking academic support. Simultaneously, critical factors that inhibited the use of social media for learning emerged, namely, collapsed online identity, uncertain group norms, the desire to present an ideal self, and academic competition. These inhibitors led to student stress when managing their social media accounts, discouraged them from actively engaging on social media, and prevented the full exploitation of social media as an effective learning tool. Conclusions: This study identified important drivers and inhibitors for students to engage with social media platforms as learning tools. Although social media supported students to manage their relationships and support their learning, the interaction of critical factors, such as collapsed online identity, uncertain group norms, the desire to present an ideal self, and academic competition, caused psychological stress and impeded student engagement. Future research should explore how these inhibitors can be removed to reduce students? stress and to increase the use of social media for learning. More specifically, such insights will allow students to take full advantage of being connected, thus facilitating a richer learning experience during their university life. UR - http://mededu.jmir.org/2018/2/e10069/ UR - http://dx.doi.org/10.2196/10069 UR - http://www.ncbi.nlm.nih.gov/pubmed/30006324 ID - info:doi/10.2196/10069 ER - TY - JOUR AU - Chon, Seung-Hun AU - Hilgers, Sabrina AU - Timmermann, Ferdinand AU - Dratsch, Thomas AU - Plum, Sven Patrick AU - Berlth, Felix AU - Datta, Rabi AU - Alakus, Hakan AU - Schlößer, Anton Hans AU - Schramm, Christoph AU - Pinto dos Santos, Daniel AU - Bruns, Christiane AU - Kleinert, Robert PY - 2018/07/04 TI - Web-Based Immersive Patient Simulator as a Curricular Tool for Objective Structured Clinical Examination Preparation in Surgery: Development and Evaluation JO - JMIR Serious Games SP - e10693 VL - 6 IS - 3 KW - immersive patient simulator KW - simulator-based curriculum KW - Objective Structured Clinical Examination KW - artificial learning interface N2 - Background: Objective Structured Clinical Examination is a standard method of testing declarative and process knowledge in clinical core competencies. It is desirable that students undergo Objective Structured Clinical Examination training before participating in the exam. However, establishing Objective Structured Clinical Examination training is resource intensive and therefore there is often limited practice time. Web-based immersive patient simulators such as ALICE (Artificial Learning Interface of Clinical Education) can possibly fill this gap as they allow for the training of complex medical procedures at the user?s individual pace and with an adaptable number of repetitions at home. ALICE has previously been shown to positively influence knowledge gain and motivation. Objective: Therefore, the aim of this study was to develop a Web-based curriculum that teaches declarative and process knowledge and prepares students for a real Objective Structured Clinical Examination station. Furthermore, we wanted to test the influence of ALICE on knowledge gain and student motivation. Methods: A specific curriculum was developed in order to implement the relevant medical content of 2 surgical Objective Structured Clinical Examination stations into the ALICE simulator framework. A total of 160 medical students were included in the study, where 100 students had access to ALICE and their performance was compared to 60 students in a control group. The simulator performance was validated on different levels and students? knowledge gain and motivation were tested at different points during the study. Results: The curriculum was developed according to the Kern cycle. Four virtual clinical cases were implemented with different teaching methods (structured feedback, keynote speech, group discussion, and debriefing by a real instructor) in order to consolidate declarative and process knowledge. Working with ALICE had significant impact on declarative knowledge gain and Objective Structured Clinical Examination performance. Simulator validation was positive for face, content, construct, and predictive validity. Students showed high levels of motivation and enjoyed working with ALICE. Conclusions: ALICE offers Web-based training for Objective Structured Clinical Examination preparation and can be used as a selective didactic intervention as it has positive effect on knowledge gain and student motivation. UR - http://games.jmir.org/2018/3/e10693/ UR - http://dx.doi.org/10.2196/10693 UR - http://www.ncbi.nlm.nih.gov/pubmed/29973333 ID - info:doi/10.2196/10693 ER - TY - JOUR AU - Gayed, Aimée AU - LaMontagne, D. Anthony AU - Milner, Allison AU - Deady, Mark AU - Calvo, A. Rafael AU - Christensen, Helen AU - Mykletun, Arnstein AU - Glozier, Nick AU - Harvey, B. Samuel PY - 2018/07/03 TI - A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness JO - JMIR Ment Health SP - e10517 VL - 5 IS - 3 KW - manager; supervisor training; workplace mental health; mental health education; online intervention; knowledge; attitudes; behaviour; eHealth N2 - Background: Mental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization?s response to a mentally ill worker. Objective: This pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers? confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace. Methods: In total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired samples t tests. Results: Of all the invited managers, 59.1% (39/66) participated in the trial, with complete pre?post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers? knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P<.001) significantly increased. In addition, a significant increase was observed from the baseline in managers? self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02). Conclusions: Although caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff. UR - http://mental.jmir.org/2018/3/e10517/ UR - http://dx.doi.org/10.2196/10517 UR - http://www.ncbi.nlm.nih.gov/pubmed/29970359 ID - info:doi/10.2196/10517 ER - TY - JOUR AU - Pascoe, Michael AU - Monroe, Forrest AU - Macfarlane, Helen PY - 2018/06/14 TI - Taking Constructivism One Step Further: Post Hoc Analysis of a Student-Created Wiki JO - JMIR Med Educ SP - e16 VL - 4 IS - 1 KW - wiki KW - constructivist learning KW - medical education KW - analytics N2 - Background: Wiki platform use has potential to improve student learning by improving engagement with course material. A student-created wiki was established to serve as a repository of study tools for students in a medical school curriculum. There is a scarcity of information describing student-led creation of wikis in medical education. Objective: The aim is to characterize website traffic of a student-created wiki and evaluate student perceptions of usage via a short anonymous online survey. Methods: Website analytics were used to track visitation statistics to the wiki and a survey was distributed to assess ease of use, interest in contributing to the wiki, and suggestions for improvement. Results: Site traffic data indicated high usage, with a mean of 315 (SD 241) pageviews per day from July 2011 to March 2013 and 74,317 total user sessions. The mean session duration was 1.94 (SD 1.39) minutes. Comparing Fall 2011 to Fall 2012 sessions revealed a large increase in returning visitors (from 12,397 to 20,544, 65.7%) and sessions via mobile devices (831 to 1560, 87.7%). The survey received 164 responses; 88.0% (162/184) were aware of the wiki at the time of the survey. On average, respondents felt that the wiki was more useful in the preclinical years (mean 2.73, SD 1.25) than in the clinical years (mean 1.88, SD 1.12; P<.001). Perceived usefulness correlated with the percent of studying for which the respondent used electronic resources (Spearman ?=.414, P<.001). Conclusions: Overall, the wiki was a highly utilized, although informal, part of the curriculum with much room for improvement and future exploration. UR - http://mededu.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/mededu.9197 UR - http://www.ncbi.nlm.nih.gov/pubmed/29903697 ID - info:doi/10.2196/mededu.9197 ER - TY - JOUR AU - de Ruijter, Dennis AU - Candel, Math AU - Smit, Suzanne Eline AU - de Vries, Hein AU - Hoving, Ciska PY - 2018/05/22 TI - The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial JO - J Med Internet Res SP - e193 VL - 20 IS - 5 KW - online learning KW - guideline adherence KW - advanced practice nursing KW - randomized controlled trial KW - smoking cessation N2 - Background: Improving practice nurses? (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet. Objective: The aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs? smoking cessation guideline adherence. Methods: A Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs? demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program?s effectiveness in improving PNs? guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results: After 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program?s effect on PNs? overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence. Conclusions: Results from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a wider range of HCPs. Trial Registration: Netherlands Trial Register NTR4436; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4436 (Archived by WebCite at http://www.webcitation.org/6zJQuSRq0) UR - http://www.jmir.org/2018/5/e193/ UR - http://dx.doi.org/10.2196/jmir.9276 UR - http://www.ncbi.nlm.nih.gov/pubmed/29789278 ID - info:doi/10.2196/jmir.9276 ER - TY - JOUR AU - Haubruck, Patrick AU - Nickel, Felix AU - Ober, Julian AU - Walker, Tilman AU - Bergdolt, Christian AU - Friedrich, Mirco AU - Müller-Stich, Peter Beat AU - Forchheim, Franziska AU - Fischer, Christian AU - Schmidmaier, Gerhard AU - Tanner, C. Michael PY - 2018/05/21 TI - Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial JO - J Med Internet Res SP - e195 VL - 20 IS - 5 KW - games, experimental KW - education, professional KW - general surgery KW - emergency medicine KW - problem-based learning KW - chest tubes KW - simulation training KW - clinical competence N2 - Background: The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective: The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods: In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module ?Thoracocentesis? discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants? performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. Results: A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. Conclusions: The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. Trial Registration: German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg) UR - http://www.jmir.org/2018/5/e195/ UR - http://dx.doi.org/10.2196/jmir.9956 UR - http://www.ncbi.nlm.nih.gov/pubmed/29784634 ID - info:doi/10.2196/jmir.9956 ER - TY - JOUR AU - Alexander, George Andrew AU - Deas, Deborah AU - Lyons, Eric Paul PY - 2018/05/18 TI - An Internet-Based Radiology Course in Medical School: Comparison of Academic Performance of Students on Campus Versus Those With Absenteeism Due to Residency Interviews JO - JMIR Med Educ SP - e14 VL - 4 IS - 1 KW - radiology clerkship KW - online education KW - imaging KW - radiology rotation KW - Web-based education N2 - Background: Imaging and its optimal use are imperative to the practice of medicine, yet many students don?t receive a formal education in radiology. Concurrently, students look for ways to take time away from medical school for residency interviewing. Web-based instruction provides an opportunity to combine these imperatives using online modalities. Objective: A largely Web-based course in radiology during the 4th year of medical school was evaluated both for its acceptance to students who needed to be away from campus for interviews, and its effectiveness on a nationally administered standardized test. Methods: All students were placed into a structured program utilizing online videos, online modules, online textbook assignments, and live interactive online lectures. Over half of the course could be completed away from campus. The Alliance of Medical Student Educators in Radiology test exam bank was used as a final exam to evaluate medical knowledge. Results: Positive student feedback included the freedom to travel for interviews, hands-on ultrasound training, interactive teaching sessions, and quality Web-based learning modules. Negative feedback included taking quizzes in-person, a perceived outdated online textbook, and physically shadowing hospital technicians. Most students elected to take the course during the interview months of October through January. The Alliance of Medical Student Educators in Radiology final exam results (70.5%) were not significantly different than the national cohort (70%) who took the course in-person. Test scores from students taking the course during interview travel months were not significantly different from students who took the course before (P=.30) or after (P=.34) the interview season. Conclusions: Students desire to learn radiology and often choose to do so when they need to be away from campus during the fall of their 4th year of study to accomplish their residency interviews. Web-based education in radiology allows students? interview traveling and radiology course objectives to be successfully met without adversely affecting the outcomes on a nationally normed examination in radiology. A curriculum that includes online content and live Web-based teleconference access to faculty can accomplish both imperatives. UR - http://mededu.jmir.org/2018/1/e14/ UR - http://dx.doi.org/10.2196/mededu.8747 UR - http://www.ncbi.nlm.nih.gov/pubmed/29776902 ID - info:doi/10.2196/mededu.8747 ER - TY - JOUR AU - Brunner, Melissa AU - McGregor, Deborah AU - Keep, Melanie AU - Janssen, Anna AU - Spallek, Heiko AU - Quinn, Deleana AU - Jones, Aaron AU - Tseris, Emma AU - Yeung, Wilson AU - Togher, Leanne AU - Solman, Annette AU - Shaw, Tim PY - 2018/05/15 TI - An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study JO - J Med Internet Res SP - e10229 VL - 20 IS - 5 KW - telemedicine KW - mobile health KW - clinical competence KW - education, professional KW - education, graduate N2 - Background: The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. Objective: This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. Methods: A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. Results: Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. Conclusions: The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development programs. UR - http://www.jmir.org/2018/5/e10229/ UR - http://dx.doi.org/10.2196/10229 UR - http://www.ncbi.nlm.nih.gov/pubmed/29764794 ID - info:doi/10.2196/10229 ER - TY - JOUR AU - de Leeuw, Adrianus Robert AU - Walsh, Kieran AU - Westerman, Michiel AU - Scheele, Fedde PY - 2018/04/26 TI - Consensus on Quality Indicators of Postgraduate Medical E-Learning: Delphi Study JO - JMIR Med Educ SP - e13 VL - 4 IS - 1 KW - postgraduate medical education KW - continuing medical education KW - e-learning KW - distance education KW - quality tool KW - quality indicators KW - education, medical KW - education, medical, continuing KW - education, distance N2 - Background: The progressive use of e-learning in postgraduate medical education calls for useful quality indicators. Many evaluation tools exist. However, these are diversely used and their empirical foundation is often lacking. Objective: We aimed to identify an empirically founded set of quality indicators to set the bar for ?good enough? e-learning. Methods: We performed a Delphi procedure with a group of 13 international education experts and 10 experienced users of e-learning. The questionnaire started with 57 items. These items were the result of a previous literature review and focus group study performed with experts and users. Consensus was met when a rate of agreement of more than two-thirds was achieved. Results: In the first round, the participants accepted 37 items of the 57 as important, reached no consensus on 20, and added 15 new items. In the second round, we added the comments from the first round to the items on which there was no consensus and added the 15 new items. After this round, a total of 72 items were addressed and, of these, 37 items were accepted and 34 were rejected due to lack of consensus. Conclusions: This study produced a list of 37 items that can form the basis of an evaluation tool to evaluate postgraduate medical e-learning. This is, to our knowledge, the first time that quality indicators for postgraduate medical e-learning have been defined and validated. The next step is to create and validate an e-learning evaluation tool from these items. UR - http://mededu.jmir.org/2018/1/e13/ UR - http://dx.doi.org/10.2196/mededu.9365 UR - http://www.ncbi.nlm.nih.gov/pubmed/29699970 ID - info:doi/10.2196/mededu.9365 ER - TY - JOUR AU - Singh, Manisha PY - 2018/04/20 TI - Value of Face-to-Face Interactions Between Clinician-Educators and Patients or Students to Improve Health Care Education JO - JMIR Hum Factors SP - e15 VL - 5 IS - 2 KW - medical education KW - human factor KW - value in human interactions UR - http://humanfactors.jmir.org/2018/2/e15/ UR - http://dx.doi.org/10.2196/humanfactors.9859 UR - http://www.ncbi.nlm.nih.gov/pubmed/29678803 ID - info:doi/10.2196/humanfactors.9859 ER - TY - JOUR AU - Nicoll, Pam AU - MacRury, Sandra AU - van Woerden, C. Hugo AU - Smyth, Keith PY - 2018/04/11 TI - Evaluation of Technology-Enhanced Learning Programs for Health Care Professionals: Systematic Review JO - J Med Internet Res SP - e131 VL - 20 IS - 4 KW - technology-enhanced learning KW - evaluation KW - e-learning KW - blended learning KW - digital learning KW - program evaluation KW - effectiveness N2 - Background: Technology-enhanced learning (TEL) programs are increasingly seen as the way in which education for health care professionals can be transformed, giving access to effective ongoing learning and training even where time or geographical barriers exist. Given the increasing emphasis on this mode of educational support for health care practitioners, it is vital that we can effectively evaluate and measure impact to ensure that TEL programs are effective and fit for purpose. This paper examines the current evidence base for the first time, in relation to the evaluation of TEL programs for health care professionals. Objective: We conducted a systematic review of the current literature relating to the evaluation of TEL programs for health care professionals and critically appraised the quality of the studies. Methods: This review employed specific search criteria to identify research studies that included evaluation of TEL for health care professionals. The databases searched included Medline Ovid, Cumulative Index of Nursing and Allied Health Literature Plus Advanced, Applied Social Sciences Index and Abstracts, ZETOC, Institute of Electrical and Electronics Engineers Explore Digital Library, Allied and Complementary Medicine, and Education Resources Information Center between January 2006 and January 2017. An additional hand search for relevant articles from reference lists was undertaken. Each of the studies identified was critically appraised for quality using the Crowe Critical Appraisal Tool. This approach produced a percentage total score for each study across specified categories. A proportion of the studies were independently assessed by an additional two reviewers. Results: The review identified 21 studies that met the inclusion criteria. The studies included scored totals across eight categories within a range of 37%-95% and an average score of 68%. Studies that measured TEL using learner satisfaction surveys, or combined pretest and posttest knowledge score testing with learner satisfaction surveys, were found to be the most common types of TEL evaluations evident in the literature. The studies reviewed had low scores across reporting on ethical matters, design, and data collection categories. Conclusions: There continues to be a need to develop effective and standard TEL evaluation tools, and good quality studies that describe effective evaluation of TEL education for health care professionals. Studies often fail to provide sufficient detail to support transferability or direct future TEL health care education programs. UR - http://www.jmir.org/2018/4/e131/ UR - http://dx.doi.org/10.2196/jmir.9085 UR - http://www.ncbi.nlm.nih.gov/pubmed/29643049 ID - info:doi/10.2196/jmir.9085 ER - TY - JOUR AU - Tang, Brandon AU - Coret, Alon AU - Qureshi, Aatif AU - Barron, Henry AU - Ayala, Patricia Ana AU - Law, Marcus PY - 2018/04/10 TI - Online Lectures in Undergraduate Medical Education: Scoping Review JO - JMIR Med Educ SP - e11 VL - 4 IS - 1 KW - online lectures KW - undergraduate medical education KW - multimedia design KW - assessment KW - scoping review KW - e-learning N2 - Background: The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools?including online lectures?before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes. Objective: The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design. Methods: This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education. Results: In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use. Conclusions: Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential. UR - http://mededu.jmir.org/2018/1/e11/ UR - http://dx.doi.org/10.2196/mededu.9091 UR - http://www.ncbi.nlm.nih.gov/pubmed/29636322 ID - info:doi/10.2196/mededu.9091 ER - TY - JOUR AU - Lee, Li-Ang AU - Wang, Shu-Ling AU - Chao, Yi-Ping AU - Tsai, Ming-Shao AU - Hsin, Li-Jen AU - Kang, Chung-Jan AU - Fu, Chia-Hsiang AU - Chao, Wei-Chieh AU - Huang, Chung-Guei AU - Li, Hsueh-Yu AU - Chuang, Cheng-Keng PY - 2018/03/08 TI - Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology?Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial JO - JMIR Med Educ SP - e8 VL - 4 IS - 1 KW - e-learning KW - gamification KW - mobile technology KW - randomized controlled trial KW - video lecture N2 - Background: The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology?head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. Objective: The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. Methods: This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. Results: Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI ?75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change ?41, 95% CI ?67 to ?20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality (difference 1.7, 95% CI 0.1-2.7; P=.03), and hedonic stimulation (difference 1.9, 95% CI 0.3-3.1; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants? attention but that the nonlinearly arranged materials affected their learning. Conclusions: Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. Trial Registration: ClinicalTrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) UR - http://mededu.jmir.org/2018/1/e8/ UR - http://dx.doi.org/10.2196/mededu.9237 UR - http://www.ncbi.nlm.nih.gov/pubmed/29519776 ID - info:doi/10.2196/mededu.9237 ER - TY - JOUR AU - Vaysse, Charlotte AU - Chantalat, Elodie AU - Beyne-Rauzy, Odile AU - Morineau, Louise AU - Despas, Fabien AU - Bachaud, Jean-Marc AU - Caunes, Nathalie AU - Poublanc, Muriel AU - Serrano, Elie AU - Bugat, Roland AU - Rougé Bugat, Marie-Eve AU - Fize, Anne-Laure PY - 2018/03/05 TI - The Impact of a Small Private Online Course as a New Approach to Teaching Oncology: Development and Evaluation JO - JMIR Med Educ SP - e6 VL - 4 IS - 1 KW - oncology KW - health education KW - continuing education KW - e-learning KW - SPOC KW - small private online course KW - education, medical KW - education, medical, continuing N2 - Background: Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. Objective: The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). Methods: A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants? satisfaction rate through a questionnaire and the success of the SPOC by participants? completion, success, and commitment rates. Results: Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients? associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7% (90/446) had an independent medical practice, 38.5% (140/446) worked in a public institution, and 36.8% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9% (384/446) thought they had learned new information, 90.8% (405/446) felt their expectations were met, and 90.4% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51% (559/1574), the success rate was 71.47% (1025/1574), and the commitment rate was 64.67% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants. Conclusions: SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students? expectations. UR - http://mededu.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/mededu.9185 UR - http://www.ncbi.nlm.nih.gov/pubmed/29506968 ID - info:doi/10.2196/mededu.9185 ER - TY - JOUR AU - Edelbring, Samuel AU - Parodis, Ioannis AU - Lundberg, E. Ingrid PY - 2018/02/27 TI - Increasing Reasoning Awareness: Video Analysis of Students? Two-Party Virtual Patient Interactions JO - JMIR Med Educ SP - e4 VL - 4 IS - 1 KW - medical education KW - clinical decision making KW - problem solving KW - computer-assisted instruction N2 - Background: Collaborative reasoning occurs in clinical practice but is rarely developed during education. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases and thus stimulate active learning. Peer settings during VP sessions are believed to have benefits in terms of reasoning but have received scant attention in the literature. Objective: The objective of this study was to thoroughly investigate interactions during medical students? clinical reasoning in two-party VP settings. Methods: An in-depth exploration of students? interactions in dyad settings of VP sessions was performed. For this purpose, two prerecorded VP sessions lasting 1 hour each were observed, transcribed in full, and analyzed. The transcriptions were analyzed using thematic analysis, and short clips from the videos were selected for subsequent analysis in relation to clinical reasoning and clinical aspects. Results: Four categories of interactions were identified: (1) task-related dialogue, in which students negotiated a shared understanding of the task and strategies for information gathering; (2) case-related insights and perspectives were gained, and the students consolidated and applied preexisting biomedical knowledge into a clinical setting; (3) clinical reasoning interactions were made explicit. In these, hypotheses were followed up and clinical examples were used. The researchers observed interactions not only between students and the VP but also (4) interactions with other resources, such as textbooks. The interactions are discussed in relation to theories of clinical reasoning and peer learning. Conclusions: The dyad VP setting is conducive to activities that promote analytic clinical reasoning. In this setting, components such as peer interaction, access to different resources, and reduced time constraints provided a productive situation in which the students pursued different lines of reasoning. UR - http://mededu.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/mededu.9137 UR - http://www.ncbi.nlm.nih.gov/pubmed/29487043 ID - info:doi/10.2196/mededu.9137 ER - TY - JOUR AU - Bond, Evan Stuart AU - Crowther, P. Shelley AU - Adhikari, Suman AU - Chubaty, J. Adriana AU - Yu, Ping AU - Borchard, P. Jay AU - Boutlis, Steven Craig AU - Yeo, Winston Wilfred AU - Miyakis, Spiros PY - 2018/02/26 TI - Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study JO - JMIR Med Educ SP - e5 VL - 4 IS - 1 KW - nursing education KW - pharmacy education KW - medical education KW - continuing education KW - survey methods KW - antibacterial agents N2 - Background: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Objective: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. Methods: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. Results: Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. Conclusions: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool?s effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future. UR - http://mededu.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/mededu.7719 UR - http://www.ncbi.nlm.nih.gov/pubmed/29483071 ID - info:doi/10.2196/mededu.7719 ER - TY - JOUR AU - Bergeron, David AU - Champagne, Jean-Nicolas AU - Qi, Wen AU - Dion, Maxime AU - Thériault, Julie AU - Renaud, Jean-Sébastien PY - 2018/02/22 TI - Impact of a Student-Driven, Virtual Patient Application on Objective Structured Clinical Examination Performance: Observational Study JO - J Med Internet Res SP - e60 VL - 20 IS - 2 KW - peer-assisted learning KW - virtual patient KW - medical education KW - undergraduate N2 - Background: Peer-assisted learning (PAL) refers to a learning activity whereby students of similar academic level teach and learn from one another. Groupe de perfectionnement des habiletés cliniques (Clinical Skills Improvement Group), a student organization at Université Laval, Canada, propelled PAL into the digital era by creating a collaborative virtual patient platform. Medical interviews can be completed in pairs (a student-patient and a student-doctor) through an interactive Web-based application, which generates a score (weighted for key questions) and automated feedback. Objectives: The aim of the study was to measure the pedagogical impact of the application on the score at medical interview stations at the summative preclerkship Objective Structured Clinical Examination (OSCE). Methods: We measured the use of the application (cases completed, mean score) in the 2 months preceding the OSCE. We also accessed the results of medical interview stations at the preclerkship summative OSCE. We analyzed whether using the application was associated with higher scores and/or better passing grades (?60%) at the OSCE. Finally, we produced an online form where students could comment on their appreciation of the application. Results: Of the 206 students completing the preclerkship summative OSCE, 170 (82.5%) were registered users on the application, completing a total of 3133 cases (18 by active user in average, 7 minutes by case in average). The appreciation questionnaire was answered online by 45 students who mentioned appreciating the intuitive, easy-to-use, and interactive design, the diversity of cases, and the automated feedback. Using the application was associated with reduced reported stress, improved scores (P=.04), and improved passing rates (P=.11) at the preclerkship summative OSCE. Conclusions: This study suggests that PAL can go far beyond small-group teaching, showing students? potential to create helpful pedagogical tools for their peers. UR - http://www.jmir.org/2018/2/e60/ UR - http://dx.doi.org/10.2196/jmir.7548 UR - http://www.ncbi.nlm.nih.gov/pubmed/29472175 ID - info:doi/10.2196/jmir.7548 ER - TY - JOUR AU - Rosen, L. Brittany AU - Bishop, M. James AU - McDonald, L. Skye AU - Kahn, A. Jessica AU - Kreps, L. Gary PY - 2018/02/16 TI - Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment JO - JMIR Cancer SP - e3 VL - 4 IS - 1 KW - papillomavirus vaccines KW - internet KW - program evaluation KW - health personnel N2 - Background: Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. Objective: The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. Methods: Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions? content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. Results: A total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. Conclusions: This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians. UR - http://cancer.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/cancer.9114 UR - http://www.ncbi.nlm.nih.gov/pubmed/29453187 ID - info:doi/10.2196/cancer.9114 ER - TY - JOUR AU - Lee, Li-Ang AU - Chao, Yi-Ping AU - Huang, Chung-Guei AU - Fang, Ji-Tseng AU - Wang, Shu-Ling AU - Chuang, Cheng-Keng AU - Kang, Chung-Jan AU - Hsin, Li-Jen AU - Lin, Wan-Ni AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu PY - 2018/02/13 TI - Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial JO - J Med Internet Res SP - e56 VL - 20 IS - 2 KW - cognitive style KW - e-learning KW - mobile technology KW - randomized controlled trial N2 - Background: Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective: The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods: This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results: All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= ?21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had a higher satisfaction score (8, IQR=6-9 vs 6, IQR=4-7, P=.01) compared with the PPS group. Using Friedman?s two-way nonparametric analysis of variance, cognitive styles (field-independent, field-intermediate, or field-dependent classification) and learning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted P<.001) and satisfaction (both adjusted P<.001). Conclusions: Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles. Trial Registration: Clinicaltrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) UR - http://www.jmir.org/2018/2/e56/ UR - http://dx.doi.org/10.2196/jmir.8987 UR - http://www.ncbi.nlm.nih.gov/pubmed/29439943 ID - info:doi/10.2196/jmir.8987 ER - TY - JOUR AU - Nicolai, Leo AU - Schmidbauer, Moritz AU - Gradel, Maximilian AU - Ferch, Sabine AU - Antón, Sofía AU - Hoppe, Boj AU - Pander, Tanja AU - von der Borch, Philip AU - Pinilla, Severin AU - Fischer, Martin AU - Dimitriadis, Konstantinos PY - 2017/12/22 TI - Facebook Groups as a Powerful and Dynamic Tool in Medical Education: Mixed-Method Study JO - J Med Internet Res SP - e408 VL - 19 IS - 12 KW - social media KW - Facebook KW - medical education KW - e-learning KW - faculty KW - networking N2 - Background: Social networking sites, in particular Facebook, are not only predominant in students? social life but are to varying degrees interwoven with the medical curriculum. Particularly, Facebook groups have been identified for their potential in higher education. However, there is a paucity of data on user types, content, and dynamics of study-related Facebook groups. Objective: The aim of this study was to identify the role of study-related Facebook group use, characterize medical students that use or avoid using Facebook groups (demographics, participation pattern, and motivation), and analyze student posting behavior, covered topics, dynamics, and limitations in Facebook groups with regards to educational usage. Methods: Using a multi-method approach (interviews, focus groups, and qualitative and quantitative analysis of Facebook posts), we analyzed two representative Facebook groups of medical preclinical semesters at Ludwig-Maximilians-University (LMU) Munich. Facebook primary posts and replies over one semester were extracted and evaluated by using thematic content analysis. We developed and applied a coding scheme for studying the frequency and distribution of these posts. Additionally, we interviewed students with various degrees of involvement in the groups, as well as ?new minorities,? students not registered on Facebook. Results: Facebook groups seem to have evolved as the main tool for medical students at LMU to complement the curriculum and to discuss study-related content. These Facebook groups are self-organizing and quickly adapt to organizational or subject-related challenges posed by the curriculum. A wide range of topics is covered, with a dominance of organization-related posts (58.35% [6916/11,853] of overall posts). By measuring reply rates and comments per category, we were able to identify learning tips and strategies, material sharing, and course content discussions as the most relevant categories. Rates of adequate replies in these categories ranged between 78% (11/14) and 100% (13/13), and the number of comments per post ranged from 8.4 to 13.7 compared with the average overall reply rate of 68.69% (1167/1699) and 3.9 comments per post. User typology revealed social media drivers (>30 posts per semester) as engines of group function, frequent users (11-30 posts), and a majority of average users acting rather as consumers or lurkers (1-10 posts). Conclusions: For the moment, the medical faculty has no active involvement in these groups and therefore no influence on accuracy of information, professionalism, and ethical issues. Nevertheless, faculty could in the future benefit by extracting relevant information, identifying common problems, and understanding semester-related dynamics. UR - http://www.jmir.org/2017/12/e408/ UR - http://dx.doi.org/10.2196/jmir.7990 UR - http://www.ncbi.nlm.nih.gov/pubmed/29273572 ID - info:doi/10.2196/jmir.7990 ER - TY - JOUR AU - Douma, Lea Kirsten Freya AU - Aalfs, M. Cora AU - Dekker, Evelien AU - Tanis, J. Pieter AU - Smets, M. Ellen PY - 2017/12/18 TI - An E-Learning Module to Improve Nongenetic Health Professionals? Assessment of Colorectal Cancer Genetic Risk: Feasibility Study JO - JMIR Med Educ SP - e24 VL - 3 IS - 2 KW - colorectal neoplasms KW - colorectal, neoplasms, hereditary nonpolyposis KW - adenomatous polyposis coli KW - genetic testing KW - gastroenterology KW - health communication KW - feasibility studies KW - education KW - professional N2 - Background: Nongenetic health providers may lack the relevant knowledge, experience, and communication skills to adequately detect familial colorectal cancer (CRC), despite a positive attitude toward the assessment of history of cancer in a family. Specific training may enable them to more optimally refer patients to genetic counseling. Objective: The aim of this study was to develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge, and comprehension of communication skills, and to assess the feasibility of the e-learning module for continued medical education of these specialists. Methods: A focus group helped to inform the development of a training framework. The e-learning module was then developed, followed by a feasibility test among a group of surgeons-in-training (3rd- and 4th-year residents) and then among gastroenterologists, using pre- and posttest questionnaires. Results: A total of 124 surgeons-in-training and 14 gastroenterologists participated. The e-learning was positively received (7.5 on a scale of 1 to 10). Between pre- and posttest, attitude increased significantly on 6 out of the 10 items. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49% to 72% correct at pretest to 67% to 87% correct at posttest. Conclusions: This study shows the feasibility of a problem-based e-learning module to help surgeons-in-training and gastroenterologists in recognizing a hereditary predisposition in patients with CRC. The e-learning led to improvements in attitude toward the assessment of cancer family history, knowledge on criteria for referral to genetic counseling for CRC, and comprehension of communication skills. UR - http://mededu.jmir.org/2017/2/e24/ UR - http://dx.doi.org/10.2196/mededu.7173 UR - http://www.ncbi.nlm.nih.gov/pubmed/29254907 ID - info:doi/10.2196/mededu.7173 ER - TY - JOUR AU - Srikesavan, Swarnalatha Cynthia AU - Williamson, Esther AU - Eldridge, Lucy AU - Heine, Peter AU - Adams, Jo AU - Cranston, Tim AU - Lamb, E. Sarah PY - 2017/12/13 TI - A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing JO - J Med Internet Res SP - e411 VL - 19 IS - 12 KW - hand function KW - hand exercises KW - rheumatoid arthritis KW - online training KW - implementation N2 - Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. UR - http://www.jmir.org/2017/12/e411/ UR - http://dx.doi.org/10.2196/jmir.8424 UR - http://www.ncbi.nlm.nih.gov/pubmed/29237581 ID - info:doi/10.2196/jmir.8424 ER - TY - JOUR AU - Perry, Suzanne AU - Bridges, M. Susan AU - Zhu, Frank AU - Leung, Keung W. AU - Burrow, F. Michael AU - Poolton, Jamie AU - Masters, SW Rich PY - 2017/12/12 TI - Getting to the Root of Fine Motor Skill Performance in Dentistry: Brain Activity During Dental Tasks in a Virtual Reality Haptic Simulation JO - J Med Internet Res SP - e371 VL - 19 IS - 12 KW - simulation KW - fNIRS KW - functional near-infrared spectroscopy KW - spectroscopy, near-infrared KW - virtual reality KW - psychomotor skills training KW - dentistry KW - education, medical N2 - Background: There is little evidence considering the relationship between movement-specific reinvestment (a dimension of personality which refers to the propensity for individuals to consciously monitor and control their movements) and working memory during motor skill performance. Functional near-infrared spectroscopy (fNIRS) measuring oxyhemoglobin demands in the frontal cortex during performance of virtual reality (VR) psychomotor tasks can be used to examine this research gap. Objective: The aim of this study was to determine the potential relationship between the propensity to reinvest and blood flow to the dorsolateral prefrontal cortices of the brain. A secondary aim was to determine the propensity to reinvest and performance during 2 dental tasks carried out using haptic VR simulators. Methods: We used fNIRS to assess oxygen demands in 24 undergraduate dental students during 2 dental tasks (clinical, nonclinical) on a VR haptic simulator. We used the Movement-Specific Reinvestment Scale questionnaire to assess the students? propensity to reinvest. Results: Students with a high propensity for movement-specific reinvestment displayed significantly greater oxyhemoglobin demands in an area associated with working memory during the nonclinical task (Spearman correlation, rs=.49, P=.03). Conclusions: This small-scale study suggests that neurophysiological differences are evident between high and low reinvesters during a dental VR task in terms of oxyhemoglobin demands in an area associated with working memory. UR - http://www.jmir.org/2017/12/e371/ UR - http://dx.doi.org/10.2196/jmir.8046 UR - http://www.ncbi.nlm.nih.gov/pubmed/29233801 ID - info:doi/10.2196/jmir.8046 ER - TY - JOUR AU - Hege, Inga AU - Kononowicz, A. Andrzej AU - Adler, Martin PY - 2017/11/02 TI - A Clinical Reasoning Tool for Virtual Patients: Design-Based Research Study JO - JMIR Med Educ SP - e21 VL - 3 IS - 2 KW - learning KW - educational technology KW - computer-assisted instruction KW - clinical decision-making N2 - Background: Clinical reasoning is a fundamental process medical students have to learn during and after medical school. Virtual patients (VP) are a technology-enhanced learning method to teach clinical reasoning. However, VP systems do not exploit their full potential concerning the clinical reasoning process; for example, most systems focus on the outcome and less on the process of clinical reasoning. Objectives: Keeping our concept grounded in a former qualitative study, we aimed to design and implement a tool to enhance VPs with activities and feedback, which specifically foster the acquisition of clinical reasoning skills. Methods: We designed the tool by translating elements of a conceptual clinical reasoning learning framework into software requirements. The resulting clinical reasoning tool enables learners to build their patient?s illness script as a concept map when they are working on a VP scenario. The student?s map is compared with the experts? reasoning at each stage of the VP, which is technically enabled by using Medical Subject Headings, which is a comprehensive controlled vocabulary published by the US National Library of Medicine. The tool is implemented using Web technologies, has an open architecture that enables its integration into various systems through an open application program interface, and is available under a Massachusetts Institute of Technology license. Results: We conducted usability tests following a think-aloud protocol and a pilot field study with maps created by 64 medical students. The results show that learners interact with the tool but create less nodes and connections in the concept map than an expert. Further research and usability tests are required to analyze the reasons. Conclusions: The presented tool is a versatile, systematically developed software component that specifically supports the clinical reasoning skills acquisition. It can be plugged into VP systems or used as stand-alone software in other teaching scenarios. The modular design allows an extension with new feedback mechanisms and learning analytics algorithms. UR - http://mededu.jmir.org/2017/2/e21/ UR - http://dx.doi.org/10.2196/mededu.8100 UR - http://www.ncbi.nlm.nih.gov/pubmed/29097355 ID - info:doi/10.2196/mededu.8100 ER - TY - JOUR AU - Scaffidi, A. Michael AU - Khan, Rishad AU - Wang, Christopher AU - Keren, Daniela AU - Tsui, Cindy AU - Garg, Ankit AU - Brar, Simarjeet AU - Valoo, Kamesha AU - Bonert, Michael AU - de Wolff, F. Jacob AU - Heilman, James AU - Grover, C. Samir PY - 2017/10/31 TI - Comparison of the Impact of Wikipedia, UpToDate, and a Digital Textbook on Short-Term Knowledge Acquisition Among Medical Students: Randomized Controlled Trial of Three Web-Based Resources JO - JMIR Med Educ SP - e20 VL - 3 IS - 2 KW - medical education KW - medical students N2 - Background: Web-based resources are commonly used by medical students to supplement curricular material. Three commonly used resources are UpToDate (Wolters Kluwer Inc), digital textbooks, and Wikipedia; there are concerns, however, regarding Wikipedia?s reliability and accuracy. Objective: The aim of this study was to evaluate the impact of Wikipedia use on medical students? short-term knowledge acquisition compared with UpToDate and a digital textbook. Methods: This was a prospective, nonblinded, three-arm randomized trial. The study was conducted from April 2014 to December 2016. Preclerkship medical students were recruited from four Canadian medical schools. Convenience sampling was used to recruit participants through word of mouth, social media, and email. Participants must have been enrolled in their first or second year of medical school at a Canadian medical school. After recruitment, participants were randomized to one of the three Web-based resources: Wikipedia, UpToDate, or a digital textbook. During testing, participants first completed a multiple-choice questionnaire (MCQ) of 25 questions emulating a Canadian medical licensing examination. During the MCQ, participants took notes on topics to research. Then, participants researched topics and took written notes using their assigned resource. They completed the same MCQ again while referencing their notes. Participants also rated the importance and availability of five factors pertinent to Web-based resources. The primary outcome measure was knowledge acquisition as measured by posttest scores. The secondary outcome measures were participants? perceptions of importance and availability of each resource factor. Results: A total of 116 medical students were recruited. Analysis of variance of the MCQ scores demonstrated a significant interaction between time and group effects (P<.001, ?g2=0.03), with the Wikipedia group scoring higher on the MCQ posttest compared with the textbook group (P<.001, d=0.86). Access to hyperlinks, search functions, and open-source editing were rated significantly higher by the Wikipedia group compared with the textbook group (P<.001). Additionally, the Wikipedia group rated open access editing significantly higher than the UpToDate group; expert editing and references were rated significantly higher by the UpToDate group compared with the Wikipedia group (P<.001). Conclusions: Medical students who used Wikipedia had superior short-term knowledge acquisition compared with those who used a digital textbook. Additionally, the Wikipedia group trended toward better posttest performance compared with the UpToDate group, though this difference was not significant. There were no significant differences between the UpToDate group and the digital textbook group. This study challenges the view that Wikipedia should be discouraged among medical students, instead suggesting a potential role in medical education. UR - http://mededu.jmir.org/2017/2/e20/ UR - http://dx.doi.org/10.2196/mededu.8188 UR - http://www.ncbi.nlm.nih.gov/pubmed/29089291 ID - info:doi/10.2196/mededu.8188 ER - TY - JOUR AU - Cooper, Zafra AU - Bailey-Straebler, Suzanne AU - Morgan, E. Katy AU - O'Connor, E. Marianne AU - Caddy, Caroline AU - Hamadi, Layla AU - Fairburn, G. Christopher PY - 2017/10/18 TI - Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods JO - J Med Internet Res SP - e355 VL - 19 IS - 10 KW - psychotherapy KW - training KW - Internet KW - eating disorders KW - cognitive therapy N2 - Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise. Objective: The goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects. Methods: Eligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training. Results: A total of 160 therapists expressed interest in the study, and 156 (97.5%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being ?0.06 (95% Cl ?1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9%) scored above the competence threshold; three-quarters (43/58, 74%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95% Cl ?1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference ?0.70, 95% CI ?1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95% Cl 0.34 to 2.62; P=.92). Conclusions: Web-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments. UR - http://www.jmir.org/2017/10/e355/ UR - http://dx.doi.org/10.2196/jmir.8336 UR - http://www.ncbi.nlm.nih.gov/pubmed/29046265 ID - info:doi/10.2196/jmir.8336 ER - TY - JOUR AU - Chan, Linda AU - Mackintosh, Jeannie AU - Dobbins, Maureen PY - 2017/09/28 TI - How the ?Understanding Research Evidence? Web-Based Video Series From the National Collaborating Centre for Methods and Tools Contributes to Public Health Capacity to Practice Evidence-Informed Decision Making: Mixed-Methods Evaluation JO - J Med Internet Res SP - e286 VL - 19 IS - 9 KW - public health KW - public health practice KW - evidence-based practice KW - capacity building KW - continuing education KW - computer-assisted instruction N2 - Background: The National Collaborating Centre for Methods and Tools (NCCMT) offers workshops and webinars to build public health capacity for evidence-informed decision-making. Despite positive feedback for NCCMT workshops and resources, NCCMT users found key terms used in research papers difficult to understand. The Understanding Research Evidence (URE) videos use plain language, cartoon visuals, and public health examples to explain complex research concepts. The videos are posted on the NCCMT website and YouTube channel. Objective: The first four videos in the URE web-based video series, which explained odds ratios (ORs), confidence intervals (CIs), clinical significance, and forest plots, were evaluated. The evaluation examined how the videos affected public health professionals? practice. A mixed-methods approach was used to examine the delivery mode and the content of the videos. Specifically, the evaluation explored (1) whether the videos were effective at increasing knowledge on the four video topics, (2) whether public health professionals were satisfied with the videos, and (3) how public health professionals applied the knowledge gained from the videos in their work. Methods: A three-part evaluation was conducted to determine the effectiveness of the first four URE videos. The evaluation included a Web-based survey, telephone interviews, and pretest and posttests, which evaluated public health professionals? experience with the videos and how the videos affected their public health work. Participants were invited to participate in this evaluation through various open access, public health email lists, through informational flyers and posters at the Canadian Public Health Association (CPHA) conference, and through targeted recruitment to NCCMT?s network. Results: In the Web-based surveys (n=46), participants achieved higher scores on the knowledge assessment questions from watching the OR (P=.04), CI (P=.04), and clinical significance (P=.05) videos but not the forest plot (P=.12) video, as compared with participants who had not watched the videos. The pretest and posttest (n=124) demonstrated that participants had a better understanding of forest plots (P<.001) and CIs (P<.001) after watching the videos. Due to small sample size numbers, there were insufficient pretest and posttest data to conduct meaningful analyses on the clinical significance and OR videos. Telephone interview participants (n=18) thought the videos? use of animation, narration, and plain language was appropriate for people with different levels of understanding and learning styles. Participants felt that by increasing their understanding of research evidence, they could develop better interventions and design evaluations to measure the impact of public health initiatives. Conclusions: Overall, the results of the evaluation showed that watching the videos resulted in an increase in knowledge, and participants had an overall positive experience with the URE videos. With increased competence in using the best available evidence, professionals are empowered to contribute to decisions that can improve health outcomes of communities. UR - http://www.jmir.org/2017/9/e286/ UR - http://dx.doi.org/10.2196/jmir.6958 UR - http://www.ncbi.nlm.nih.gov/pubmed/28958986 ID - info:doi/10.2196/jmir.6958 ER - TY - JOUR AU - Noll, Christoph AU - von Jan, Ute AU - Raap, Ulrike AU - Albrecht, Urs-Vito PY - 2017/09/14 TI - Mobile Augmented Reality as a Feature for Self-Oriented, Blended Learning in Medicine: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e139 VL - 5 IS - 9 KW - problem-based learning KW - cellular phone KW - education KW - medical KW - mHealth N2 - Background: Advantages of mobile Augmented Reality (mAR) application-based learning versus textbook-based learning were already shown in a previous study. However, it was unclear whether the augmented reality (AR) component was responsible for the success of the self-developed app or whether this was attributable to the novelty of using mobile technology for learning. Objective: The study?s aim was to test the hypothesis whether there is no difference in learning success between learners who employed the mobile AR component and those who learned without it to determine possible effects of mAR. Also, we were interested in potential emotional effects of using this technology. Methods: Forty-four medical students (male: 25, female: 19, mean age: 22.25 years, standard deviation [SD]: 3.33 years) participated in this study. Baseline emotional status was evaluated using the Profile of Mood States (POMS) questionnaire. Dermatological knowledge was ascertained using a single choice (SC) test (10 questions). The students were randomly assigned to learn 45 min with either a mobile learning method with mAR (group A) or without AR (group B). Afterwards, both groups were again asked to complete the previous questionnaires. AttrakDiff 2 questionnaires were used to evaluate the perceived usability as well as pragmatic and hedonic qualities. For capturing longer term effects, after 14 days, all participants were again asked to complete the SC questionnaire. All evaluations were anonymous, and descriptive statistics were calculated. For hypothesis testing, an unpaired signed-rank test was applied. Results: For the SC tests, there were only minor differences, with both groups gaining knowledge (average improvement group A: 3.59 [SD 1.48]; group B: 3.86 [SD 1.51]). Differences between both groups were statistically insignificant (exact Mann Whitney U, U=173.5; P=.10; r=.247). However, in the follow-up SC test after 14 days, group A had retained more knowledge (average decrease of the number of correct answers group A: 0.33 [SD 1.62]; group B: 1.14 [SD 1.30]). For both groups, descriptively, there were only small variations regarding emotional involvement, and learning experiences also differed little, with both groups rating the app similar for its stimulating effect. Conclusions: We were unable to show significant effects for mAR on the immediate learning success of the mobile learning setting. However, the similar level of stimulation being noted for both groups is inconsistent with the previous assumption of the success of mAR-based approach being solely attributable to the excitement of using mobile technology, independent of mAR; the mAR group showed some indications for a better long-term retention of knowledge. Further studies are needed to examine this aspect. Trial Registration: German Clinical Trials Register (DRKS): 00012980; http://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012980 (Archived by WebCite at http://www.webcitation.org/ 6tCWoM2Jb). UR - http://mhealth.jmir.org/2017/9/e139/ UR - http://dx.doi.org/10.2196/mhealth.7943 UR - http://www.ncbi.nlm.nih.gov/pubmed/28912113 ID - info:doi/10.2196/mhealth.7943 ER - TY - JOUR AU - Matava, Clyde AU - Leo, Anne-Marie AU - Alam, Fahad PY - 2017/09/05 TI - Mobile Apps for Teaching Intubation: Scoping Review and Critical Analysis in eLearning JO - JMIR Med Educ SP - e15 VL - 3 IS - 2 KW - anesthesia KW - apps KW - eLearning KW - mLearning KW - intubation KW - difficult airway KW - residents KW - anesthesiology N2 - Background: Airway management is a core skill in anesthesia ensuring adequate oxygenation and delivery of inhalational agents for the patient. Objective: The goals of this study were to critically evaluate the quality of airway management apps and target revised Bloom's Taxonomy cognitive levels. Methods: An electronic search using the keywords ?airway? and ?airway management? was conducted in May 2015 across the App Store, Google Play, BlackBerry World, and Windows Store. Apps were included in the study if their content was related to airway management. App content and characteristics were extracted into a standard form and evaluated. Results: A total of 65 apps met the inclusion criteria, and 73% (47/65) of apps were developed by companies or industry. Anesthesiology trainees were the target audience in only 20% (13/65) of apps. Bag mask ventilation and laryngeal mask airways were covered in only 20% (13/65) of apps. Only 2 apps were supported in the scientific literature. For Bloom?s Taxonomy, 37% (24/65) of apps targeted knowledge, 5% (3/65) comprehension, 22% (14/65) application, 28% (18/65) analysis, 9% (6/65) evaluation, and 0% synthesis. Multivariate analysis identified cost of apps, size of apps (MB), and apps targeting trainees and paramedics to be associated with higher levels of cognitive processing of revised Bloom?s Taxonomy. Conclusions: Apps developed for teaching intubation target lower levels of cognitive processing and are largely not validated by research. Cost, app size, and targeted user are associated with higher cognitive levels. Trainees and all users should be aware of the paucity of the published evidence behind the efficacy of some of these apps. UR - http://mededu.jmir.org/2017/2/e15/ UR - http://dx.doi.org/10.2196/mededu.7919 UR - http://www.ncbi.nlm.nih.gov/pubmed/28874335 ID - info:doi/10.2196/mededu.7919 ER - TY - JOUR AU - Micheel, M. Christine AU - Anderson, A. Ingrid AU - Lee, Patricia AU - Chen, Sheau-Chiann AU - Justiss, Katy AU - Giuse, B. Nunzia AU - Ye, Fei AU - Kusnoor, V. Sheila AU - Levy, A. Mia PY - 2017/07/25 TI - Internet-Based Assessment of Oncology Health Care Professional Learning Style and Optimization of Materials for Web-Based Learning: Controlled Trial With Concealed Allocation JO - J Med Internet Res SP - e265 VL - 19 IS - 7 KW - e-learning KW - Web-based Instruction KW - learning KW - teaching materials KW - information dissemination KW - online systems KW - education, distance KW - continuing education KW - medical oncology/education N2 - Background: Precision medicine has resulted in increasing complexity in the treatment of cancer. Web-based educational materials can help address the needs of oncology health care professionals seeking to understand up-to-date treatment strategies. Objective: This study aimed to assess learning styles of oncology health care professionals and to determine whether learning style-tailored educational materials lead to enhanced learning. Methods: In all, 21,465 oncology health care professionals were invited by email to participate in the fully automated, parallel group study. Enrollment and follow-up occurred between July 13 and September 7, 2015. Self-enrolled participants took a learning style survey and were assigned to the intervention or control arm using concealed alternating allocation. Participants in the intervention group viewed educational materials consistent with their preferences for learning (reading, listening, and/or watching); participants in the control group viewed educational materials typical of the My Cancer Genome website. Educational materials covered the topic of treatment of metastatic estrogen receptor-positive (ER+) breast cancer using cyclin-dependent kinases 4/6 (CDK4/6) inhibitors. Participant knowledge was assessed immediately before (pretest), immediately after (posttest), and 2 weeks after (follow-up test) review of the educational materials. Study statisticians were blinded to group assignment. Results: A total of 751 participants enrolled in the study. Of these, 367 (48.9%) were allocated to the intervention arm and 384 (51.1%) were allocated to the control arm. Of those allocated to the intervention arm, 256 (69.8%) completed all assessments. Of those allocated to the control arm, 296 (77.1%) completed all assessments. An additional 12 participants were deemed ineligible and one withdrew. Of the 552 participants, 438 (79.3%) self-identified as multimodal learners. The intervention arm showed greater improvement in posttest score compared to the control group (0.4 points or 4.0% more improvement on average; P=.004) and a higher follow-up test score than the control group (0.3 points or 3.3% more improvement on average; P=.02). Conclusions: Although the study demonstrated more learning with learning style-tailored educational materials, the magnitude of increased learning and the largely multimodal learning styles preferred by the study participants lead us to conclude that future content-creation efforts should focus on multimodal educational materials rather than learning style-tailored content. UR - http://www.jmir.org/2017/7/e265/ UR - http://dx.doi.org/10.2196/jmir.7506 UR - http://www.ncbi.nlm.nih.gov/pubmed/28743680 ID - info:doi/10.2196/jmir.7506 ER - TY - JOUR AU - Kobak, A. Kenneth AU - Lipsitz, D. Joshua AU - Markowitz, C. John AU - Bleiberg, L. Kathryn PY - 2017/07/17 TI - Web-Based Therapist Training in Interpersonal Psychotherapy for Depression: Pilot Study JO - J Med Internet Res SP - e257 VL - 19 IS - 7 KW - psychotherapy KW - Internet KW - depression KW - education KW - humans KW - computer-assisted instruction N2 - Background: Training mental health professionals to deliver evidence-based therapy (EBT) is now required by most academic accreditation bodies, and evaluating the effectiveness of such training is imperative. However, shortages of time, money, and trained EBT clinician teachers make these challenges daunting. New technologies may help. The authors have developed the first empirically evaluated comprehensive Internet therapist training program for interpersonal psychotherapy (IPT). Objective: The aim of this study was to examine whether (1) the training protocol would increase clinicians? knowledge of IPT concepts and skills and (2) clinicians would deem the training feasible as measured by satisfaction and utility ratings. Methods: A total of 26 clinicians enrolled in the training, consisting of (1) a Web-based tutorial on IPT concepts and techniques; (2) live remote training via videoconference, with trainees practicing IPT techniques in a role-play using a case vignette; and (3) a Web-based portal for therapists posttraining use to help facilitate implementation of IPT and maintain adherence over time. Results: Trainees? knowledge of IPT concepts and skills improved significantly (P<.001). The standardized effect size for the change was large: d=2.53, 95% CI 2.23-2.92. Users found the technical features easy to use, the content useful for helping them treat depressed clients, and felt the applied training component enhanced their professional expertise. Mean rating of applied learning was 3.9 (scale range from 1=very little to 5=a great deal). Overall satisfaction rating was 3.5 (range from 1=very dissatisfied to 4=very satisfied). Conclusions: Results support the efficacy and feasibility of this technology in training clinicians in EBTs and warrant further empirical evaluation. UR - http://www.jmir.org/2017/7/e257/ UR - http://dx.doi.org/10.2196/jmir.7966 UR - http://www.ncbi.nlm.nih.gov/pubmed/28716769 ID - info:doi/10.2196/jmir.7966 ER - TY - JOUR AU - Fontaine, Guillaume AU - Cossette, Sylvie AU - Maheu-Cadotte, Marc-André AU - Mailhot, Tanya AU - Deschênes, Marie-France AU - Mathieu-Dupuis, Gabrielle PY - 2017/7/5 TI - Effectiveness of Adaptive E-Learning Environments on Knowledge, Competence, and Behavior in Health Professionals and Students: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e128 VL - 6 IS - 7 KW - adaptive learning environments KW - intelligent tutoring systems KW - interactive learning environments KW - medical education KW - nursing education KW - e-learning KW - systematic review KW - meta-analysis N2 - Background: Adaptive e-learning environments (AEEs) can provide tailored instruction by adapting content, navigation, presentation, multimedia, and tools to each user?s navigation behavior, individual objectives, knowledge, and preferences. AEEs can have various levels of complexity, ranging from systems using a simple adaptive functionality to systems using artificial intelligence. While AEEs are promising, their effectiveness for the education of health professionals and health professions students remains unclear. Objective: The purpose of this systematic review is to assess the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. Methods: We will follow the Cochrane Collaboration and the Effective Practice and Organisation of Care (EPOC) Group guidelines on systematic review methodology. A systematic search of the literature will be conducted in 6 bibliographic databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed, and Web of Science) using the concepts ?adaptive e-learning environments,? ?health professionals/students,? and ?effects on knowledge/skills/behavior.? We will include randomized and nonrandomized controlled trials, in addition to controlled before-after, interrupted time series, and repeated measures studies published between 2005 and 2017. The title and the abstract of each study followed by a full-text assessment of potentially eligible studies will be independently screened by 2 review authors. Using the EPOC extraction form, 1 review author will conduct data extraction and a second author will validate the data extraction. The methodological quality of included studies will be independently assessed by 2 review authors using the EPOC risk of bias criteria. Included studies will be synthesized by a descriptive analysis. Where appropriate, data will be pooled using meta-analysis by applying the RevMan software version 5.1, considering the heterogeneity of studies. Results: The review is in progress. We plan to submit the results in the beginning of 2018. Conclusions: Providing tailored instruction to health professionals and students is a priority in order to optimize learning and clinical outcomes. This systematic review will synthesize the best available evidence regarding the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. It will provide guidance to policy makers, hospital managers, and researchers in terms of AEE development, implementation, and evaluation in health care. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42017065585; https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017065585 (Archived by WebCite® at http://www.webcitation.org/6rXGdDwf4) UR - http://www.researchprotocols.org/2017/7/e128/ UR - http://dx.doi.org/10.2196/resprot.8085 UR - http://www.ncbi.nlm.nih.gov/pubmed/28679491 ID - info:doi/10.2196/resprot.8085 ER - TY - JOUR AU - Liang, Jun AU - Wei, Kunyan AU - Meng, Qun AU - Chen, Zhenying AU - Zhang, Jiajie AU - Lei, Jianbo PY - 2017/06/21 TI - The Gap in Medical Informatics and Continuing Education Between the United States and China: A Comparison of Conferences in 2016 JO - J Med Internet Res SP - e224 VL - 19 IS - 6 KW - medical informatics KW - conferences KW - continuing education KW - Sino-American comparison N2 - Background: China launched its second health reform in 2010 with considerable investments in medical informatics (MI). However, to the best of our knowledge, research on the outcomes of this ambitious undertaking has been limited. Objective: Our aim was to understand the development of MI and the state of continuing education in China and the United States from the perspective of conferences. Methods: We conducted a quantitative and qualitative analysis of four MI conferences in China and two in the United States: China Medical Information Association Annual Symposium (CMIAAS), China Hospital Information Network Annual Conference (CHINC), China Health Information Technology Exchange Annual Conference (CHITEC), China Annual Proceeding of Medical Informatics (CPMI) versus the American Medical Informatics Association (AMIA) and Healthcare Information and Management Systems Society (HIMSS). The scale, composition, and regional distribution of attendees, topics, and research fields for each conference were summarized and compared. Results: CMIAAS and CPMI are mainstream academic conferences, while CHINC and CHITEC are industry conferences in China. Compared to HIMSS 2016, the meeting duration of CHITEC was 3 versus 5 days, the number of conference sessions was 132 versus 950+, the number of attendees was 5000 versus 40,000+, the number of vendors was 152 versus 1400+, the number of subforums was 12 versus 230, the number of preconference education symposiums and workshops was 0 versus 12, and the duration of preconference educational symposiums and workshops was 0 versus 1 day. Compared to AMIA, the meeting duration of Chinese CMIAAS was 2 versus 5 days, the number of conference sessions was 42 versus 110, the number of attendees was 200 versus 2500+, the number of vendors was 5 versus 75+, and the number of subforums was 4 versus 10. The number of preconference tutorials and working groups was 0 versus 29, and the duration of tutorials and working group was 0 versus 1.5 days. Conclusions: Given the size of the Chinese economy and the substantial investment in MI, the output in terms of conferences remains low. The impact of conferences on continuing education to professionals is not significant. Chinese researchers and professionals should approach MI with greater rigor, including validated research methods, formal training, and effective continuing education, in order to utilize knowledge gained by other countries and to expand collaboration. UR - http://www.jmir.org/2017/6/e224/ UR - http://dx.doi.org/10.2196/jmir.8014 UR - http://www.ncbi.nlm.nih.gov/pubmed/28637638 ID - info:doi/10.2196/jmir.8014 ER - TY - JOUR AU - Fairburn, G. Christopher AU - Allen, Elizabeth AU - Bailey-Straebler, Suzanne AU - O'Connor, E. Marianne AU - Cooper, Zafra PY - 2017/06/16 TI - Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists JO - J Med Internet Res SP - e214 VL - 19 IS - 6 KW - psychotherapy KW - training KW - dissemination KW - Internet KW - eating disorders KW - cognitive behavior therapy N2 - Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl ?6.62 to ?5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. UR - http://www.jmir.org/2017/6/e214/ UR - http://dx.doi.org/10.2196/jmir.7864 UR - http://www.ncbi.nlm.nih.gov/pubmed/28623184 ID - info:doi/10.2196/jmir.7864 ER - TY - JOUR AU - Ma, Zhenyu AU - Yang, Li AU - Yang, Lan AU - Huang, Kaiyong AU - Yu, Hongping AU - He, Huimin AU - Wang, Jiaji AU - Cai, Le AU - Wang, Jie AU - Fu, Hua AU - Quintiliani, Lisa AU - Friedman, H. Robert AU - Xiao, Jian AU - Abdullah, S. Abu PY - 2017/06/12 TI - Developing a Curriculum for Information and Communications Technology Use in Global Health Research and Training: A Qualitative Study Among Chinese Health Sciences Graduate Students JO - JMIR Med Educ SP - e11 VL - 3 IS - 1 KW - information and communication technology KW - ICT KW - global health KW - research KW - training KW - China N2 - Background: Rapid development of information and communications technology (ICT) during the last decade has transformed biomedical and population-based research and has become an essential part of many types of research and educational programs. However, access to these ICT resources and the capacity to use them in global health research are often lacking in low- and middle-income country (LMIC) institutions. Objective: The aim of our study was to assess the practical issues (ie, perceptions and learning needs) of ICT use among health sciences graduate students at 6 major medical universities of southern China. Methods: Ten focus group discussions (FGDs) were conducted from December 2015 to March 2016, involving 74 health sciences graduate students studying at 6 major medical universities in southern China. The sampling method was opportunistic, accounting for the graduate program enrolled and the academic year. All FGDs were audio recorded and thematic content analysis was performed. Results: Researchers had different views and arguments about the use of ICT which are summarized under six themes: (1) ICT use in routine research, (2) ICT-related training experiences, (3) understanding about the pros and cons of Web-based training, (4) attitudes toward the design of ICT training curriculum, (5) potential challenges to promoting ICT courses, and (6) related marketing strategies for ICT training curriculum. Many graduate students used ICT on a daily basis in their research to stay up-to-date on current development in their area of research or study or practice. The participants were very willing to participate in ICT courses that were relevant to their academic majors and would count credits. Suggestion for an ICT curriculum included (1) both organized training course or short lecture series, depending on the background and specialty of the students, (2) a mixture of lecture and Web-based activities, and (3) inclusion of topics that are career focused. Conclusions: The findings of this study suggest that a need exists for a specialized curriculum related to ICT use in health research for health sciences graduate students in China. The results have important implications for the design and implementation of ICT-related educational program in China or other developing countries. UR - http://mededu.jmir.org/2017/1/e11/ UR - http://dx.doi.org/10.2196/mededu.6590 UR - http://www.ncbi.nlm.nih.gov/pubmed/28606894 ID - info:doi/10.2196/mededu.6590 ER - TY - JOUR AU - Mira, Joaquín José AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Lorenzo, Susana AU - Pérez-Pérez, Pastora AU - Silvestre, Carmen AU - Ferrús, Lena AU - PY - 2017/06/08 TI - The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers? Emotional Responses After a Clinical Error JO - J Med Internet Res SP - e203 VL - 19 IS - 6 KW - patient safety KW - professionals KW - hospital KW - primary care KW - second victims KW - clinical error KW - e-learning N2 - Background: Adverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening. Objective: The aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon. Methods: The design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design). Results: The website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88% (23/26) and 92% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse event (P<.001). Conclusions: The MISE program differs from existing intervention initiatives by its preventive nature in relation to the second victim phenomenon. Its online nature makes it an easily accessible tool for the professional community. This program has shown to increase user?s knowledge on this issue and it helps them correct their approach. Furthermore, it is one of the first initiatives to attempt to bring the second victim phenomenon closer to primary care. UR - http://www.jmir.org/2017/6/e203/ UR - http://dx.doi.org/10.2196/jmir.7840 UR - http://www.ncbi.nlm.nih.gov/pubmed/28596148 ID - info:doi/10.2196/jmir.7840 ER - TY - JOUR AU - Adjedj, Julien AU - Ducrocq, Gregory AU - Bouleti, Claire AU - Reinhart, Louise AU - Fabbro, Eleonora AU - Elbez, Yedid AU - Fischer, Quentin AU - Tesniere, Antoine AU - Feldman, Laurent AU - Varenne, Olivier PY - 2017/05/16 TI - Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment JO - JMIR Serious Games SP - e11 VL - 5 IS - 2 KW - serious game KW - multiple choice questions KW - medical student KW - student evaluation N2 - Background: The gold standard for evaluating medical students? knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students? medical skills. Objectives: The study aimed to compare MCQs with SG for medical student evaluation. Methods: We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction. Results: A total of 68 medical students were included. The score variability was significantly higher in the SG group (?2 =265.4) than the MCQs group (?2=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R2=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001). Conclusions: Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students. UR - http://games.jmir.org/2017/2/e11/ UR - http://dx.doi.org/10.2196/games.7033 UR - http://www.ncbi.nlm.nih.gov/pubmed/28512082 ID - info:doi/10.2196/games.7033 ER - TY - JOUR AU - Oliveira, Cristina Ana AU - Mattos, Sandra AU - Coimbra, Miguel PY - 2017/05/10 TI - Development and Assessment of an E-learning Course on Pediatric Cardiology Basics JO - JMIR Med Educ SP - e10 VL - 3 IS - 1 KW - distance learning KW - continuing medical education KW - pediatrics KW - cardiology KW - congenital heart defects N2 - Background: Early detection of congenital heart disease is a worldwide problem. This is more critical in developing countries, where shortage of professional specialists and structural health care problems are a constant. E-learning has the potential to improve capacity, by overcoming distance barriers and by its ability to adapt to the reduced time of health professionals. Objective: The study aimed to develop an e-learning pediatric cardiology basics course and evaluate its pedagogical impact and user satisfaction. Methods: The sample consisted of 62 health professionals, including doctors, nurses, and medical students, from 20 hospitals linked via a telemedicine network in Northeast Brazil. The course was developed using Moodle (Modular Object Oriented Dynamic Learning Environment; Moodle Pty Ltd, Perth, Australia) and contents adapted from a book on this topic. Pedagogical impact evaluation used a pre and posttest approach. User satisfaction was evaluated using Wang?s questionnaire. Results: Pedagogical impact results revealed differences in knowledge assessment before and after the course (Z=?4.788; P<.001). Questionnaire results indicated high satisfaction values (Mean=87%; SD=12%; minimum=67%; maximum=100%). Course adherence was high (79%); however, the withdrawal exhibited a value of 39%, with the highest rate in the early chapters. Knowledge gain revealed significant differences according to the profession (X22=8.6; P=.01) and specialty (X22=8.4; P=.04). Time dedication to the course was significantly different between specialties (X22=8.2; P=.04). Conclusions: The main contributions of this study are the creation of an asynchronous e-learning course on Moodle and the evaluation of its impact, confirming that e-learning is a viable tool to improve training in neonatal congenital heart diseases. UR - http://mededu.jmir.org/2017/1/e10/ UR - http://dx.doi.org/10.2196/mededu.5434 UR - http://www.ncbi.nlm.nih.gov/pubmed/28490416 ID - info:doi/10.2196/mededu.5434 ER - TY - JOUR AU - Zhan, Xingxin AU - Zhang, Zhixia AU - Sun, Fang AU - Liu, Qian AU - Peng, Weijun AU - Zhang, Heng AU - Yan, Weirong PY - 2017/05/01 TI - Effects of Improving Primary Health Care Workers? Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning JO - J Med Internet Res SP - e116 VL - 19 IS - 5 KW - blended learning KW - e-learning KW - primary health care workers KW - public health services N2 - Background: Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs? competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers? education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning. Objective: The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach. Methods: The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs?the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs?the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses? knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]). Results: The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95% CI 92.49-93.93) in experimental group versus 88.29 (95% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95% CI 93.37-94.73) in the experimental group vs 90.22 (95% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95% CI 93.08-94.68) in the experimental group versus 89.09 (95% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95% CI 1.08-2.48; P=.02). Conclusions: Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings. UR - http://www.jmir.org/2017/5/e116/ UR - http://dx.doi.org/10.2196/jmir.6453 UR - http://www.ncbi.nlm.nih.gov/pubmed/28461286 ID - info:doi/10.2196/jmir.6453 ER - TY - JOUR AU - Katz, Aric AU - Tepper, Ronnie AU - Shtub, Avraham PY - 2017/04/21 TI - Simulation Training: Evaluating the Instructor?s Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training JO - JMIR Med Educ SP - e8 VL - 3 IS - 1 KW - distance learning KW - feedback KW - simulation training KW - evaluation research N2 - Background: Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow?s graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse. Objectives: This quantitative study assessed the effectiveness of a computerized interactive simulator coupled with an instructor who monitored students? progress and provided Web-based immediate feedback. Methods: A low-cost, globally accessible, telemedicine simulator, developed at the Technion?Israel Institute of Technology, Haifa, Israel?was used. A previous study in the field of interventional cardiology, evaluating the efficacy of the simulator to enhanced learning via knowledge exams, presented promising results of average scores varying from 94% after training and 54% before training (n=20) with P<.001. Two independent experiments involving obstetrics and gynecology (Ob-Gyn) physicians and senior ultrasound sonographers, with 32 subjects, were conducted using a new interactive concept of the WOZ (Wizard of OZ) simulator platform. The contribution of an instructor to learning outcomes was evaluated by comparing students? knowledge before and after each interactive instructor-led session as well as after fully automated e-learning in the field of Ob-Gyn. Results from objective knowledge tests were analyzed using hypothesis testing and model fitting. Results: A significant advantage (P=.01) was found in favor of the WOZ training approach. Content type and training audience were not significant. Conclusions: This study evaluated the contribution of an integrated teaching environment using a computerized interactive simulator, with an instructor providing immediate Web-based immediate feedback to trainees. Involvement of an instructor in the simulation-based training process provided better learning outcomes that varied training content and trainee populations did not affect the overall learning gains. UR - http://mededu.jmir.org/2017/1/e8/ UR - http://dx.doi.org/10.2196/mededu.6312 UR - http://www.ncbi.nlm.nih.gov/pubmed/28432039 ID - info:doi/10.2196/mededu.6312 ER - TY - JOUR AU - Schoenthaler, Antoinette AU - Albright, Glenn AU - Hibbard, Judith AU - Goldman, Ron PY - 2017/04/19 TI - Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study JO - JMIR Med Educ SP - e7 VL - 3 IS - 1 KW - simulation training KW - health communication KW - patient activation KW - motivational interviewing KW - decision making N2 - Background: Despite clear evidence that antibiotics do not cure viral infections, the problem of unnecessary prescribing of antibiotics in ambulatory care persists, and in some cases, prescribing patterns have increased. The overuse of antibiotics for treating viral infections has created numerous economic and clinical consequences including increased medical costs due to unnecessary hospitalizations, antibiotic resistance, disruption of gut bacteria, and obesity. Recent research has underscored the importance of collaborative patient-provider communication as a means to reduce the high rates of unnecessary prescriptions for antibiotics. However, most patients and providers do not feel prepared to engage in such challenging conversations. Objectives: The aim of this pilot study was to assess the ability of a brief 15-min simulated role-play conversation with virtual humans to serve as a preliminary step to help health care providers and patients practice, and learn how to engage in effective conversations about antibiotics overuse. Methods: A total of 69 participants (35 providers and 34 patients) completed the simulation once in one sitting. A pre-post repeated measures design was used to assess changes in patients? and providers? self-reported communication behaviors, activation, and preparedness, intention, and confidence to effectively communicate in the patient-provider encounter. Changes in patients? knowledge and beliefs regarding antibiotic use were also evaluated. Results: Patients experienced a short-term positive improvement in beliefs about appropriate antibiotic use for infection (F1,30=14.10, P=.001). Knowledge scores regarding the correct uses of antibiotics improved immediately postsimulation, but decreased at the 1-month follow-up (F1,30=31.16, P<.001). There was no change in patient activation and shared decision-making (SDM) scores in the total sample of patients (P>.10) Patients with lower levels of activation exhibited positive, short-term benefits in increased intent and confidence to discuss their needs and ask questions in the clinic visit, positive attitudes regarding participation in SDM with their provider, and accurate beliefs about the use of antibiotics (P<.10). The results also suggest small immediate gains in providers? attitudes about SDM (mean change 0.20; F1,33= 8.03, P=.01). Conclusions: This pilot study provided preliminary evidence on the efficacy of the use of simulated conversations with virtual humans as a tool to improve patient-provider communication (ie, through increasing patient confidence to actively participate in the visit and physician attitudes about SDM) for engaging in conversations about antibiotic use. Future research should explore if repeated opportunities to use the 15-min simulation as well as providing users with several different conversations to practice with would result in sustained improvements in antibiotics beliefs and knowledge and communication behaviors over time. The results of this pilot study offered several opportunities to improve on the simulation in order to bolster communication skills and knowledge retention. UR - http://mededu.jmir.org/2017/1/e7/ UR - http://dx.doi.org/10.2196/mededu.6305 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428160 ID - info:doi/10.2196/mededu.6305 ER - TY - JOUR AU - Kessler, Craig AU - Peerschke, I. Ellinor AU - Chitlur, B. Meera AU - Kulkarni, Roshni AU - Holot, Natalia AU - Cooper, L. David PY - 2017/04/18 TI - The Coags Uncomplicated App: Fulfilling Educational Gaps Around Diagnosis and Laboratory Testing of Coagulation Disorders JO - JMIR Med Educ SP - e6 VL - 3 IS - 1 KW - blood coagulation disorders KW - smartphone KW - diagnosis KW - hematology KW - differential diagnosis N2 - Background: Patients with coagulation disorders may present to a variety of physician specialties; however, accurate and efficient diagnosis can be challenging for physicians not specialized in hematology, due to identified gaps in knowledge around appropriate laboratory assays and interpretation of test results. Coags Uncomplicated was developed to fill this unmet educational need by increasing practical knowledge of coagulation disorders among nonexpert physicians and other health care professionals (HCPs) in a point-of-care (POC) setting. Objective: The aim of this study was to assess patterns of use of the mobile app Coags Uncomplicated, a tool designed to support education regarding accurate and efficient diagnosis of bleeding disorders. Methods: App metrics were obtained by tracking registered user data. Additionally, a survey was distributed to registered users, to assess circumstances and frequency of use. Results: The most common specialties of 7596 registered US users were hematology-oncology (n=1534, 20.19%), hematology (n=1014, 13.35%), and emergency medicine (n=1222, 16.09%); most identified as physicians (n=4082, 53.74%). Specialties accounting for the greatest numbers of screen views were hematology-oncology (99,390 views), hematology (47,808 views), emergency medicine (23,121 views), and internal medicine (22,586 views). The most common diagnostic endpoints reached were disseminated intravascular coagulation (DIC; 2713 times), liver disease effect (2108 times), and vitamin K deficiency (1584 times). Of 3424 users asked to take the survey, 262 responded (7.65%); most were physicians in direct clinical care (71%) and specialized in hematology-oncology (39%) or emergency medicine (21%). Most frequent use was reported by hematologists (69%, ?6 times) and hematologists-oncologists (38%, ?6 times). Most physicians (89.2%) reported using the app for patient-case-related education around appropriate use of laboratory tests in diagnostic evaluation. Physicians rated Lab Value Analyzer (mean 4.43) and Lab Test Algorithm (mean 4.46) tools highly on a 5-point ?how helpful? scale and were likely to recommend the app to colleagues. Conclusions: App use among physicians and other HCPs is consistent with value as a POC educational tool, which may facilitate differential diagnoses and appropriate early consultation with hematologists. UR - http://mededu.jmir.org/2017/1/e6/ UR - http://dx.doi.org/10.2196/mededu.6858 UR - http://www.ncbi.nlm.nih.gov/pubmed/28420603 ID - info:doi/10.2196/mededu.6858 ER - TY - JOUR AU - Christ, Hildegard AU - Franklin, Jeremy AU - Griebenow, Reinhard AU - Baethge, Christopher PY - 2017/04/03 TI - An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers JO - J Med Internet Res SP - e49 VL - 19 IS - 4 KW - education KW - medical KW - continuing interactive tutorial KW - journal article N2 - Background: Physicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches Ärzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians. Objective: The aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants. Methods: Using obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association. Results: A total of 128,398 physicians and therapists (male: 54.64%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33% (44,064/357,252) and 16.15% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53%, 1,041,931/2,339,802) as well as over the weekend (28.70%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25%, 23,434/128,392), general medicine (16.38%, 21,033/128,392), anesthesiology (10.00%, 12,840/128,392), and surgery (7.06%, 9059/128,392). Participants rated the CME articles as intelligible to a wider medical audience and filling clinically relevant knowledge gaps; 78.57% (1,838,358/2,339,781) of the sample gave the CME articles very good or good marks. Cluster analysis revealed three groups, one comprised of only women, with two-thirds working in private practice. Conclusions: The CME article series of Deutsches Ärzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for physicians in private practice and those who want to participate from their homes and on weekends. Although many physicians emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts professional performance and patient outcomes. UR - http://www.jmir.org/2017/4/e49/ UR - http://dx.doi.org/10.2196/jmir.6052 UR - http://www.ncbi.nlm.nih.gov/pubmed/28373156 ID - info:doi/10.2196/jmir.6052 ER - TY - JOUR AU - Bond, Evan Stuart AU - Crowther, P. Shelley AU - Adhikari, Suman AU - Chubaty, J. Adriana AU - Yu, Ping AU - Borchard, P. Jay AU - Boutlis, Steven Craig AU - Yeo, Winston Wilfred AU - Miyakis, Spiros PY - 2017/03/30 TI - Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin JO - J Med Internet Res SP - e93 VL - 19 IS - 3 KW - nursing education KW - pharmacy education KW - medical education KW - continuing education KW - vancomycin KW - survey methods KW - anti-bacterial agents N2 - Background: Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context. Objectives: The study aimed to (1) determine health professionals? experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area. Methods: We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals? knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected. Results: From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0%, 433/577) and rate of administration (64.9%, 375/577) were answered most correctly, followed by timing of first level (49%, 283/577), maintenance dose (41.9%, 242/577), and loading dose (38.0%, 219/577). Self-reported ?very? and ?reasonably? experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65% for nurses (n=63), 68% for doctors (n=86), and 82% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2% correct on first attempt; 64/163), timing of first trough level (50.3%, 82/163), and subsequent trough levels (47.9%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of ?entertaining,? ?engaging,? and ?fun? identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers. Conclusions: A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations. UR - http://www.jmir.org/2017/3/e93/ UR - http://dx.doi.org/10.2196/jmir.6971 UR - http://www.ncbi.nlm.nih.gov/pubmed/28360025 ID - info:doi/10.2196/jmir.6971 ER - TY - JOUR AU - Badran, Hani AU - Pluye, Pierre AU - Grad, Roland PY - 2017/03/14 TI - When Educational Material Is Delivered: A Mixed Methods Content Validation Study of the Information Assessment Method JO - JMIR Med Educ SP - e4 VL - 3 IS - 1 KW - validity and reliability KW - continuing education KW - Internet KW - electronic mail KW - physicians, family KW - knowledge translation KW - primary health care N2 - Background: The Information Assessment Method (IAM) allows clinicians to report the cognitive impact, clinical relevance, intention to use, and expected patient health benefits associated with clinical information received by email. More than 15,000 Canadian physicians and pharmacists use the IAM in continuing education programs. In addition, information providers can use IAM ratings and feedback comments from clinicians to improve their products. Objective: Our general objective was to validate the IAM questionnaire for the delivery of educational material (ecological and logical content validity). Our specific objectives were to measure the relevance and evaluate the representativeness of IAM items for assessing information received by email. Methods: A 3-part mixed methods study was conducted (convergent design). In part 1 (quantitative longitudinal study), the relevance of IAM items was measured. Participants were 5596 physician members of the Canadian Medical Association who used the IAM. A total of 234,196 ratings were collected in 2012. The relevance of IAM items with respect to their main construct was calculated using descriptive statistics (relevance ratio R). In part 2 (qualitative descriptive study), the representativeness of IAM items was evaluated. A total of 15 family physicians completed semistructured face-to-face interviews. For each construct, we evaluated the representativeness of IAM items using a deductive-inductive thematic qualitative data analysis. In part 3 (mixing quantitative and qualitative parts), results from quantitative and qualitative analyses were reviewed, juxtaposed in a table, discussed with experts, and integrated. Thus, our final results are derived from the views of users (ecological content validation) and experts (logical content validation). Results: Of the 23 IAM items, 21 were validated for content, while 2 were removed. In part 1 (quantitative results), 21 items were deemed relevant, while 2 items were deemed not relevant (R=4.86% [N=234,196] and R=3.04% [n=45,394], respectively). In part 2 (qualitative results), 22 items were deemed representative, while 1 item was not representative. In part 3 (mixing quantitative and qualitative results), the content validity of 21 items was confirmed, and the 2 nonrelevant items were excluded. A fully validated version was generated (IAM-v2014). Conclusions: This study produced a content validated IAM questionnaire that is used by clinicians and information providers to assess the clinical information delivered in continuing education programs. UR - http://mededu.jmir.org/2017/1/e4/ UR - http://dx.doi.org/10.2196/mededu.6415 UR - http://www.ncbi.nlm.nih.gov/pubmed/28292738 ID - info:doi/10.2196/mededu.6415 ER - TY - JOUR AU - Diehl, Arthur Leandro AU - Souza, Martins Rodrigo AU - Gordan, Alejandro Pedro AU - Esteves, Zonato Roberto AU - Coelho, Meister Izabel Cristina PY - 2017/03/09 TI - InsuOnline, an Electronic Game for Medical Education on Insulin Therapy: A Randomized Controlled Trial With Primary Care Physicians JO - J Med Internet Res SP - e72 VL - 19 IS - 3 KW - diabetes mellitus KW - insulin KW - video games KW - medical education KW - continuing medical education KW - educational technology N2 - Background: Most patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated. Objective: The objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity. Methods: Primary care physicians (PCPs) from South of Brazil were invited by phone or email to participate in an unblinded randomized controlled trial and randomly allocated to play the game InsuOnline, installed as an app in their own computers, at the time of their choice, with minimal or no external guidance, or to participate in a traditional CME session, composed by onsite lectures and cases discussion. Both interventions had the same content and duration (~4 h). Applicability was assessed by the number of subjects who completed the assigned intervention in each group. Insulin-prescribing competence (factual knowledge, problem-solving skills, and attitudes) was self-assessed through a questionnaire applied before, immediately after, and 3 months after the interventions. Acceptance of the intervention (satisfaction and perceived importance for clinical practice) was also assessed immediately after and 3 months after the interventions, respectively. Results: Subjects? characteristics were similar between groups (mean age 38, 51.4% [69/134] male). In the game group, 69 of 88 (78%) completed the intervention, compared with 65 of 73 (89%) in the control group, with no difference in applicability. Percentage of right answers in the competence subscale, which was 52% at the baseline in both groups, significantly improved immediately after both interventions to 92% in the game group and to 85% in control (P<.001). After 3 months, it remained significantly higher than that at the baseline in both groups (80% in game, and 76% in control; P<.001). Absolute increase in competence score was better with the game (40%) than with traditional CME (34%; P=.01). Insulin-related attitudes were improved both after the game (significant improvement in 4 of 9 items) and after control activity (3 of 9). Both interventions were very well accepted, with most subjects rating them as ?fun or pleasant,? ?useful,? and ?practice-changing.? Conclusions: The game InsuOnline was applicable, very well accepted, and highly effective for medical education on insulin therapy. In view of its flexibility and easy dissemination, it is a valid option for large-scale CME, potentially helping to reduce clinical inertia and to improve quality of care for DM patients. Trial Registration: Clinicaltrials.gov NCT001759953; https://clinicaltrials.gov/ct2/show/NCT01759953 (Archived by WebCite at http://www.webcitation.org/6oeHoTrBf) UR - http://www.jmir.org/2017/3/e72/ UR - http://dx.doi.org/10.2196/jmir.6944 UR - http://www.ncbi.nlm.nih.gov/pubmed/28279950 ID - info:doi/10.2196/jmir.6944 ER - TY - JOUR AU - Wlodarczyk, Dorota AU - Chyli?ska, Joanna AU - Lazarewicz, Magdalena AU - Rzadkiewicz, Marta AU - Jaworski, Mariusz AU - Adamus, Miroslawa AU - Haugan, Gørill AU - Lillefjell, Monica AU - Espnes, Arild Geir PY - 2017/02/22 TI - Enhancing Doctors? Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study JO - J Med Internet Res SP - e45 VL - 19 IS - 2 KW - health services for the aged KW - active aging KW - e-learning KW - general practioners KW - professional competence KW - psychosocial competencies KW - health communication KW - seniors? expectations KW - seniors? attitude toward treatment and health N2 - Background: Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. Objective: Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. Methods: The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. Results: GPs participating in e-learning demonstrated a significant rise in their perception of older patients? expectations for disease explanation (Wald ?2=19.7, P<.001) and in perception of motivational aspect of older patients? attitude toward treatment and health (Wald ?2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald ?2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility?s organizational structure. Conclusions: Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors? reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients? proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients. UR - http://www.jmir.org/2017/2/e45/ UR - http://dx.doi.org/10.2196/jmir.6948 UR - http://www.ncbi.nlm.nih.gov/pubmed/28228370 ID - info:doi/10.2196/jmir.6948 ER - TY - JOUR AU - Blok, C. Amanda AU - May, N. Christine AU - Sadasivam, S. Rajani AU - Houston, K. Thomas PY - 2017/02/15 TI - Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations JO - JMIR Med Educ SP - e3 VL - 3 IS - 1 KW - virtual patients KW - interdisciplinary health teams KW - clinical staff engagement KW - environment design KW - health promotion KW - tobacco use cessation N2 - Background: Engaging health care staff in new quality improvement programs is challenging. Objective: We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. Methods: Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). Results: A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high-performing practices that referred 20 or more smokers to the ePortal (13/76), the majority of clinic staff were motivated by or liked the virtual patient (20/26, 77%). Conclusions: Medical providers are more likely motivated by VPs that are similar to their patient population, while nurses and other staff may prefer avatars that are more similar to them. UR - http://mededu.jmir.org/2017/1/e3/ UR - http://dx.doi.org/10.2196/mededu.7042 UR - http://www.ncbi.nlm.nih.gov/pubmed/28202429 ID - info:doi/10.2196/mededu.7042 ER - TY - JOUR AU - Paim, Padilha Crislaine Pires AU - Goldmeier, Silvia PY - 2017/01/10 TI - Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology JO - JMIR Serious Games SP - e1 VL - 5 IS - 1 KW - nursing education research KW - educational technology KW - perioperative nursing N2 - Background: Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. Objective: To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. Methods: The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom?s taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. Results: The development of the game called ?Playing with Tweezers? was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. Conclusions: The ?digital? nursing student needs engagement, stimulation, reality, and entertainment, not just readings. ?Playing with Tweezers? is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not replace curricular practice, but helps. UR - http://games.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/games.6048 UR - http://www.ncbi.nlm.nih.gov/pubmed/28073736 ID - info:doi/10.2196/games.6048 ER - TY - JOUR AU - O'Sullivan, Elizabeth AU - Cutts, Emily AU - Kavikondala, Sushma AU - Salcedo, Alejandra AU - D'Souza, Karan AU - Hernandez-Torre, Martin AU - Anderson, Claire AU - Tiwari, Agnes AU - Ho, Kendall AU - Last, Jason PY - 2017/01/04 TI - Social Media in Health Science Education: An International Survey JO - JMIR Med Educ SP - e1 VL - 3 IS - 1 KW - health education KW - health surveys KW - interdisciplinary studies KW - learning KW - professionalism KW - self report KW - social media KW - students KW - surveys and questionnaires KW - universities N2 - Background: Social media is an asset that higher education students can use for an array of purposes. Studies have shown the merits of social media use in educational settings; however, its adoption in health science education has been slow, and the contributing reasons remain unclear. Objective: This multidisciplinary study aimed to examine health science students? opinions on the use of social media in health science education and identify factors that may discourage its use. Methods: Data were collected from the Universitas 21 ?Use of social media in health education? survey, distributed electronically among the health science staff and students from 8 universities in 7 countries. The 1640 student respondents were grouped as users or nonusers based on their reported frequency of social media use in their education. Results: Of the 1640 respondents, 1343 (81.89%) use social media in their education. Only 462 of the 1320 (35.00%) respondents have received specific social media training, and of those who have not, the majority (64.9%, 608/936) would like the opportunity. Users and nonusers reported the same 3 factors as the top barriers to their use of social media: uncertainty on policies, concerns about professionalism, and lack of support from the department. Nonusers reported all the barriers more frequently and almost half of nonusers reported not knowing how to incorporate social media into their learning. Among users, more than one fifth (20.5%, 50/243) of students who use social media ?almost always? reported sharing clinical images without explicit permission. Conclusions: Our global, interdisciplinary study demonstrates that a significant number of students across all health science disciplines self-reported sharing clinical images inappropriately, and thus request the need for policies and training specific to social media use in health science education. UR - http://mededu.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/mededu.6304 UR - http://www.ncbi.nlm.nih.gov/pubmed/28052842 ID - info:doi/10.2196/mededu.6304 ER - TY - JOUR AU - Creutzfeldt, Johan AU - Hedman, Leif AU - Felländer-Tsai, Li PY - 2016/12/16 TI - Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students? Experiences Using a Multiplayer Virtual World JO - JMIR Serious Games SP - e22 VL - 4 IS - 2 KW - avatars KW - cardiopulmonary resuscitation KW - educational technology KW - medical students KW - experiences KW - multiplayer virtual worlds KW - patient simulation KW - virtual learning environments N2 - Background: Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. Objective: The objective of this study was to reach a better understanding of the learners? reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Methods: Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students? perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Results: Four categories characterizing the students? experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Conclusions: Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance. UR - http://games.jmir.org/2016/2/e22/ UR - http://dx.doi.org/10.2196/games.6448 UR - http://www.ncbi.nlm.nih.gov/pubmed/27986645 ID - info:doi/10.2196/games.6448 ER - TY - JOUR AU - DelSignore, A. Lisa AU - Wolbrink, A. Traci AU - Zurakowski, David AU - Burns, P. Jeffrey PY - 2016/11/21 TI - Test-Enhanced E-Learning Strategies in Postgraduate Medical Education: A Randomized Cohort Study JO - J Med Internet Res SP - e299 VL - 18 IS - 11 KW - distance learning KW - computer-assisted instruction KW - medical education KW - educational measurement KW - retention N2 - Background: The optimal design of pedagogical strategies for e-learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with initial research suggesting that taking short breaks while watching videos (independent of answering test questions) may improve learning by focusing attention on the content presented. Interspersed test questions may also improve knowledge acquisition and retention. Objective: To examine the effect of interspersed test questions and periodic breaks on immediate knowledge acquisition and retention at 6 months by pediatric residents engaged in video-based e-learning. Methods: First- and second-year pediatric residents were randomized to 1 of the following 3 groups: viewing the complete video uninterrupted (full video), viewing the video interrupted with unrelated logic puzzles (logic puzzles), or viewing the video interrupted with brief comprehension test questions (short answer questions). Residents answered pre- and post-tests before and after video viewing, followed by a retention test at 6 months. Primary outcome included comparison of the change in test scores between groups. Results: A total of 49 residents completed the initial testing session. All 3 learning groups had comparable mean increases in immediate knowledge gain, but with no significant differences between groups (F2,46=0.35, P=.71). Thirty-five residents completed retention testing with comparable degrees of knowledge retention in the full video and short answer test questions groups (P<.001), but no significant change in the logic puzzles group (F1,32=2.44, P=.13). Conclusions: Improved knowledge gain was not demonstrated among residents answering interspersed questions or completing logic puzzles during interrupted online video viewing when compared with residents viewing uninterrupted video content. However, residents who either participated in uninterrupted video viewing or answered interspersed questions during interrupted video viewing demonstrated significant knowledge retention at 6 months. UR - http://www.jmir.org/2016/11/e299/ UR - http://dx.doi.org/10.2196/jmir.6199 UR - http://www.ncbi.nlm.nih.gov/pubmed/27872034 ID - info:doi/10.2196/jmir.6199 ER - TY - JOUR AU - Walldorf, Jens AU - Jähnert, Tina AU - Berman, B. Norman AU - Fischer, R. Martin PY - 2016/09/27 TI - Using Foreign Virtual Patients With Medical Students in Germany: Are Cultural Differences Evident and Do They Impede Learning? JO - J Med Internet Res SP - e260 VL - 18 IS - 9 KW - virtual patients KW - medical education KW - cultural differences KW - competency-based education KW - e-learning N2 - Background: Learning with virtual patients (VPs) is considered useful in medical education for fostering clinical reasoning. As the authoring of VPs is highly demanding, an international exchange of cases might be desirable. However, cultural differences in foreign VPs might hamper learning success. Objective: We investigated the need for support for using VPs from the United States at a German university, with respect to language and cultural differences. Our goal was to better understand potential implementation barriers of a intercultural VP exchange. Methods: Two VPs were presented to 30 German medical students featuring a cultural background different from German standards with respect to diagnostic and therapeutic procedures, ethical aspects, role models, and language (as identified by a cultural adaptation framework). Participants were assigned to two groups: 14 students were advised to complete the cases without further instructions (basic group), and 16 students received written explanatory supplemental information specifically with regard to cultural differences (supplement group). Using a 6-point scale (6=strongly agree), we analyzed the results of an integrated assessment of learning success as well as an evaluation of cases by the students on usefulness for learning and potential issues regarding the language and cultural background. Results: The German students found it motivating to work with cases written in English (6-point scale, 4.5 points). The clinical relevance of the VPs was clearly recognized (6 points), and the foreign language was considered a minor problem in this context (3 points). The results of the integrated learning assessment were similar in both groups (basic 53% [SD 4] vs supplement 52% [SD 4] correct answers, P=.32). However, students using the supplemental material more readily realized culturally different diagnostic and therapeutic strategies (basic 4 vs supplement 5 points, P=.39) and were less affirmative when asked about the transferability of cases to a German context (basic 5 vs supplement 3 points, P=.048). Conclusions: German students found English VPs to be highly clinically relevant, and they rated language problems much lower than they rated motivation to work on cases in English. This should encourage the intercultural exchange of VPs. The provision of supplemental explanatory material facilitates the recognition of cultural differences and might help prevent unexpected learning effects. UR - http://www.jmir.org/2016/9/e260/ UR - http://dx.doi.org/10.2196/jmir.6040 UR - http://www.ncbi.nlm.nih.gov/pubmed/27678418 ID - info:doi/10.2196/jmir.6040 ER - TY - JOUR AU - Liu, Chunfeng AU - Lim, L. Renee AU - McCabe, L. Kathryn AU - Taylor, Silas AU - Calvo, A. Rafael PY - 2016/09/12 TI - A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study JO - J Med Internet Res SP - e246 VL - 18 IS - 9 KW - nonverbal communication KW - nonverbal behavior KW - clinical consultation KW - medical education KW - communication skills KW - nonverbal behavior detection KW - automated feedback KW - affective computing N2 - Background: In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students? awareness of their nonverbal communication. Objective: This study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students. Methods: We conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1?5 (group A) or to complete EQClinic training during weeks 8?11 (group B). EQClinic delivered an automated visual presentation of students? nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6?7 and 12?13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students? performance during face-to-face consultations pre- and postexposure to EQClinic. Results: We randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4?16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement. Conclusions: The EQClinic is a useful tool for medical students? clinical communication skills training that can be applied to university settings to improve students clinical communication skills development. UR - http://www.jmir.org/2016/9/e246/ UR - http://dx.doi.org/10.2196/jmir.6299 UR - http://www.ncbi.nlm.nih.gov/pubmed/27619564 ID - info:doi/10.2196/jmir.6299 ER - TY - JOUR AU - Alsobayel, Hana PY - 2016/09/12 TI - Use of Social Media for Professional Development by Health Care Professionals: A Cross-Sectional Web-Based Survey JO - JMIR Med Educ SP - e15 VL - 2 IS - 2 KW - social media KW - education, professional KW - health education KW - professional competence N2 - Background: Social media can be used in health care settings to enhance professional networking and education; patient communication, care, and education; public health programs; organizational promotion; and research. Objective: The aim of this study was to explore the use of social media networks for the purpose of professional development among health care professionals in Saudi Arabia using a purpose-designed Web-based survey. Methods: A cross-sectional web-based survey was undertaken. A link to the survey was posted on the investigator?s personal social media accounts including Twitter, LinkedIn, and WhatsApp. Results: A total of 231 health care professionals, who are generally social media users, participated in the study. Of these professionals, 70.6% (163/231) use social media for their professional development. The social media applications most frequently used, in the descending order, for professional development were Twitter, YouTube, Instagram, Facebook, Snapchat, and LinkedIn. The majority of respondents used social media for professional development irrespective of their age group, with the highest proportion seen in those aged 20-30 years. Social media were perceived as being most beneficial for professional development in terms of their impact on the domains of knowledge and problem solving and least helpful for enhancing clinical skills. Twitter was perceived as the most helpful type of social media for all domains listed. Respondents most frequently reported that social media were useful for professional development for the reasons of knowledge exchange and networking. Conclusions: Social media are frequently used by health care professionals in Saudi Arabia for the purposes of professional development, with Twitter most frequently used for this purpose. These findings suggest that social media networks can be powerful tools for engaging health care professionals in their professional development. UR - http://mededu.jmir.org/2016/2/e15/ UR - http://dx.doi.org/10.2196/mededu.6232 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731855 ID - info:doi/10.2196/mededu.6232 ER - TY - JOUR AU - Fontaine, Guillaume AU - Cossette, Sylvie AU - Heppell, Sonia AU - Boyer, Louise AU - Mailhot, Tanya AU - Simard, Marie-Josée AU - Tanguay, Jean-Francois PY - 2016/08/18 TI - Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study JO - J Med Internet Res SP - e224 VL - 18 IS - 8 KW - motivational interviewing KW - cardiovascular diseases KW - coronary artery disease KW - health behavior change KW - Web-based learning KW - e-learning KW - pilot study N2 - Background: Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers. Objective: The primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@C?UR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses? perceived brief MI skills and self-reported clinical use of brief MI. Methods: We conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@C?UR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@C?UR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients? motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session. Results: We enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%?91%) completed both sessions in ?20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0?7), perceived ease of use (mean 6.16, SD 0.78; scale 0?7), and system quality (mean 6.15, SD 0.58; scale 0?7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10?50). Other results were nonsignificant. Conclusions: Brief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx) UR - http://www.jmir.org/2016/8/e224/ UR - http://dx.doi.org/10.2196/jmir.6298 UR - http://www.ncbi.nlm.nih.gov/pubmed/27539960 ID - info:doi/10.2196/jmir.6298 ER - TY - JOUR AU - Ahmed, Laura AU - Seal, H. Leonard AU - Ainley, Carol AU - De la Salle, Barbara AU - Brereton, Michelle AU - Hyde, Keith AU - Burthem, John AU - Gilmore, Samuel William PY - 2016/08/11 TI - Web-Based Virtual Microscopy of Digitized Blood Slides for Malaria Diagnosis: An Effective Tool for Skills Assessment in Different Countries and Environments JO - J Med Internet Res SP - e213 VL - 18 IS - 8 KW - Malaria KW - Virtual microscopy KW - External quality assessment KW - Internet N2 - Background: Morphological examination of blood films remains the reference standard for malaria diagnosis. Supporting the skills required to make an accurate morphological diagnosis is therefore essential. However, providing support across different countries and environments is a substantial challenge. Objective: This paper reports a scheme supplying digital slides of malaria-infected blood within an Internet-based virtual microscope environment to users with different access to training and computing facilities. The feasibility of the approach was established, allowing users to test, record, and compare their own performance with that of other users. Methods: From Giemsa stained thick and thin blood films, 56 large high-resolution digital slides were prepared, using high-quality image capture and 63x oil-immersion objective lens. The individual images were combined using the photomerge function of Adobe Photoshop and then adjusted to ensure resolution and reproduction of essential diagnostic features. Web delivery employed the Digital Slidebox platform allowing digital microscope viewing facilities and image annotation with data gathering from participants. Results: Engagement was high with images viewed by 38 participants in five countries in a range of environments and a mean completion rate of 42/56 cases. The rate of parasite detection was 78% and accuracy of species identification was 53%, which was comparable with results of similar studies using glass slides. Data collection allowed users to compare performance with other users over time or for each individual case. Conclusions: Overall, these results demonstrate that users worldwide can effectively engage with the system in a range of environments, with the potential to enhance personal performance through education, external quality assessment, and personal professional development, especially in regions where educational resources are difficult to access. UR - http://www.jmir.org/2016/8/e213/ UR - http://dx.doi.org/10.2196/jmir.6027 UR - http://www.ncbi.nlm.nih.gov/pubmed/27515009 ID - info:doi/10.2196/jmir.6027 ER - TY - JOUR AU - Daruwalla, J. Zubin AU - Loh, L. Jing AU - Dong, Chaoyan PY - 2016/08/09 TI - Spaced Education and the Importance of Raising Awareness of the Personal Data Protection Act: A Medical Student Population-Based Study JO - JMIR Med Educ SP - e12 VL - 2 IS - 2 KW - medical education KW - MyDoc KW - Personal Data Protection Act KW - secure messaging KW - spaced education KW - telehealth KW - telemedicine N2 - Background: The Personal Data Protection Act (PDPA) of Singapore was first passed in 2012, with subsequent enforcement regulations effective in 2014. Although medical education via digital platforms is not often used in medical schools in Singapore as of yet, many current means of communication at all levels in the medical community from medical schools to clinics to hospitals are unsecure and noncompliant with the PDPA. Objective: This pilot study will assess the effectiveness of MyDoc, a secure, mobile telehealth application and messaging platform, as an educational tool, secure communications tool, and a tool to raise awareness of the PDPA. Methods: By replacing current methods of communication with MyDoc and using weekly clinical case discussions in the form of unidentifiable clinical photos and questions and answers, we raised awareness the PDPA among medical students and gained feedback and determined user satisfaction with this innovative system via questionnaires handed to 240 medical students who experienced using MyDoc over a 6-week period. Results: All 240 questionnaires were answered with very positive and promising results, including all 100 students who were not familiar with the PDPA prior to the study attributing their awareness of it to MyDoc. Conclusions: Potential uses of MyDoc in a medical school setting include PDPA-compliant student-to-student and student-to-doctor communication and clinical group case discussions with the sharing of patient-sensitive data, including clinical images and/or videos of hospital patients that students may benefit from viewing from an educational perspective. With our pilot study having excellent results in terms of acceptance and satisfaction from medical students and raising awareness of the PDPA, the integration of a secure, mobile digital health application and messaging platform is something all medical schools should consider, because our students of today are our doctors of tomorrow. UR - http://mededu.jmir.org/2016/2/e12/ UR - http://dx.doi.org/10.2196/mededu.5586 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731866 ID - info:doi/10.2196/mededu.5586 ER - TY - JOUR AU - Taveira-Gomes, Tiago AU - Ferreira, Patrícia AU - Taveira-Gomes, Isabel AU - Severo, Milton AU - Ferreira, Amélia Maria PY - 2016/08/01 TI - What Are We Looking for in Computer-Based Learning Interventions in Medical Education? A Systematic Review JO - J Med Internet Res SP - e204 VL - 18 IS - 8 KW - medical education KW - internet-based learning KW - computer-based learning KW - e-learning KW - b-learning KW - systematic review N2 - Background: Computer-based learning (CBL) has been widely used in medical education, and reports regarding its usage and effectiveness have ranged broadly. Most work has been done on the effectiveness of CBL approaches versus traditional methods, and little has been done on the comparative effects of CBL versus CBL methodologies. These findings urged other authors to recommend such studies in hopes of improving knowledge about which CBL methods work best in which settings. Objective: In this systematic review, we aimed to characterize recent studies of the development of software platforms and interventions in medical education, search for common points among studies, and assess whether recommendations for CBL research are being taken into consideration. Methods: We conducted a systematic review of the literature published from 2003 through 2013. We included studies written in English, specifically in medical education, regarding either the development of instructional software or interventions using instructional software, during training or practice, that reported learner attitudes, satisfaction, knowledge, skills, or software usage. We conducted 2 latent class analyses to group articles according to platform features and intervention characteristics. In addition, we analyzed references and citations for abstracted articles. Results: We analyzed 251 articles. The number of publications rose over time, and they encompassed most medical disciplines, learning settings, and training levels, totaling 25 different platforms specifically for medical education. We uncovered 4 latent classes for educational software, characteristically making use of multimedia (115/251, 45.8%), text (64/251, 25.5%), Web conferencing (54/251, 21.5%), and instructional design principles (18/251, 7.2%). We found 3 classes for intervention outcomes: knowledge and attitudes (175/212, 82.6%), knowledge, attitudes, and skills (11.8%), and online activity (12/212, 5.7%). About a quarter of the articles (58/227, 25.6%) did not hold references or citations in common with other articles. The number of common references and citations increased in articles reporting instructional design principles (P=.03), articles measuring online activities (P=.01), and articles citing a review by Cook and colleagues on CBL (P=.04). There was an association between number of citations and studies comparing CBL versus CBL, independent of publication date (P=.02). Conclusions: Studies in this field vary highly, and a high number of software systems are being developed. It seems that past recommendations regarding CBL interventions are being taken into consideration. A move into a more student-centered model, a focus on implementing reusable software platforms for specific learning contexts, and the analysis of online activity to track and predict outcomes are relevant areas for future research in this field. UR - http://www.jmir.org/2016/8/e204/ UR - http://dx.doi.org/10.2196/jmir.5461 UR - http://www.ncbi.nlm.nih.gov/pubmed/27480053 ID - info:doi/10.2196/jmir.5461 ER - TY - JOUR AU - Pathipati, S. Akhilesh AU - Azad, D. Tej AU - Jethwani, Kamal PY - 2016/07/12 TI - Telemedical Education: Training Digital Natives in Telemedicine JO - J Med Internet Res SP - e193 VL - 18 IS - 7 KW - telemedicine KW - medical education KW - medical school KW - curriculum reform UR - http://www.jmir.org/2016/7/e193/ UR - http://dx.doi.org/10.2196/jmir.5534 UR - http://www.ncbi.nlm.nih.gov/pubmed/27405323 ID - info:doi/10.2196/jmir.5534 ER - TY - JOUR AU - Ling, Lowell AU - Gomersall, David Charles AU - Samy, Winnie AU - Joynt, Matthew Gavin AU - Leung, CH Czarina AU - Wong, Wai-Tat AU - Lee, Anna PY - 2016/07/05 TI - The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study JO - J Med Internet Res SP - e180 VL - 18 IS - 7 KW - patient safety KW - critical care KW - education, professional KW - education, distance KW - safety culture N2 - Background: Patient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture. Objective: Our aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture. Methods: Health care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User?s Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents. Results: We distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions. Conclusions: Our study demonstrates that a structured, reproducible short course on patient safety may be associated with an enhancement in several domains in ICU patient safety culture. UR - http://www.jmir.org/2016/7/e180/ UR - http://dx.doi.org/10.2196/jmir.5378 UR - http://www.ncbi.nlm.nih.gov/pubmed/27381876 ID - info:doi/10.2196/jmir.5378 ER - TY - JOUR AU - Buabbas, Jassem Ali AU - Al-Shawaf, Hassan Hamza Mohammad AU - Almajran, Abdulaziz Abdullah PY - 2016/06/20 TI - Health Sciences Students? Self-Assessment of Information and Communication Technology Skills and Attitude Toward e-Learning JO - JMIR Med Educ SP - e9 VL - 2 IS - 1 KW - ICT literacy KW - health sciences student attitudes KW - health informatics KW - e-learning KW - medical education N2 - Background: In medical education, information and communication technology (ICT) knowledge and skills have become a necessity and an integral part of preparing tomorrow?s doctors to be sufficiently competent to use informatics resources effectively and efficiently for the best practice of medicine. Objective: This research aimed to study the literacy of the preprofessional students in ICT before and after taking the basic informatics course at the Health Sciences Center at Kuwait University, to understand their potential and their attitudes toward using ICT, including e-learning. Methods: A validated questionnaire was used to collect data from 200 students in 2 stages: before and after the informatics course on the preprofessional program. In addition, the tutors? observational assessments of the students? achievements during the informatics course were obtained. Results: The response rate of students before the course was 85.5% (171/200) and after was 77% (154/200). Of 200 students, 85% were female, and 15% were male. This disproportional representation of genders was due to the fact that 85% of registered students were female. Approximately 59% (101/171) of the students assessed themselves before the course as computer literate; afterward, this increased to 70.1% (108/154). Students who were still computer illiterate (29.2%; 45/154) mostly used the excuse of a lack of time (60%; 27/45). In generic ICT skills, the highest levels were for word processing, email, and Web browsing, whereas the lowest levels were for spreadsheets and database. In specific ICT skills, most respondents were reported low levels for statistical package use and Web page design. The results found that there was a significant improvement between students? general ICT skills before and after the course. The results showed that there were significant improvement between how frequently students were using Medline (P<.001), Google Scholar (P<.001), and Cochrane Library (P<.001) before and after the informatics course. Furthermore, most of the students who completed the course (72.8%; 110/151) chose the learning management system as the most useful e-learning tool. The results of the tutors? assessments confirmed the obvious improvement in most of the students? skills in using ICT. Conclusions: The ICT knowledge and skills of the students before the course seemed insufficient, and the magnitude of the improvements that were acquired throughout the informatics course was obvious in most of the students? performance. However, the findings reveal that more practice was required. The attitudes of most of the students toward the potential of e-learning were considered positive, although the potential of Web-based learning in medical training was not well known among the students. UR - http://mededu.jmir.org/2016/1/e9/ UR - http://dx.doi.org/10.2196/mededu.5606 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731863 ID - info:doi/10.2196/mededu.5606 ER - TY - JOUR AU - Lino, Arcanjo Juliana AU - Gomes, Carvalho Gabriela AU - Sousa, Canjura Nancy Delma Silva Vega AU - Carvalho, K. Andrea AU - Diniz, Bezerra Marcelo Emanoel AU - Viana Junior, Brazil Antonio AU - Holanda, Alcantara Marcelo PY - 2016/06/14 TI - A Critical Review of Mechanical Ventilation Virtual Simulators: Is It Time to Use Them? JO - JMIR Med Educ SP - e8 VL - 2 IS - 1 KW - positive-pressure respiration KW - medical education KW - computer simulation KW - learning N2 - Background: Teaching mechanical ventilation at the bedside with real patients is difficult with many logistic limitations. Mechanical ventilators virtual simulators (MVVS) may have the potential to facilitate mechanical ventilation (MV) training by allowing Web-based virtual simulation. Objective: We aimed to identify and describe the current available MVVS, to compare the usability of their interfaces as a teaching tool and to review the literature on validation studies. Methods: We performed a comparative evaluation of the MVVS, based on a literature/Web review followed by usability tests according to heuristic principles evaluation of their interfaces as performed by professional experts on MV. Results: Eight MVVS were identified. They showed marked heterogeneity, mainly regarding virtual patient's anthropomorphic parameters, pulmonary gas exchange, respiratory mechanics and muscle effort configurations, ventilator terminology, basic ventilatory modes, settings alarms, monitoring parameters, and design. The Hamilton G5 and the Xlung covered a broader number of parameters, tools, and have easier Web-based access. Except for the Xlung, none of the simulators displayed monitoring of arterial blood gases and alternatives to load and save the simulation. The Xlung obtained the greater scores on heuristic principles assessments and the greater score of easiness of use, being the preferred MVVS for teaching purposes. No strong scientific evidence on the use and validation of the current MVVS was found. Conclusions: There are only a few MVVS currently available. Among them, the Xlung showed a better usability interface. Validation tests and development of new or improvement of the current MVVS are needed. UR - http://mededu.jmir.org/2016/1/e8/ UR - http://dx.doi.org/10.2196/mededu.5350 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731850 ID - info:doi/10.2196/mededu.5350 ER - TY - JOUR AU - Rusatira, Christophe Jean AU - Tomaszewski, Brian AU - Dusabejambo, Vincent AU - Ndayiragije, Vincent AU - Gonsalves, Snedden AU - Sawant, Aishwarya AU - Mumararungu, Angeline AU - Gasana, George AU - Amendezo, Etienne AU - Haake, Anne AU - Mutesa, Leon PY - 2016/06/01 TI - Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps JO - JMIR Med Educ SP - e7 VL - 2 IS - 1 KW - mobile medical education KW - technology KW - user-centered design N2 - Background: Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. Objective: The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. Methods: Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? Results: General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app that utilizes specific Rwandan medical education resources. Based on our results, we propose a mobile medical education app that could provide many benefits such as rapid decision making with lower error rates, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. In areas where Internet access is limited, the proposed mobile medical education app would need to run on a mobile device without Internet access. Conclusions: A user-centered design approach was adopted, starting with a needs assessment with representative end users, which provided recommendations for the development of a mobile medical education app specific to Rwanda. Specific app features were identified through the needs assessment and it was evident that there will be future benefits to ongoing incorporation of user-centered design methods to better inform the software development and improve its usability. Results of the user-centered design reported here can inform other medical education technology developments in LMIC to ensure that technologies developed are usable by all stakeholders. UR - http://mededu.jmir.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/mededu.5336 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731861 ID - info:doi/10.2196/mededu.5336 ER - TY - JOUR AU - Palojoki, Sari AU - Pajunen, Tuuli AU - Saranto, Kaija AU - Lehtonen, Lasse PY - 2016/05/06 TI - Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users JO - JMIR Med Inform SP - e13 VL - 4 IS - 2 KW - Electronic Health Records KW - Health Information Technology KW - Patient Safety KW - Risk Assessment KW - Questionnaire N2 - Background: The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective: This study addresses two important questions: (1) ?which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users??, and (2) ?which variables are associated with high- and extreme-risk severity ratings?? Methods: This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach?s alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results: A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type ?extended EHR unavailability?. The lowest overall risk level was associated with ?selecting incorrectly from a list of items?. In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels (P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions: Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately. UR - http://medinform.jmir.org/2016/2/e13/ UR - http://dx.doi.org/10.2196/medinform.5238 UR - http://www.ncbi.nlm.nih.gov/pubmed/27154599 ID - info:doi/10.2196/medinform.5238 ER - TY - JOUR AU - Nicklen, Peter AU - Keating, L. Jennifer AU - Maloney, Stephen PY - 2016/03/22 TI - Student Response to Remote-Online Case-Based Learning: A Qualitative Study JO - JMIR Medical Education SP - e3 VL - 2 IS - 1 KW - case-based learning KW - Web conferencing KW - remote-online case-based learning KW - student satisfaction KW - perceived depth of learning N2 - Background: Case-based learning (CBL) typically involves face-to-face interaction in small collaborative groups with a focus on self-directed study. To our knowledge, no published studies report an evaluation of Web conferencing in CBL. Objective: The primary aim of this study was to explore student perceptions and attitudes in response to a remote-online case-based learning (RO-CBL) experience. Methods: This study took place over a 2-week period in 2013 at Monash University, Victoria, Australia. A third year cohort (n=73) of physiotherapy students was invited to participate. Students were required to participate in 2 training sessions, followed by RO-CBL across 2 sessions. The primary outcome of interest was the student feedback on the quality of the learning experience during RO-CBL participation. This was explored with a focus group and a survey. Results: Most students (68/73) completed the postintervention survey (nonparticipation rate 8%). RO-CBL was generally well received by participants, with 59% (40/68) of participates stating that they?d like RO-CBL to be used in the future and 78% (53/68) of participants believing they could meet the CBL?s learning objectives via RO-CBL. The 4 key themes relevant to student response to RO-CBL that emerged from the focus groups and open-ended questions on the postintervention survey were how RO-CBL compared to expectations, key benefits of RO-CBL including flexibility and time and cost savings, communication challenges in the online environment compared to face-to-face, and implications of moving to an online platform. Conclusions: Web conferencing may be a suitable medium for students to participate in CBL. Participants were satisfied with the learning activity and felt they could meet the CBL?s learning objectives. Further study should evaluate Web conferencing CBL across an entire semester in regard to student satisfaction, perceived depth of learning, and learning outcomes. UR - http://mededu.jmir.org/2016/1/e3/ UR - http://dx.doi.org/10.2196/mededu.5025 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731852 ID - info:doi/10.2196/mededu.5025 ER - TY - JOUR AU - Liaw, Ying Sok AU - Wong, Fun Lai AU - Lim, Ping Eunice Ya AU - Ang, Leng Sophia Bee AU - Mujumdar, Sandhya AU - Ho, Yin Jasmine Tze AU - Mordiffi, Zubaidah Siti AU - Ang, Kim Emily Neo PY - 2016/02/19 TI - Effectiveness of a Web-Based Simulation in Improving Nurses? Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study JO - J Med Internet Res SP - e37 VL - 18 IS - 2 KW - Web-based simulation KW - clinical deterioration KW - nursing education KW - online learning KW - transfer of learning KW - nursing practice N2 - Background: Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses? role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses? clinical performance in a simulated environment, no study has examined its impact on nurses? actual practice in the clinical setting. Objective: The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick?s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. Methods: A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. Results: The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The nurses also perceived positively their motivation (mean 3.78, SD 0.56) to engage in the Web-based simulation. Conclusions: This study provides evidence on the effectiveness of Web-based simulation in improving nursing practice when recognizing and responding to deteriorating patients. This educational tool could be implemented by nurse educators worldwide to address the educational needs of a large group of hospital nurses responsible for patients in clinical deterioration. UR - http://www.jmir.org/2016/2/e37/ UR - http://dx.doi.org/10.2196/jmir.5294 UR - http://www.ncbi.nlm.nih.gov/pubmed/26895723 ID - info:doi/10.2196/jmir.5294 ER - TY - JOUR AU - Pennaforte, Thomas AU - Moussa, Ahmed AU - Loye, Nathalie AU - Charlin, Bernard AU - Audétat, Marie-Claude PY - 2016/02/17 TI - Exploring a New Simulation Approach to Improve Clinical Reasoning Teaching and Assessment: Randomized Trial Protocol JO - JMIR Res Protoc SP - e26 VL - 5 IS - 1 KW - clinical reasoning KW - simulation KW - debriefing KW - iterative discussions KW - diagnostic errors KW - cognitive bias KW - verbalization KW - dual-process theory N2 - Background: Helping trainees develop appropriate clinical reasoning abilities is a challenging goal in an environment where clinical situations are marked by high levels of complexity and unpredictability. The benefit of simulation-based education to assess clinical reasoning skills has rarely been reported. More specifically, it is unclear if clinical reasoning is better acquired if the instructor's input occurs entirely after or is integrated during the scenario. Based on educational principles of the dual-process theory of clinical reasoning, a new simulation approach called simulation with iterative discussions (SID) is introduced. The instructor interrupts the flow of the scenario at three key moments of the reasoning process (data gathering, integration, and confirmation). After each stop, the scenario is continued where it was interrupted. Finally, a brief general debriefing ends the session. System-1 process of clinical reasoning is assessed by verbalization during management of the case, and System-2 during the iterative discussions without providing feedback. Objective: The aim of this study is to evaluate the effectiveness of Simulation with Iterative Discussions versus the classical approach of simulation in developing reasoning skills of General Pediatrics and Neonatal-Perinatal Medicine residents. Methods: This will be a prospective exploratory, randomized study conducted at Sainte-Justine hospital in Montreal, Qc, between January and March 2016. All post-graduate year (PGY) 1 to 6 residents will be invited to complete one SID or classical simulation 30 minutes audio video-recorded complex high-fidelity simulations covering a similar neonatology topic. Pre- and post-simulation questionnaires will be completed and a semistructured interview will be conducted after each simulation. Data analyses will use SPSS and NVivo softwares. Results: This study is in its preliminary stages and the results are expected to be made available by April, 2016. Conclusions: This will be the first study to explore a new simulation approach designed to enhance clinical reasoning. By assessing more closely reasoning processes throughout a simulation session, we believe that Simulation with Iterative Discussions will be an interesting and more effective approach for students. The findings of the study will benefit medical educators, education programs, and medical students. UR - http://www.researchprotocols.org/2016/1/e26/ UR - http://dx.doi.org/10.2196/resprot.4938 UR - http://www.ncbi.nlm.nih.gov/pubmed/26888076 ID - info:doi/10.2196/resprot.4938 ER - TY - JOUR AU - Ghoncheh, Rezvan AU - Gould, S. Madelyn AU - Twisk, WR Jos AU - Kerkhof, JFM Ad AU - Koot, M. Hans PY - 2016/01/29 TI - Efficacy of Adolescent Suicide Prevention E-Learning Modules for Gatekeepers: A Randomized Controlled Trial JO - JMIR Mental Health SP - e8 VL - 3 IS - 1 KW - Adolescent KW - E-learning KW - Gatekeepers KW - Learning KW - Modules KW - Online Systems KW - Suicide KW - Prevention KW - Training KW - Web-based KW - Referral and Consultation N2 - Background: Face-to-face gatekeeper training can be an effective strategy in the enhancement of gatekeepers? knowledge and self-efficacy in adolescent suicide prevention. However, barriers related to access (eg, time, resources) may hamper participation in face-to-face training sessions. The transition to a Web-based setting could address obstacles associated with face-to-face gatekeeper training. Although Web-based suicide prevention training targeting adolescents exists, so far no randomized controlled trials (RCTs) have been conducted to investigate their efficacy. Objective: This RCT study investigated the efficacy of a Web-based adolescent suicide prevention program entitled Mental Health Online, which aimed to improve the knowledge and self-confidence of gatekeepers working with adolescents (12-20 years old). The program consisted of 8 short e-learning modules each capturing an important aspect of the process of early recognition, guidance, and referral of suicidal adolescents, alongside additional information on the topic of (adolescent) suicide prevention. Methods: A total of 190 gatekeepers (ages 21 to 62 years) participated in this study and were randomized to either the experimental group or waitlist control group. The intervention was not masked. Participants from both groups completed 3 Web-based assessments (pretest, posttest, and 3-month follow-up). The outcome measures of this study were actual knowledge, and participants? ratings of perceived knowledge and perceived self-confidence using questionnaires developed specifically for this study. Results: The actual knowledge, perceived knowledge, and perceived self-confidence of gatekeepers in the experimental group improved significantly compared to those in the waitlist control group at posttest, and the effects remained significant at 3-month follow-up. The overall effect sizes were 0.76, 1.20, and 1.02, respectively, across assessments. Conclusions: The findings of this study indicate that Web-based suicide prevention e-learning modules can be an effective educational method to enhance knowledge and self-confidence of gatekeepers with regard to adolescent suicide prevention. Gatekeepers with limited time and resources can benefit from the accessibility, simplicity, and flexibility of Web-based training. Trial Registration: Netherlands Trial Register NTR3625; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3625 (Archived by WebCite at http://www.webcitation.org/6eHvyRh6M) UR - http://mental.jmir.org/2016/1/e8/ UR - http://dx.doi.org/10.2196/mental.4614 UR - http://www.ncbi.nlm.nih.gov/pubmed/26825006 ID - info:doi/10.2196/mental.4614 ER - TY - JOUR AU - Liyanagunawardena, Rekha Tharindu AU - Williams, Ann Shirley PY - 2016/01/07 TI - Elderly Learners and Massive Open Online Courses: A Review JO - Interact J Med Res SP - e1 VL - 5 IS - 1 KW - massive open online courses KW - loneliness KW - older adults KW - elderly KW - eLearning KW - education KW - continuing education KW - computer-assisted instruction N2 - Background: Massive open online courses (MOOCs) have become commonplace in the e-learning landscape. Thousands of elderly learners are participating in courses offered by various institutions on a multitude of platforms in many different languages. However, there is very little research into understanding elderly learners in MOOCs. Objective: We aim to show that a considerable proportion of elderly learners are participating in MOOCs and that there is a lack of research in this area. We hope this assertion of the wide gap in research on elderly learners in MOOCs will pave the way for more research in this area. Methods: Pre-course survey data for 10 University of Reading courses on the FutureLearn platform were analyzed to show the level of participation of elderly learners in MOOCs. Two MOOC aggregator sites (Class Central and MOOC List) were consulted to gather data on MOOC offerings that include topics relating to aging. In parallel, a selected set of MOOC platform catalogues, along with a recently published review on health and medicine-related MOOCs, were searched to find courses relating to aging. A systematic literature search was then employed to identify research articles on elderly learners in MOOCs. Results: The 10 courses reviewed had a considerable proportion of elderly learners participating in them. For the over-66 age group, this varied from 0.5% (on the course ?Managing people?) to 16.3% (on the course ?Our changing climate?), while for the over-56 age group it ranged from 3.0% (on ?A beginners guide to writing in English?) to 39.5% (on ?Heart health?). Only six MOOCs were found to include topics related to aging: three were on the Coursera platform, two on the FutureLearn platform, and one on the Open2Study platform. Just three scholarly articles relating to MOOCs and elderly learners were retrieved from the literature search. Conclusions: This review presents evidence to suggest that elderly learners are already participating in MOOCs. Despite this, there has been very little research into their engagement with MOOCs. Similarly, there has been little research into exploiting the scope of MOOCs for delivering topics that would be of interest to elderly learners. We believe there is potential to use MOOCs as a way of tackling the issue of loneliness among older adults by engaging them as either resource personnel or learners. UR - http://www.i-jmr.org/2016/1/e1/ UR - http://dx.doi.org/10.2196/ijmr.4937 UR - http://www.ncbi.nlm.nih.gov/pubmed/26742809 ID - info:doi/10.2196/ijmr.4937 ER - TY - JOUR AU - Liu, Qian AU - Peng, Weijun AU - Zhang, Fan AU - Hu, Rong AU - Li, Yingxue AU - Yan, Weirong PY - 2016/01/04 TI - The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e2 VL - 18 IS - 1 KW - blended learning KW - effectiveness KW - knowledge KW - health professions KW - meta-analysis N2 - Background: Blended learning, defined as the combination of traditional face-to-face learning and asynchronous or synchronous e-learning, has grown rapidly and is now widely used in education. Concerns about the effectiveness of blended learning have led to an increasing number of studies on this topic. However, there has yet to be a quantitative synthesis evaluating the effectiveness of blended learning on knowledge acquisition in health professions. Objective: We aimed to assess the effectiveness of blended learning for health professional learners compared with no intervention and with nonblended learning. We also aimed to explore factors that could explain differences in learning effects across study designs, participants, country socioeconomic status, intervention durations, randomization, and quality score for each of these questions. Methods: We conducted a search of citations in Medline, CINAHL, Science Direct, Ovid Embase, Web of Science, CENTRAL, and ERIC through September 2014. Studies in any language that compared blended learning with no intervention or nonblended learning among health professional learners and assessed knowledge acquisition were included. Two reviewers independently evaluated study quality and abstracted information including characteristics of learners and intervention (study design, exercises, interactivity, peer discussion, and outcome assessment). Results: We identified 56 eligible articles. Heterogeneity across studies was large (I2 ?93.3) in all analyses. For studies comparing knowledge gained from blended learning versus no intervention, the pooled effect size was 1.40 (95% CI 1.04-1.77; P<.001; n=20 interventions) with no significant publication bias, and exclusion of any single study did not change the overall result. For studies comparing blended learning with nonblended learning (pure e-learning or pure traditional face-to-face learning), the pooled effect size was 0.81 (95% CI 0.57-1.05; P<.001; n=56 interventions), and exclusion of any single study did not change the overall result. Although significant publication bias was found, the trim and fill method showed that the effect size changed to 0.26 (95% CI -0.01 to 0.54) after adjustment. In the subgroup analyses, pre-posttest study design, presence of exercises, and objective outcome assessment yielded larger effect sizes. Conclusions: Blended learning appears to have a consistent positive effect in comparison with no intervention, and to be more effective than or at least as effective as nonblended instruction for knowledge acquisition in health professions. Due to the large heterogeneity, the conclusion should be treated with caution. UR - http://www.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/jmir.4807 UR - http://www.ncbi.nlm.nih.gov/pubmed/26729058 ID - info:doi/10.2196/jmir.4807 ER - TY - JOUR AU - Flickinger, E. Tabor AU - O'Hagan, Thomas AU - Chisolm, S. Margaret PY - 2015/12/01 TI - Developing a Curriculum to Promote Professionalism for Medical Students Using Social Media: Pilot of a Workshop and Blog-Based Intervention JO - JMIR Medical Education SP - e17 VL - 1 IS - 2 KW - medical education KW - medical students KW - professionalism KW - social media KW - social networking N2 - Background: As the use of social media (SM) tools becomes increasingly widespread, medical trainees need guidance on applying principles of professionalism to their online behavior. Objective: To develop a curriculum to improve knowledge and skills regarding professionalism of SM use by medical students. Methods: This project was conducted in 3 phases: (1) a needs assessment was performed via a survey of medical students regarding SM use, rationale for and frequency of use, and concerns; (2) a workshop-format curriculum was designed and piloted for preclinical students to gain foundational knowledge of online professionalism; and (3) a complementary longitudinal SM-based curriculum was designed and piloted for clinical students to promote both medical humanism and professionalism. Results: A total of 72 medical students completed the survey (response rate 30%). Among the survey respondents, 71/72 (99%) reported visiting social networking sites, with 55/72 (76%) reporting daily visits. Privacy of personal information (62/72, 86%) and mixing of personal/professional identities (49/72, 68%) were the students? most commonly endorsed concerns regarding SM use. The workshop-format curriculum was evaluated qualitatively via participant feedback. Of the 120 students who participated in the workshop, 91 completed the post workshop evaluation (response rate 76%), with 56 positive comments and 54 suggestions for improvement. The workshop was experienced by students as enjoyable, thought provoking, informative, and relevant. Suggestions for improvement included adjustments to timing, format, and content of the workshop. The SM-based curriculum was evaluated by a small-scale pilot of 11 students, randomized to the intervention group (participation in faculty-moderated blog) or the control group. Outcomes were assessed quantitatively and qualitatively via personal growth scales, participant feedback, and analysis of blog themes. There was a trend toward improvement in total personal growth scores among those students in the blog group from 3.65 (0.47) to 4.11 (0.31) (mean [SD]) with no change observed for the students in the control group (3.89 [0.11] before and after evaluation). Themes relevant to humanism and professionalism were observed in the blog discussion. Conclusions: Most medical students surveyed reported using SM and identified privacy and personal-professional boundaries as areas of concern. The workshop format and SM-based curricula were well-received by students whose formative feedback will inform the refinement and further development of efforts to promote professionalism among medical students. UR - http://mededu.jmir.org/2015/2/e17/ UR - http://dx.doi.org/10.2196/mededu.4886 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731846 ID - info:doi/10.2196/mededu.4886 ER - TY - JOUR AU - Kleinert, Robert AU - Heiermann, Nadine AU - Plum, Sven Patrick AU - Wahba, Roger AU - Chang, De-Hua AU - Maus, Martin AU - Chon, Seung-Hun AU - Hoelscher, H. Arnulf AU - Stippel, Ludger Dirk PY - 2015/11/17 TI - Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education JO - J Med Internet Res SP - e263 VL - 17 IS - 11 KW - medical education KW - simulation KW - virtual patients KW - immersive N2 - Background: Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching Objective: It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance. Methods: The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students. Results: Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use. Conclusions: ALICE has a positive effect on knowledge gain and raises students? motivation. It is a suitable tool for supporting clinical education in the blended learning context. UR - http://www.jmir.org/2015/11/e263/ UR - http://dx.doi.org/10.2196/jmir.5035 UR - http://www.ncbi.nlm.nih.gov/pubmed/26577020 ID - info:doi/10.2196/jmir.5035 ER - TY - JOUR AU - Tix, Nadine AU - Gießler, Paul AU - Ohnesorge-Radtke, Ursula AU - Spreckelsen, Cord PY - 2015/11/11 TI - Semantic Indexing of Medical Learning Objects: Medical Students' Usage of a Semantic Network JO - JMIR Medical Education SP - e16 VL - 1 IS - 2 KW - semantic net KW - usability evaluation KW - semantic indexing KW - learning objects KW - medical education N2 - Background: The Semantically Annotated Media (SAM) project aims to provide a flexible platform for searching, browsing, and indexing medical learning objects (MLOs) based on a semantic network derived from established classification systems. Primarily, SAM supports the Aachen emedia skills lab, but SAM is ready for indexing distributed content and the Simple Knowledge Organizing System standard provides a means for easily upgrading or even exchanging SAM?s semantic network. There is a lack of research addressing the usability of MLO indexes or search portals like SAM and the user behavior with such platforms. Objective: The purpose of this study was to assess the usability of SAM by investigating characteristic user behavior of medical students accessing MLOs via SAM. Methods: In this study, we chose a mixed-methods approach. Lean usability testing was combined with usability inspection by having the participants complete four typical usage scenarios before filling out a questionnaire. The questionnaire was based on the IsoMetrics usability inventory. Direct user interaction with SAM (mouse clicks and pages accessed) was logged. Results: The study analyzed the typical usage patterns and habits of students using a semantic network for accessing MLOs. Four scenarios capturing characteristics of typical tasks to be solved by using SAM yielded high ratings of usability items and showed good results concerning the consistency of indexing by different users. Long-tail phenomena emerge as they are typical for a collaborative Web 2.0 platform. Suitable but nonetheless rarely used keywords were assigned to MLOs by some users. Conclusions: It is possible to develop a Web-based tool with high usability and acceptance for indexing and retrieval of MLOs. SAM can be applied to indexing multicentered repositories of MLOs collaboratively. UR - http://mededu.jmir.org/2015/2/e16/ UR - http://dx.doi.org/10.2196/mededu.4479 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731860 ID - info:doi/10.2196/mededu.4479 ER - TY - JOUR AU - Alvarez, Graziela Ana AU - Sasso, Grace AU - Iyengar, Sriram PY - 2015/11/06 TI - Mobile Virtual Learning Object for the Assessment of Acute Pain as a Learning Tool to Assess Acute Pain in Nursing: An Analysis of the Mental Workload JO - JMIR Medical Education SP - e15 VL - 1 IS - 2 KW - nursing KW - nursing informatics KW - distance learning KW - computer-assisted instruction KW - educational technology KW - nursing education KW - acute pain KW - persuasive technology KW - mental workload N2 - Background: The inclusion of new technologies in education has motivated the development of studies on mental workload. These technologies are now being used in the teaching and learning process. The analysis enables identification of factors intervening in this workload as well as planning of overload prevention for educational activities using these technologies. Objective: To analyze the mental workload of an educational intervention with the Mobile Virtual Learning Object for the Assessment of Acute Pain in adults and newborns, according to the NASA Task Load Index criteria. Methods: A methodological study with data collected from 5 nurses and 75 students, from November of 2013 to February of 2014. Results: The highest students? and specialists? means were in the dimensions of ?Mental demand? (57.20 ± 22.27; 51 ± 29.45) and ?Performance? (58.47 ± 24.19; 73 ± 28.85). The specialists? mental workload index was higher (50.20 ± 7.28) when compared with students? (47.87 ± 16.85) on a scale from 0 to 100 (P=.557). Conclusions: The instrument allowed for the assessment of mental workload after an online educational intervention with a mobile learning virtual object. An excessive overload was not identified among participants. Assessing mental workload from the use of educational technologies at the end of a task is a key to their applicability, with the aim of providing a more effective, stimulating, and long-lasting experience of the learning process. UR - http://mededu.jmir.org/2015/2/e15/ UR - http://dx.doi.org/10.2196/mededu.4958 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731849 ID - info:doi/10.2196/mededu.4958 ER - TY - JOUR AU - Ngune, Irene AU - Jiwa, Moyez AU - McManus, Alexandra AU - Parsons, Richard AU - Pagey, Georgina AU - Hodder, Rupert PY - 2015/11/05 TI - Do Patients Treated for Colorectal Cancer Benefit from General Practitioner Support? A Video Vignette Study JO - J Med Internet Res SP - e249 VL - 17 IS - 11 KW - colorectal cancer KW - general practice KW - Internet survey KW - side effects KW - video vignettes N2 - Background: Patients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice. Objective: To explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer. Methods: This was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts. Results: In total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts? opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion. Conclusions: In this pilot study, years of experience and direct patient contact hours had a significant and positive impact on the management of patients. This study also showed promising results indicating that management of the common side effects of colorectal cancer treatment can be delegated to general practice. Such an intervention could support the application of shared models of care. However, a larger study, including the management of side effects in real patients, needs to be conducted before this can be safely recommended. UR - http://www.jmir.org/2015/11/e249/ UR - http://dx.doi.org/10.2196/jmir.4942 UR - http://www.ncbi.nlm.nih.gov/pubmed/26541077 ID - info:doi/10.2196/jmir.4942 ER - TY - JOUR AU - Torous, John AU - O'Connor, Ryan AU - Franzen, Jamie AU - Snow, Caitlin AU - Boland, Robert AU - Kitts, Robert PY - 2015/11/05 TI - Creating a Pilot Educational Psychiatry Website: Opportunities, Barriers, and NextSteps JO - JMIR Medical Education SP - e14 VL - 1 IS - 2 KW - Psychiatry KW - Internet KW - Online KW - Education KW - Website N2 - Background: While medical students and residents may be utilizing websites as online learning resources, medical trainees and educators now have the opportunity to create such educational websites and digital tools on their own. However, the process and theory of building educational websites for medical education have not yet been fully explored. Objective: To understand the opportunities, barriers, and process of creating a novel medical educational website. Methods: We created a pilot psychiatric educational website to better understand the options, opportunities, challenges, and processes involved in the creation of a psychiatric educational website. We sought to integrate visual and interactive Web design elements to underscore the potential of such Web technology. Results: A pilot website (PsychOnCall) was created to demonstrate the potential of Web technology in medical and psychiatric education. Conclusions: Creating an educational website is now technically easier than ever before, and the primary challenge no longer is technology but rather the creation, validation, and maintenance of information for such websites as well as translating text-based didactics into visual and interactive tools. Medical educators can influence the design and implementation of online educational resources through creating their own websites and engaging medical students and residents in the process. UR - http://mededu.jmir.org/2015/2/e14/ UR - http://dx.doi.org/10.2196/mededu.4580 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731837 ID - info:doi/10.2196/mededu.4580 ER - TY - JOUR AU - Antoniades, Athos AU - Nicolaidou, Iolie AU - Spachos, Dimitris AU - Mylläri, Jarkko AU - Giordano, Daniela AU - Dafli, Eleni AU - Mitsopoulou, Evangelia AU - Schizas, N. Christos AU - Pattichis, Constantinos AU - Nikolaidou, Maria AU - Bamidis, Panagiotis PY - 2015/10/09 TI - Medical Content Searching, Retrieving, and Sharing Over the Internet: Lessons Learned From the mEducator Through a Scenario-Based Evaluation JO - J Med Internet Res SP - e229 VL - 17 IS - 10 KW - searching and sharing of medical educational content KW - repurposing KW - metadata KW - evaluation N2 - Background: The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users? performance, was designed and utilized for the evaluation of these solutions. Objective: The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - ?MEdical Education LINnked Arena? MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. Methods: A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. Results: The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end-user perspective, users faced difficulties in achieving a shared understanding of the meaning of some metadata fields and in correctly managing the intellectual property rights of repurposed content. Conclusions: The results of this evaluation impact researchers, medical professionals, and designers interested in using similar systems for educational content sharing in medical and other domains. Recommendations on how to improve the search, retrieval, identification, and obtaining of medical resources are provided, by addressing issues of content description metadata, content description procedures, and intellectual property rights for re-purposed content. UR - http://www.jmir.org/2015/10/e229/ UR - http://dx.doi.org/10.2196/jmir.3650 UR - http://www.ncbi.nlm.nih.gov/pubmed/26453250 ID - info:doi/10.2196/jmir.3650 ER - TY - JOUR AU - Mesko, Bertalan AU - Gy?rffy, Zsuzsanna AU - Kollár, János PY - 2015/10/01 TI - Digital Literacy in the Medical Curriculum: A Course With Social Media Tools and Gamification JO - JMIR Medical Education SP - e6 VL - 1 IS - 2 KW - medical education KW - social media KW - digital literacy N2 - Background: The profession of practicing medicine is based on communication, and as social media and other digital technologies play a major role in today?s communication, digital literacy must be included in the medical curriculum. The value of social media has been demonstrated several times in medicine and health care, therefore it is time to prepare medical students for the conditions they will have to face when they graduate. Objective: The aim of our study was to design a new e-learning-based curriculum and test it with medical students. Method: An elective course was designed to teach students how to use the Internet, with a special emphasis on social media. An e-learning platform was also made available and students could access material about using digital technologies on the online platforms they utilized the most. All students filled in online surveys before and after the course in order to provide feedback about the curriculum. Results: Over a 3-year period, 932 students completed the course. The course did not increase the number of hours spent online but aimed at making that time more efficient and useful. Based on the responses of students, they found the information provided by the curriculum useful for their studies and future practices. Conclusions: A well-designed course, improved by constant evaluation-based feedback, can be suitable for preparing students for the massive use of the Internet, social media platforms, and digital technologies. New approaches must be applied in modern medical education in order to teach students new skills. Such curriculums that put emphasis on reaching students on the online channels they use in their studies and everyday lives introduce them to the world of empowered patients and prepare them to deal with the digital world. UR - http://mededu.jmir.org/2015/2/e6/ UR - http://dx.doi.org/10.2196/mededu.4411 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731856 ID - info:doi/10.2196/mededu.4411 ER - TY - JOUR AU - Janssen, Anna AU - Shaw, Tim AU - Goodyear, Peter PY - 2015/09/28 TI - Using Video Games to Enhance Motivation States in Online Education: Protocol for a Team-Based Digital Game JO - JMIR Res Protoc SP - e114 VL - 4 IS - 3 KW - digital games KW - medical education KW - online learning N2 - Background: Video and computer games for education have been of interest to researchers for several decades. Over the last half decade, researchers in the health sector have also begun exploring the value of this medium. However, there are still many gaps in the literature regarding the effective use of video and computer games in medical education, particularly in relation to how learners interact with the platform, and how the games can be used to enhance collaboration. Objective: The objective of the study is to evaluate a team-based digital game as an educational tool for engaging learners and supporting knowledge consolidation in postgraduate medical education. Methods: A mixed methodology will be used in order to establish efficacy and level of motivation provided by a team-based digital game. Second-year medical students will be recruited as participants to complete 3 matches of the game at spaced intervals, in 2 evenly distributed teams. Prior to playing the game, participants will complete an Internet survey to establish baseline data. After playing the game, participants will voluntarily complete a semistructured interview to establish motivation and player engagement. Additionally, metrics collected from the game platform will be analyzed to determine efficacy. Results: The research is in the preliminary stages, but thus far a total of 54 participants have been recruited into the study. Additionally, a content development group has been convened to develop appropriate content for the platform. Conclusions: Video and computer games have been demonstrated to have value for educational purposes. Significantly less research has addressed how the medium can be effectively utilized in the health sector. Preliminary data from this study would suggest there is an interest in games for learning in the medical student body. As such, it is beneficial to undertake further research into how these games teach and engage learners in order to evaluate their role in tertiary and postgraduate medical education in the future. UR - http://www.researchprotocols.org/2002/3/e114/ UR - http://dx.doi.org/10.2196/resprot.4016 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416522 ID - info:doi/10.2196/resprot.4016 ER - TY - JOUR AU - Raupach, Tobias AU - Grefe, Clemens AU - Brown, Jamie AU - Meyer, Katharina AU - Schuelper, Nikolai AU - Anders, Sven PY - 2015/09/28 TI - Moving Knowledge Acquisition From the Lecture Hall to the Student Home: A Prospective Intervention Study JO - J Med Internet Res SP - e223 VL - 17 IS - 9 KW - knowledge KW - lecture KW - medical education KW - podcast KW - retention N2 - Background: Podcasts are popular with medical students, but the impact of podcast use on learning outcomes in undergraduate medical education has not been studied in detail. Objective: Our aim was to assess the impact of podcasts accompanied by quiz questions and lecture attendance on short- and medium-term knowledge retention. Methods: Students enrolled for a cardio-respiratory teaching module were asked to prepare for 10 specific lectures by watching podcasts and submitting answers to related quiz questions before attending live lectures. Performance on the same questions was assessed in a surprise test and a retention test. Results: Watching podcasts and submitting answers to quiz questions (versus no podcast/quiz use) was associated with significantly better test performance in all items in the surprise test and 7 items in the retention test. Lecture attendance (versus no attendance) was associated with higher test performance in 3 items and 1 item, respectively. In a linear regression analysis adjusted for age, gender, and overall performance levels, both podcast/quiz use and lecture attendance were significant predictors of student performance. However, the variance explained by podcast/quiz use was greater than the variance explained by lecture attendance in the surprise test (38.7% vs 2.2%) and retention test (19.1% vs 4.0%). Conclusions: When used in conjunction with quiz questions, podcasts have the potential to foster knowledge acquisition and retention over and above the effect of live lectures. UR - http://www.jmir.org/2015/9/e223/ UR - http://dx.doi.org/10.2196/jmir.3814 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416467 ID - info:doi/10.2196/jmir.3814 ER - TY - JOUR AU - Perera, Marlon AU - Roberts, Matthew AU - Lawrentschuk, Nathan AU - Bolton, Damien PY - 2015/09/18 TI - Response to ?Twitter-Based Journal Clubs: Some Additional Facts and Clarifications? JO - J Med Internet Res SP - e217 VL - 17 IS - 9 UR - http://www.jmir.org/2015/9/e217/ UR - http://dx.doi.org/10.2196/jmir.4786 UR - http://www.ncbi.nlm.nih.gov/pubmed/26385506 ID - info:doi/10.2196/jmir.4786 ER - TY - JOUR AU - Zhu, Egui AU - Lilienthal, Anneliese AU - Shluzas, Aquino Lauren AU - Masiello, Italo AU - Zary, Nabil PY - 2015/09/18 TI - Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework JO - JMIR Medical Education SP - e10 VL - 1 IS - 2 KW - augmented reality KW - health care education KW - antibiotics KW - general practitioners KW - learning environment KW - learning theory KW - mobile technology N2 - Background: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. Objective: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs? rational use of antibiotics. Methods: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. Results: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories?situated, experiential, and transformative learning?provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners? personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners? personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. Conclusions: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework. UR - http://mededu.jmir.org/2015/2/e10/ UR - http://dx.doi.org/10.2196/mededu.4443 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731839 ID - info:doi/10.2196/mededu.4443 ER - TY - JOUR AU - Topf, M. Joel AU - Sparks, A. Matthew AU - Iannuzzella, Francesco AU - Lerma, Edgar AU - Oates, Thomas AU - Phelan, J. Paul AU - Hiremath, Swapnil PY - 2015/09/16 TI - Twitter-Based Journal Clubs: Additional Facts and Clarifications JO - J Med Internet Res SP - e216 VL - 17 IS - 9 UR - http://www.jmir.org/2015/9/e216/ UR - http://dx.doi.org/10.2196/jmir.4639 UR - http://www.ncbi.nlm.nih.gov/pubmed/26376668 ID - info:doi/10.2196/jmir.4639 ER - TY - JOUR AU - Kononowicz, A. Andrzej AU - Berman, H. Anne AU - Stathakarou, Natalia AU - McGrath, Cormac AU - Barty?ski, Tomasz AU - Nowakowski, Piotr AU - Malawski, Maciej AU - Zary, Nabil PY - 2015/09/10 TI - Virtual Patients in a Behavioral Medicine Massive Open Online Course (MOOC): A Case-Based Analysis of Technical Capacity and User Navigation Pathways JO - JMIR Medical Education SP - e8 VL - 1 IS - 2 KW - computer-assisted instruction KW - education, medical KW - medical informatics applications N2 - Background: Massive open online courses (MOOCs) have been criticized for focusing on presentation of short video clip lectures and asking theoretical multiple-choice questions. A potential way of vitalizing these educational activities in the health sciences is to introduce virtual patients. Experiences from such extensions in MOOCs have not previously been reported in the literature. Objective: This study analyzes technical challenges and solutions for offering virtual patients in health-related MOOCs and describes patterns of virtual patient use in one such course. Our aims are to reduce the technical uncertainty related to these extensions, point to aspects that could be optimized for a better learner experience, and raise prospective research questions by describing indicators of virtual patient use on a massive scale. Methods: The Behavioral Medicine MOOC was offered by Karolinska Institutet, a medical university, on the EdX platform in the autumn of 2014. Course content was enhanced by two virtual patient scenarios presented in the OpenLabyrinth system and hosted on the VPH-Share cloud infrastructure. We analyzed web server and session logs and a participant satisfaction survey. Navigation pathways were summarized using a visual analytics tool developed for the purpose of this study. Results: The number of course enrollments reached 19,236. At the official closing date, 2317 participants (12.1% of total enrollment) had declared completing the first virtual patient assignment and 1640 (8.5%) participants confirmed completion of the second virtual patient assignment. Peak activity involved 359 user sessions per day. The OpenLabyrinth system, deployed on four virtual servers, coped well with the workload. Participant survey respondents (n=479) regarded the activity as a helpful exercise in the course (83.1%). Technical challenges reported involved poor or restricted access to videos in certain areas of the world and occasional problems with lost sessions. The visual analyses of user pathways display the parts of virtual patient scenarios that elicited less interest and may have been perceived as nonchallenging options. Analyzing the user navigation pathways allowed us to detect indications of both surface and deep approaches to the content material among the MOOC participants. Conclusions: This study reported on first inclusion of virtual patients in a MOOC. It adds to the body of knowledge by demonstrating how a biomedical cloud provider service can ensure technical capacity and flexible design of a virtual patient platform on a massive scale. The study also presents a new way of analyzing the use of branched virtual patients by visualization of user navigation pathways. Suggestions are offered on improvements to the design of virtual patients in MOOCs. UR - http://mededu.jmir.org/2015/2/e8/ UR - http://dx.doi.org/10.2196/mededu.4394 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731844 ID - info:doi/10.2196/mededu.4394 ER - TY - JOUR AU - Maloney, Stephen AU - Nicklen, Peter AU - Rivers, George AU - Foo, Jonathan AU - Ooi, Ying Ying AU - Reeves, Scott AU - Walsh, Kieran AU - Ilic, Dragan PY - 2015/07/21 TI - A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students JO - J Med Internet Res SP - e182 VL - 17 IS - 7 KW - evidence-based medicine KW - economic evaluation KW - eLearning KW - medical education N2 - Background: Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. Objective: This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. Methods: The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. Results: The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Conclusions: Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context. UR - http://www.jmir.org/2015/7/e182/ UR - http://dx.doi.org/10.2196/jmir.4346 UR - http://www.ncbi.nlm.nih.gov/pubmed/26197801 ID - info:doi/10.2196/jmir.4346 ER - TY - JOUR AU - Lehmann, Ronny AU - Thiessen, Christiane AU - Frick, Barbara AU - Bosse, Martin Hans AU - Nikendei, Christoph AU - Hoffmann, Friedrich Georg AU - Tönshoff, Burkhard AU - Huwendiek, Sören PY - 2015/07/02 TI - Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial JO - J Med Internet Res SP - e162 VL - 17 IS - 7 KW - virtual patients KW - blended learning KW - simulation KW - pediatric basic life support KW - performance N2 - Background: E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches. Objective: This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment. Methods: A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants? self-assessments were recorded in all three measurements. Results: Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group. Conclusions: Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures. UR - http://www.jmir.org/2015/7/e162/ UR - http://dx.doi.org/10.2196/jmir.4141 UR - http://www.ncbi.nlm.nih.gov/pubmed/26139388 ID - info:doi/10.2196/jmir.4141 ER - TY - JOUR AU - Woodham, A. Luke AU - Ellaway, H. Rachel AU - Round, Jonathan AU - Vaughan, Sophie AU - Poulton, Terry AU - Zary, Nabil PY - 2015/06/18 TI - Medical Student and Tutor Perceptions of Video Versus Text in an Interactive Online Virtual Patient for Problem-Based Learning: A Pilot Study JO - J Med Internet Res SP - e151 VL - 17 IS - 6 KW - problem-based learning KW - educational technology KW - multimedia KW - Internet KW - audiovisual aids N2 - Background: The impact of the use of video resources in primarily paper-based problem-based learning (PBL) settings has been widely explored. Although it can provide many benefits, the use of video can also hamper the critical thinking of learners in contexts where learners are developing clinical reasoning. However, the use of video has not been explored in the context of interactive virtual patients for PBL. Objective: A pilot study was conducted to explore how undergraduate medical students interpreted and evaluated information from video- and text-based materials presented in the context of a branched interactive online virtual patient designed for PBL. The goal was to inform the development and use of virtual patients for PBL and to inform future research in this area. Methods: An existing virtual patient for PBL was adapted for use in video and provided as an intervention to students in the transition year of the undergraduate medicine course at St George?s, University of London. Survey instruments were used to capture student and PBL tutor experiences and perceptions of the intervention, and a formative review meeting was run with PBL tutors. Descriptive statistics were generated for the structured responses and a thematic analysis was used to identify emergent themes in the unstructured responses. Results: Analysis of student responses (n=119) and tutor comments (n=18) yielded 8 distinct themes relating to the perceived educational efficacy of information presented in video and text formats in a PBL context. Although some students found some characteristics of the videos beneficial, when asked to express a preference for video or text the majority of those that responded to the question (65%, 65/100) expressed a preference for text. Student responses indicated that the use of video slowed the pace of PBL and impeded students? ability to review and critically appraise the presented information. Conclusions: Our findings suggest that text was perceived to be a better source of information than video in virtual patients for PBL. More specifically, the use of video was perceived as beneficial for providing details, visual information, and context where text was unable to do so. However, learner acceptance of text was higher in the context of PBL, particularly when targeting clinical reasoning skills. This pilot study has provided the foundation for further research into the effectiveness of different virtual patient designs for PBL. UR - http://www.jmir.org/2015/6/e151/ UR - http://dx.doi.org/10.2196/jmir.3922 UR - http://www.ncbi.nlm.nih.gov/pubmed/26088435 ID - info:doi/10.2196/jmir.3922 ER - TY - JOUR AU - Nicolaidou, Iolie AU - Antoniades, Athos AU - Constantinou, Riana AU - Marangos, Charis AU - Kyriacou, Efthyvoulos AU - Bamidis, Panagiotis AU - Dafli, Eleni AU - Pattichis, S. Constantinos PY - 2015/06/17 TI - A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study JO - J Med Internet Res SP - e150 VL - 17 IS - 6 KW - telemedicine KW - emergency telemedicine KW - serious games KW - virtual patients KW - medical education KW - professional feedback-informed evaluation KW - emergency assessment and management N2 - Background: Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students? preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. Objective: The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: ?What are professionals? perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?? Methods: The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game. Results: Overall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users? perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them. Conclusions: Overall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals? input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants? problem-solving skills in treating a patient?s symptoms in an emergency situation. UR - http://www.jmir.org/2015/6/e150/ UR - http://dx.doi.org/10.2196/jmir.3667 UR - http://www.ncbi.nlm.nih.gov/pubmed/26084866 ID - info:doi/10.2196/jmir.3667 ER - TY - JOUR AU - Zhang, WB Melvyn AU - Cheok, CS Christopher AU - Ho, CM Roger PY - 2015/06/08 TI - Global Outreach of a Locally-Developed Mobile Phone App for Undergraduate Psychiatry Education JO - JMIR Medical Education SP - e3 VL - 1 IS - 1 KW - psychiatry KW - education KW - eLearning KW - mobile phone apps KW - mobile phones KW - feasibility KW - proof of concept N2 - Background: Over the past decade, there have been massive developments in both Web-based and mobile phone technologies. Mobile phones are well accepted by students, trainees, and doctors. A review of the current literature has identified the following specialties that have used mobile phones in education: pediatrics, ophthalmology, nephrology, plastic surgery, orthopedics, pharmacology, and urology. However, to date, there are no published papers examining the application of the latest mobile phone technologies for psychiatry education internationally. Objectives: The main objectives of this study are (1) to determine the feasibility and receptiveness of a locally-developed psychiatry mobile phone app and user perspectives (both quantitative and qualitative) towards it, and (2) to determine the receptiveness of a locally-developed app for psychiatry education internationally. Methods: A Web-based app that contained textbook contents, videos, and quizzes was developed using HTML5 technologies in 2012. Native apps were subsequently developed in 2013. Information about the apps was disseminated locally to Singaporean medical students, but the respective native apps were made available on the app stores. A user perspective survey was conducted locally to determine student?s perception of the app. Results: From the inception of the app until the time of preparation of this manuscript, there have been a cumulative total of 28,500 unique visits of the responsive HTML5 Web-based mobile phone app. There have been a cumulative total of 2200 downloads of the Mastering Psychiatry app from the Apple app store and 7000 downloads of the same app from the Android app store. The initial user perspective survey conducted locally highlighted that approximately a total of 95.2% (177/186) of students felt that having a psychiatry mobile phone app was deemed to be useful. Further chi-squared analysis demonstrated that there was a significant difference between males and females in their perception of having textbook contents in the mobile phone app (?24=12.9, P=.0012). Conclusions: To the best of our knowledge, this is the first study to demonstrate the feasibility and global acceptance of a local, self-designed educational app for psychiatry education. Whilst the current research has managed to demonstrate the feasibility and acceptance of such an app, future studies would be warranted to look, in-depth, into whether there are cultural differences in terms of perceptions towards having such an app in psychiatry and what contents different cultures and cohorts of students might want within an app. UR - https://medinform.jmir.org/2015/1/e3/ UR - http://dx.doi.org/10.2196/mededu.4179 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731838 ID - info:doi/10.2196/mededu.4179 ER - TY - JOUR AU - Tunnecliff, Jacqueline AU - Ilic, Dragan AU - Morgan, Prue AU - Keating, Jennifer AU - Gaida, E. James AU - Clearihan, Lynette AU - Sadasivan, Sivalal AU - Davies, David AU - Ganesh, Shankar AU - Mohanty, Patitapaban AU - Weiner, John AU - Reynolds, John AU - Maloney, Stephen PY - 2015/05/20 TI - The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study JO - J Med Internet Res SP - e119 VL - 17 IS - 5 KW - social media KW - evidence-based medicine KW - communication KW - eLearning N2 - Background: Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. Objective: The aim of this study was to explore health researchers? and clinicians? current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. Methods: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. Results: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information. Conclusions: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice. UR - http://www.jmir.org/2015/5/e119/ UR - http://dx.doi.org/10.2196/jmir.4347 UR - http://www.ncbi.nlm.nih.gov/pubmed/25995192 ID - info:doi/10.2196/jmir.4347 ER - TY - JOUR AU - Roberts, John Matthew AU - Perera, Marlon AU - Lawrentschuk, Nathan AU - Romanic, Diana AU - Papa, Nathan AU - Bolton, Damien PY - 2015/04/23 TI - Globalization of Continuing Professional Development by Journal Clubs via Microblogging: A Systematic Review JO - J Med Internet Res SP - e103 VL - 17 IS - 4 KW - journal club KW - social media KW - continuing medical education KW - continuing professional development KW - systematic review N2 - Background: Journal clubs are an essential tool in promoting clinical evidence-based medical education to all medical and allied health professionals. Twitter represents a public, microblogging forum that can facilitate traditional journal club requirements, while also reaching a global audience, and participation for discussion with study authors and colleagues. Objective: The aim of the current study was to evaluate the current state of social media?facilitated journal clubs, specifically Twitter, as an example of continuing professional development. Methods: A systematic review of literature databases (Medline, Embase, CINAHL, Web of Science, ERIC via ProQuest) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of Twitter, the followers of identified journal clubs, and Symplur was also performed. Demographic and monthly tweet data were extracted from Twitter and Symplur. All manuscripts related to Twitter-based journal clubs were included. Statistical analyses were performed in MS Excel and STATA. Results: From a total of 469 citations, 11 manuscripts were included and referred to five Twitter-based journal clubs (#ALiEMJC, #BlueJC, #ebnjc, #urojc, #meded). A Twitter-based journal club search yielded 34 potential hashtags/accounts, of which 24 were included in the final analysis. The median duration of activity was 11.75 (interquartile range [IQR] 19.9, SD 10.9) months, with 7 now inactive. The median number of followers and participants was 374 (IQR 574) and 157 (IQR 272), respectively. An overall increasing establishment of active Twitter-based journal clubs was observed, resulting in an exponential increase in total cumulative tweets (R2=.98), and tweets per month (R2=.72). Cumulative tweets for specific journal clubs increased linearly, with @ADC_JC, @EBNursingBMJ, @igsjc, @iurojc, and @NephJC, and showing greatest rate of change, as well as total impressions per month since establishment. An average of two tweets per month was estimated for the majority of participants, while the ?Top 10? tweeters for @iurojc showed a significantly lower contribution to overall tweets for each month (P<.005). A linearly increasing impression:tweet ratio was observed for the top five journal clubs. Conclusions: Twitter-based journal clubs are free, time-efficient, and publicly accessible means to facilitate international discussions regarding clinically important evidence-based research. UR - http://www.jmir.org/2015/4/e103/ UR - http://dx.doi.org/10.2196/jmir.4194 UR - http://www.ncbi.nlm.nih.gov/pubmed/25908092 ID - info:doi/10.2196/jmir.4194 ER - TY - JOUR AU - Selby, Peter AU - Goncharenko, Karina AU - Barker, Megan AU - Fahim, Myra AU - Timothy, Valerie AU - Dragonetti, Rosa AU - Kemper, Katherine AU - Herie, Marilyn AU - Hays, Taylor J. PY - 2015/04/17 TI - Review and Evaluation of Online Tobacco Dependence Treatment Training Programs for Health Care Practitioners JO - J Med Internet Res SP - e97 VL - 17 IS - 4 KW - distance education KW - tobacco use KW - health care KW - smoking cessation KW - tobacco dependence KW - program evaluation KW - continuing medical education N2 - Background: Training health care professionals is associated with increased capacity to deliver evidence-based smoking cessation interventions and increased quit rates among their patients. Online training programs hold promise to provide training but questions remain regarding the quality and usability of available programs. Objective: The aim was to assess the quality of English-language online courses in tobacco dependence treatment using a validated instrument. Methods: An environmental scan was conducted using the Google search engine to identify available online tobacco dependence treatment courses. The identified courses were then evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. It also has clear and concise criteria descriptions to ensure uniformity of evaluations by trained experts. Results: A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor?s role, and assessment and evaluation. Evaluation results and suggestions for improvement were shared with course administrators. Conclusions: Based on the courses evaluated in this review, course developers are encouraged to employ best practices in instructional design, such as cohesiveness of material, linearity of design, practice exercises, problem solving, and ongoing evaluation to improve existing courses and in the design of new online learning opportunities. UR - http://www.jmir.org/2015/4/e97/ UR - http://dx.doi.org/10.2196/jmir.3284 UR - http://www.ncbi.nlm.nih.gov/pubmed/25887187 ID - info:doi/10.2196/jmir.3284 ER - TY - JOUR AU - Li, Yan Tse AU - Gao, Xiaoli AU - Wong, Kin AU - Tse, Kwan Christine Shuk AU - Chan, Yee Ying PY - 2015/04/14 TI - Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties JO - JMIR Medical Education SP - e1 VL - 1 IS - 1 KW - clinical skills KW - distance learning KW - dentistry KW - medicine KW - nursing N2 - Background: Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students? acquisition of clinical competence. Objective: This study aimed to understand the experience of undergraduate students across clinical disciplines?medicine, dentistry, and nursing?in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods: Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong?Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results: Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions: Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students across clinical faculties as an important supplement to their formal learning in the planned curriculum. This trend calls for a transformation of the educator?s role from dispensing knowledge to guidance and support. UR - http://mededu.jmir.org/2015/1/e1/ UR - http://dx.doi.org/10.2196/mededu.3866 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731303 ID - info:doi/10.2196/mededu.3866 ER - TY - JOUR AU - Kleinert, Robert AU - Wahba, Roger AU - Chang, De-Hua AU - Plum, Patrick AU - Hölscher, H. Arnulf AU - Stippel, L. Dirk PY - 2015/04/08 TI - 3D Immersive Patient Simulators and Their Impact on Learning Success: A Thematic Review JO - J Med Internet Res SP - e91 VL - 17 IS - 4 KW - immersive patient simulators KW - Web-based learning KW - validity KW - immersion KW - procedural knowledge N2 - Background: Immersive patient simulators (IPSs) combine the simulation of virtual patients with a three-dimensional (3D) environment and, thus, allow an illusionary immersion into a synthetic world, similar to computer games. Playful learning in a 3D environment is motivating and allows repetitive training and internalization of medical workflows (ie, procedural knowledge) without compromising real patients. The impact of this innovative educational concept on learning success requires review of feasibility and validity. Objective: It was the aim of this paper to conduct a survey of all immersive patient simulators currently available. In addition, we address the question of whether the use of these simulators has an impact on knowledge gain by summarizing the existing validation studies. Methods: A systematic literature search via PubMed was performed using predefined inclusion criteria (ie, virtual worlds, focus on education of medical students, validation testing) to identify all available simulators. Validation testing was defined as the primary end point. Results: There are currently 13 immersive patient simulators available. Of these, 9 are Web-based simulators and represent feasibility studies. None of these simulators are used routinely for student education. The workstation-based simulators are commercially driven and show a higher quality in terms of graphical quality and/or data content. Out of the studies, 1 showed a positive correlation between simulated content and real content (ie, content validity). There was a positive correlation between the outcome of simulator training and alternative training methods (ie, concordance validity), and a positive coherence between measured outcome and future professional attitude and performance (ie, predictive validity). Conclusions: IPSs can promote learning and consolidation of procedural knowledge. The use of immersive patient simulators is still marginal, and technical and educational approaches are heterogeneous. Academic-driven IPSs could possibly enhance the content quality, improve the validity level, and make this educational concept accessible to all medical students. UR - http://www.jmir.org/2015/4/e91/ UR - http://dx.doi.org/10.2196/jmir.3492 UR - http://www.ncbi.nlm.nih.gov/pubmed/25858862 ID - info:doi/10.2196/jmir.3492 ER - TY - JOUR AU - Elliot, Diane AU - Rohlman, Diane AU - Parish, Megan PY - 2015/03/27 TI - Focus Groups Move Online: Feasibility of Tumblr Use for eHealth Curriculum Development JO - JMIR Res Protoc SP - e34 VL - 4 IS - 1 KW - Tumblr KW - focus group KW - crowdsourcing KW - curriculum development KW - Internet N2 - Background: Constructing successful online programs requires engaging potential users in development. However, assembling focus groups can be costly and time consuming. Objective: The aim of this study is to assess whether Tumblr can be used to prioritize activities for an online younger worker risk reduction and health promotion program. Methods: Younger summer parks and recreation employees were encouraged to visit Tumblr using weekly announcements and competitions. Each week, new activities were posted on Tumblr with linked survey questions. Responses were downloaded and analyzed. Results: An average of 36 young workers rated each activity on its likeability and perceived educational value. The method was feasible, efficient, and sustainable across the summer weeks. Ratings indicated significant differences in likeability among activities (P<.005). Conclusions: Tumblr is a means to crowdsource formative feedback on potential curricular components when assembling an online intervention. This paper describes its initial use as well as suggestions for future refinements. UR - http://www.researchprotocols.org/2015/1/e34/ UR - http://dx.doi.org/10.2196/resprot.3432 UR - http://www.ncbi.nlm.nih.gov/pubmed/25831197 ID - info:doi/10.2196/resprot.3432 ER - TY - JOUR AU - Badran, Hani AU - Pluye, Pierre AU - Grad, Roland PY - 2015/02/27 TI - Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint JO - J Med Internet Res SP - e49 VL - 17 IS - 2 KW - theory of planned behavior KW - continuing medical education KW - educational email alerts KW - electronic knowledge resources KW - family physicians KW - health informatics KW - knowledge translation KW - primary health care N2 - Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians? knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants? suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the ?Knowledge, Attitude, Behavior? model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results: All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. UR - http://www.jmir.org/2015/2/e49/ UR - http://dx.doi.org/10.2196/jmir.3773 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803184 ID - info:doi/10.2196/jmir.3773 ER - TY - JOUR AU - Bacon, Rachel AU - Williams, Therese Lauren AU - Grealish, Laurie AU - Jamieson, Maggie PY - 2015/02/27 TI - Competency-Based Assessment for Clinical Supervisors: Design-Based Research on a Web-Delivered Program JO - JMIR Res Protoc SP - e26 VL - 4 IS - 1 KW - competency-based education KW - preceptorship KW - e-learning KW - pedagogy KW - constructivist KW - dietitian N2 - Background: Clinicians need to be supported by universities to use credible and defensible assessment practices during student placements. Web-based delivery of clinical education in student assessment offers professional development regardless of the geographical location of placement sites. Objective: This paper explores the potential for a video-based constructivist Web-based program to support site supervisors in their assessments of student dietitians during clinical placements. Methods: This project was undertaken as design-based research in two stages. Stage 1 describes the research consultation, development of the prototype, and formative feedback. In Stage 2, the program was pilot-tested and evaluated by a purposeful sample of nine clinical supervisors. Data generated as a result of user participation during the pilot test is reported. Users? experiences with the program were also explored via interviews (six in a focus group and three individually). The interviews were transcribed verbatim and thematic analysis conducted from a pedagogical perspective using van Manen?s highlighting approach. Results: This research succeeded in developing a Web-based program, ?Feed our Future?, that increased supervisors? confidence with their competency-based assessments of students on clinical placements. Three pedagogical themes emerged: constructivist design supports transformative Web-based learning; videos make abstract concepts tangible; and accessibility, usability, and pedagogy are interdependent. Conclusions: Web-based programs, such as Feed our Future, offer a viable means for universities to support clinical supervisors in their assessment practices during clinical placements. A design-based research approach offers a practical process for such Web-based tool development, highlighting pedagogical barriers for planning purposes. UR - http://www.researchprotocols.org/2015/1/e26/ UR - http://dx.doi.org/10.2196/resprot.3893 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803172 ID - info:doi/10.2196/resprot.3893 ER - TY - JOUR AU - Pantziaras, Ioannis AU - Fors, Uno AU - Ekblad, Solvig PY - 2015/02/16 TI - Training With Virtual Patients in Transcultural Psychiatry: Do the Learners Actually Learn? JO - J Med Internet Res SP - e46 VL - 17 IS - 2 KW - mental health KW - transcultural psychiatry KW - virtual systems KW - PTSD KW - medical informatics KW - education KW - patient simulation N2 - Background: The rapid increase in the number of patients with diverse ethnic backgrounds and previous exposure to severe mental trauma dictates the need for improvement in the quality of transcultural psychiatric health care through the development of relevant and effective training tools. Objective: This study aimed to evaluate the impact of training with a virtual patient on the learner?s knowledge of posttraumatic stress disorder symptoms, clinical management, and basic communication skills. Methods: The authors constructed an interactive educational tool based on virtual patient methodology that portrayed a refugee with severe symptoms of posttraumatic stress disorder and depression. A total of 32 resident psychiatrists tested the tool and completed a pre-interaction and post-interaction knowledge test, including skills, at the time and several weeks later. Results: All of the participants (N=32) completed the pre-interaction and post-interaction test, and 26 (81%) of them completed the online follow-up test. The mean pre-interaction score was 7.44 (male: 7.08, female: 7.65, no statistical significance). The mean post-interaction score was 8.47, which was significantly higher (P<.001) than the pre-interaction score (mean score 7.44). The mean score for the follow-up test several weeks later was 8.38, higher than the pre-interaction score by 0.69 points but not statistically significant. Conclusions: Our results suggest that virtual patients can successfully facilitate the acquisition of core knowledge in the field of psychiatry, in addition to developing skills such as clinical reasoning, decision making, and history taking. Repeated training sessions with virtual patients are proposed in order to achieve sustainable educational effects. UR - http://www.jmir.org/2015/2/e46/ UR - http://dx.doi.org/10.2196/jmir.3497 UR - http://www.ncbi.nlm.nih.gov/pubmed/25689716 ID - info:doi/10.2196/jmir.3497 ER - TY - JOUR AU - Dafli, Eleni AU - Antoniou, Panagiotis AU - Ioannidis, Lazaros AU - Dombros, Nicholas AU - Topps, David AU - Bamidis, D. Panagiotis PY - 2015/01/22 TI - Virtual Patients on the Semantic Web: A Proof-of-Application Study JO - J Med Internet Res SP - e16 VL - 17 IS - 1 KW - semantics KW - medical education KW - problem-based learning KW - data sharing KW - patient simulation KW - educational assessment N2 - Background: Virtual patients are interactive computer simulations that are increasingly used as learning activities in modern health care education, especially in teaching clinical decision making. A key challenge is how to retrieve and repurpose virtual patients as unique types of educational resources between different platforms because of the lack of standardized content-retrieving and repurposing mechanisms. Semantic Web technologies provide the capability, through structured information, for easy retrieval, reuse, repurposing, and exchange of virtual patients between different systems. Objective: An attempt to address this challenge has been made through the mEducator Best Practice Network, which provisioned frameworks for the discovery, retrieval, sharing, and reuse of medical educational resources. We have extended the OpenLabyrinth virtual patient authoring and deployment platform to facilitate the repurposing and retrieval of existing virtual patient material. Methods: A standalone Web distribution and Web interface, which contains an extension for the OpenLabyrinth virtual patient authoring system, was implemented. This extension was designed to semantically annotate virtual patients to facilitate intelligent searches, complex queries, and easy exchange between institutions. The OpenLabyrinth extension enables OpenLabyrinth authors to integrate and share virtual patient case metadata within the mEducator3.0 network. Evaluation included 3 successive steps: (1) expert reviews; (2) evaluation of the ability of health care professionals and medical students to create, share, and exchange virtual patients through specific scenarios in extended OpenLabyrinth (OLabX); and (3) evaluation of the repurposed learning objects that emerged from the procedure. Results: We evaluated 30 repurposed virtual patient cases. The evaluation, with a total of 98 participants, demonstrated the system?s main strength: the core repurposing capacity. The extensive metadata schema presentation facilitated user exploration and filtering of resources. Usability weaknesses were primarily related to standard computer applications? ease of use provisions. Most evaluators provided positive feedback regarding educational experiences on both content and system usability. Evaluation results replicated across several independent evaluation events. Conclusions: The OpenLabyrinth extension, as part of the semantic mEducator3.0 approach, is a virtual patient sharing approach that builds on a collection of Semantic Web services and federates existing sources of clinical and educational data. It is an effective sharing tool for virtual patients and has been merged into the next version of the app (OpenLabyrinth 3.3). Such tool extensions may enhance the medical education arsenal with capacities of creating simulation/game-based learning episodes, massive open online courses, curricular transformations, and a future robust infrastructure for enabling mobile learning. UR - http://www.jmir.org/2015/1/e16/ UR - http://dx.doi.org/10.2196/jmir.3933 UR - http://www.ncbi.nlm.nih.gov/pubmed/25616272 ID - info:doi/10.2196/jmir.3933 ER - TY - JOUR AU - Liaw, Ying Sok AU - Wong, Fun Lai AU - Chan, Wai-Chi Sally AU - Ho, Yin Jasmine Tze AU - Mordiffi, Zubaidah Siti AU - Ang, Leng Sophia Bee AU - Goh, Sun Poh AU - Ang, Kim Emily Neo PY - 2015/01/12 TI - Designing and Evaluating an Interactive Multimedia Web-Based Simulation for Developing Nurses? Competencies in Acute Nursing Care: Randomized Controlled Trial JO - J Med Internet Res SP - e5 VL - 17 IS - 1 KW - acute nursing care KW - authentic learning KW - clinical competency KW - deterioration KW - multimedia KW - instructional strategies KW - simulation KW - Web-based simulation N2 - Background: Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice. Objective: This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses? competencies in acute nursing care. Methods: Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants? clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool. Results: The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving. Conclusions: Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses? competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency. UR - http://www.jmir.org/2015/1/e5/ UR - http://dx.doi.org/10.2196/jmir.3853 UR - http://www.ncbi.nlm.nih.gov/pubmed/25583029 ID - info:doi/10.2196/jmir.3853 ER - TY - JOUR AU - Moreira, C. Inês AU - Ventura, Rua Sandra AU - Ramos, Isabel AU - Rodrigues, Pereira Pedro PY - 2015/01/05 TI - Development and Assessment of an E-Learning Course on Breast Imaging for Radiographers: A Stratified Randomized Controlled Trial JO - J Med Internet Res SP - e3 VL - 17 IS - 1 KW - breast neoplasms KW - continuing education KW - distance learning KW - evaluation studies KW - mammography N2 - Background: Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services. Objective: Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy, effectiveness, and user satisfaction. Methods: A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis. Results: A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students? posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful. Conclusions: This e-learning course is effective, especially for radiographers, which highlights the need for continuing education. UR - http://www.jmir.org/2015/1/e3/ UR - http://dx.doi.org/10.2196/jmir.3344 UR - http://www.ncbi.nlm.nih.gov/pubmed/25560547 ID - info:doi/10.2196/jmir.3344 ER - TY - JOUR AU - Mather, Carey AU - Cummings, Elizabeth AU - Allen, Penny PY - 2014/12/10 TI - Nurses? Use of Mobile Devices to Access Information in Health Care Environments in Australia: A Survey of Undergraduate Students JO - JMIR mHealth uHealth SP - e56 VL - 2 IS - 4 KW - undergraduate nurse KW - mobile KW - work integrated learning N2 - Background: The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. Objective: This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. Methods: A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. Results: There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (P<.001), social networking (P<.001), shopping on the Internet (P=.01), conducting personal business online (P=.01), and checking or sending non-work related texts or emails to co-workers (P=.04). Study-related activities were conducted more regularly away from the workplace and included accessing University sites for information (P=.03) and checking or sending study-related text messages or emails to friends or co-workers (P=.01). Students continued to access nursing, medical, professional development, and study-related information away from the workplace. Conclusions: Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients. UR - http://mhealth.jmir.org/2014/4/e56/ UR - http://dx.doi.org/10.2196/mhealth.3467 UR - http://www.ncbi.nlm.nih.gov/pubmed/25499736 ID - info:doi/10.2196/mhealth.3467 ER - TY - JOUR AU - Jin, Jun AU - Bridges, M. Susan PY - 2014/12/10 TI - Educational Technologies in Problem-Based Learning in Health Sciences Education: A Systematic Review JO - J Med Internet Res SP - e251 VL - 16 IS - 12 KW - systematic review KW - educational technologies KW - problem-based learning KW - medical education KW - health sciences KW - software KW - digital learning object KW - interactive whiteboard KW - learning management system N2 - Background: As a modern pedagogical philosophy, problem-based learning (PBL) is increasingly being recognized as a major research area in student learning and pedagogical innovation in health sciences education. A new area of research interest has been the role of emerging educational technologies in PBL. Although this field is growing, no systematic reviews of studies of the usage and effects of educational technologies in PBL in health sciences education have been conducted to date. Objective: The aim of this paper is to review new and emerging educational technologies in problem-based curricula, with a specific focus on 3 cognate clinical disciplines: medicine, dentistry, and speech and hearing sciences. Analysis of the studies reviewed focused on the effects of educational technologies in PBL contexts while addressing the particular issue of scaffolding of student learning. Methods: A comprehensive computerized database search of full-text articles published in English from 1996 to 2014 was carried out using 3 databases: ProQuest, Scopus, and EBSCOhost. Eligibility criteria for selection of studies for review were also determined in light of the population, intervention, comparison, and outcomes (PICO) guidelines. The population was limited to postsecondary education, specifically in dentistry, medicine, and speech and hearing sciences, in which PBL was the key educational pedagogy and curriculum design. Three types of educational technologies were identified as interventions used to support student inquiry: learning software and digital learning objects; interactive whiteboards (IWBs) and plasma screens; and learning management systems (LMSs). Results: Of 470 studies, 28 were selected for analysis. Most studies examined the effects of learning software and digital learning objects (n=20) with integration of IWB (n=5) and LMS (n=3) for PBL receiving relatively less attention. The educational technologies examined in these studies were seen as potentially fit for problem-based health sciences education. Positive outcomes for student learning included providing rich, authentic problems and/or case contexts for learning; supporting student development of medical expertise through the accessing and structuring of expert knowledge and skills; making disciplinary thinking and strategies explicit; providing a platform to elicit articulation, collaboration, and reflection; and reducing perceived cognitive load. Limitations included cumbersome scenarios, infrastructure requirements, and the need for staff and student support in light of the technological demands of new affordances. Conclusions: This literature review demonstrates the generally positive effect of educational technologies in PBL. Further research into the various applications of educational technology in PBL curricula is needed to fully realize its potential to enhance problem-based approaches in health sciences education. UR - http://www.jmir.org/2014/12/e251/ UR - http://dx.doi.org/10.2196/jmir.3240 UR - http://www.ncbi.nlm.nih.gov/pubmed/25498126 ID - info:doi/10.2196/jmir.3240 ER - TY - JOUR AU - Poulton, Terry AU - Ellaway, H. Rachel AU - Round, Jonathan AU - Jivram, Trupti AU - Kavia, Sheetal AU - Hilton, Sean PY - 2014/11/05 TI - Exploring the Efficacy of Replacing Linear Paper-Based Patient Cases in Problem-Based Learning With Dynamic Web-Based Virtual Patients: Randomized Controlled Trial JO - J Med Internet Res SP - e240 VL - 16 IS - 11 KW - problem-based learning KW - decision making KW - education, medical KW - virtual patients KW - curriculum N2 - Background: Problem-based learning (PBL) is well established in medical education and beyond, and continues to be developed and explored. Challenges include how to connect the somewhat abstract nature of classroom-based PBL with clinical practice and how to maintain learner engagement in the process of PBL over time. Objective: A study was conducted to investigate the efficacy of decision-PBL (D-PBL), a variant form of PBL that replaces linear PBL cases with virtual patients. These Web-based interactive cases provided learners with a series of patient management pathways. Learners were encouraged to consider and discuss courses of action, take their chosen management pathway, and experience the consequences of their decisions. A Web-based application was essential to allow scenarios to respond dynamically to learners? decisions, to deliver the scenarios to multiple PBL classrooms in the same timeframe, and to record centrally the paths taken by the PBL groups. Methods: A randomized controlled trial in crossover design was run involving all learners (N=81) in the second year of the graduate entry stream for the undergraduate medicine program at St George?s University of London. Learners were randomized to study groups; half engaged in a D-PBL activity whereas the other half had a traditional linear PBL activity on the same subject material. Groups alternated D-PBL and linear PBL over the semester. The measure was mean cohort performance on specific face-to-face exam questions at the end of the semester. Results: D-PBL groups performed better than linear PBL groups on questions related to D-PBL with the difference being statistically significant for all questions. Differences between the exam performances of the 2 groups were not statistically significant for the questions not related to D-PBL. The effect sizes for D-PBL?related questions were large and positive (>0.6) except for 1 question that showed a medium positive effect size. The effect sizes for questions not related to D-PBL were all small (?0.3) with a mix of positive and negative values. Conclusions: The efficacy of D-PBL was indicated by improved exam performance for learners who had D-PBL compared to those who had linear PBL. This suggests that the use of D-PBL leads to better midterm learning outcomes than linear PBL, at least for learners with prior experience with linear PBL. On the basis of tutor and student feedback, St George?s University of London and the University of Nicosia, Cyprus have replaced paper PBL cases for midstage undergraduate teaching with D-PBL virtual patients, and 6 more institutions in the ePBLnet partnership will be implementing D-PBL in Autumn 2015. UR - http://www.jmir.org/2014/11/e240/ UR - http://dx.doi.org/10.2196/jmir.3748 UR - http://www.ncbi.nlm.nih.gov/pubmed/25373314 ID - info:doi/10.2196/jmir.3748 ER - TY - JOUR AU - Janssen, Anna AU - Robinson, Tracy AU - Shaw, Tim PY - 2014/10/31 TI - The Evolution of a Professional Practice Forum: Balancing Peer-to-Peer Learning With Course Objectives JO - JMIR Res Protoc SP - e58 VL - 3 IS - 4 KW - medical education KW - peer-to-peer KW - online learning KW - formative assessment N2 - Background: The Opioid Treatment Accreditation Course (OTAC) is a mandatory accreditation requirement in New South Wales, Australia, and aims to prepare medical practitioners for the provision of safe and effective Opioid Substitution Treatment to people with opioid dependence. The course has a strong focus on safe prescribing practices and the course design includes a Professional Practice Forum that is engaging for participants and effective at imparting complex ideas and concepts that do not place additional time constraints on already time-poor health professionals. Objective: The study aimed to use participatory action research methods to develop and evaluate an online Professional Practice Forum that is a key component of the OTAC teaching and learning experience. Methods: Three evaluation cycles were implemented with three cohorts of participants (N=40) to inform the design and review of the updated OTAC course. Overall, the study relied on participatory action research methods to enhance a sense of online community and to revise the Professional Practice Forum component of the course. Findings from survey feedback and an examination of Web metrics were used to monitor participant learning and were subsequently subject to thematic analysis in order to identify key themes. Results: The use of participatory action techniques in the redesign of the OTAC course was a successful means of engaging with participants and resulted in four revisions based on feedback from facilitators and participants. The Professional Practice Forum was rated highly and received positive feedback from both moderators and participants. Conclusions: The use of interactive forums in online learning in an educational module for adult learners can prove extremely valuable as a means for participants to share their expertise and improve their learning outcomes. In particular, the use of sticky and welcome threads were significant features that enhanced interactions between participants and facilitators and resulted in increased quantity and quality of postings. These findings can help inform future researchers on how to develop peer engagement modules that are amenable to assessment and that build an online sense of community. UR - http://www.researchprotocols.org/2014/4/e58/ UR - http://dx.doi.org/10.2196/resprot.3287 UR - http://www.ncbi.nlm.nih.gov/pubmed/25363273 ID - info:doi/10.2196/resprot.3287 ER - TY - JOUR AU - Valladares, Felix Angel AU - Aebersold, Michelle AU - Tschannen, Dana AU - Villarruel, Maria Antonia PY - 2014/09/30 TI - Preparing Facilitators From Community-Based Organizations for Evidence-Based Intervention Training in Second Life JO - J Med Internet Res SP - e220 VL - 16 IS - 9 KW - evidence-based intervention KW - virtual environment KW - Second Life KW - health education KW - community-based organization KW - facilitator training KW - computer simulation KW - distance education KW - serious gaming N2 - Background: A major barrier to the use and scale-up of evidence-based interventions are challenges related to training and capacity building. A cost-effective and highly interactive multi-user virtual environment, Second Life (SL) is a promising alternative for comprehensive face-to-face facilitator training. Objective: The purpose of this study was to examine the feasibility of using SL to train facilitators from community-based organizations to use ¡Cuídate! (Take Care of Yourself), one of the few evidence-based interventions developed and tested with Latino youth to reduce sexual risk behaviors. Methods: We recruited 35 participants from community-based organizations throughout the United States to participate in the SL ¡Cuídate! Training of Facilitators. Preparation to use SL consisted of four phases: (1) recruitment and computer capacity screening, (2) enrollment, (3) orientation to the SL program, and (4) technical support throughout the synchronous training sessions. Technical difficulties, the associated cause, and the mitigation strategy implemented were recorded during each session. Participants completed evaluations including perceptions of self-efficacy and confidence to complete the necessary skills to participate in SL training. Results: Overall, participants reported high levels of self-efficacy for all skills necessary to participate in SL training. Based on an 11-point scale (0-10), self-efficacy to download and access the software was rated the highest: mean 8.29 (SD 2.19). Interacting with items in SL had the lowest mean score: mean 7.49 (SD 2.89). The majority of technical difficulties experienced by participants were related to inadequate Internet connections or computer malfunctions. Conclusions: Our findings support the feasibility of using SL for the ¡Cuídate! Training of Facilitators. The process used in this study to prepare participants to use SL can be used as a basis for other evidence-based intervention training in SL. This study is an important contribution to developing cost-effective and accessible training options for evidence-based interventions. UR - http://www.jmir.org/2014/9/e220/ UR - http://dx.doi.org/10.2196/jmir.3606 UR - http://www.ncbi.nlm.nih.gov/pubmed/25270991 ID - info:doi/10.2196/jmir.3606 ER - TY - JOUR AU - Liaw, Ying Sok AU - Chan, Wai-Chi Sally AU - Chen, Fun-Gee AU - Hooi, Chuan Shing AU - Siau, Chiang PY - 2014/09/17 TI - Comparison of Virtual Patient Simulation With Mannequin-Based Simulation for Improving Clinical Performances in Assessing and Managing Clinical Deterioration: Randomized Controlled Trial JO - J Med Internet Res SP - e214 VL - 16 IS - 9 KW - simulation KW - education KW - virtual patient KW - deterioration KW - clinical performance KW - patient safety N2 - Background: Virtual patient simulation has grown substantially in health care education. A virtual patient simulation was developed as a refresher training course to reinforce nursing clinical performance in assessing and managing deteriorating patients. Objective: The objective of this study was to describe the development of the virtual patient simulation and evaluate its efficacy, by comparing with a conventional mannequin-based simulation, for improving the nursing students? performances in assessing and managing patients with clinical deterioration. Methods: A randomized controlled study was conducted with 57 third-year nursing students who were recruited through email. After a baseline evaluation of all participants? clinical performance in a simulated environment, the experimental group received a 2-hour fully automated virtual patient simulation while the control group received 2-hour facilitator-led mannequin-based simulation training. All participants were then re-tested one day (first posttest) and 2.5 months (second posttest) after the intervention. The participants from the experimental group completed a survey to evaluate their learning experiences with the newly developed virtual patient simulation. Results: Compared to their baseline scores, both experimental and control groups demonstrated significant improvements (P<.001) in first and second post-test scores. While the experimental group had significantly lower (P<.05) second post-test scores compared with the first post-test scores, no significant difference (P=.94) was found between these two scores for the control group. The scores between groups did not differ significantly over time (P=.17). The virtual patient simulation was rated positively. Conclusions: A virtual patient simulation for a refreshing training course on assessing and managing clinical deterioration was developed. Although the randomized controlled study did not show that the virtual patient simulation was superior to mannequin-based simulation, both simulations have demonstrated to be effective refresher learning strategies for improving nursing students? clinical performance. Given the greater resource requirements of mannequin-based simulation, the virtual patient simulation provides a more promising alternative learning strategy to mitigate the decay of clinical performance over time. UR - http://www.jmir.org/2014/9/e214/ UR - http://dx.doi.org/10.2196/jmir.3322 UR - http://www.ncbi.nlm.nih.gov/pubmed/25230684 ID - info:doi/10.2196/jmir.3322 ER - TY - JOUR AU - Jiwa, Moyez AU - Long, Anne AU - Shaw, Tim AU - Pagey, Georgina AU - Halkett, Georgia AU - Pillai, Vinita AU - Meng, Xingqiong PY - 2014/09/03 TI - The Management of Acute Adverse Effects of Breast Cancer Treatment in General Practice: A Video-Vignette Study JO - J Med Internet Res SP - e204 VL - 16 IS - 9 KW - breast cancer KW - treatment KW - general practice KW - adverse effects KW - patient care planning N2 - Background: There has been a focus recently on the use of the Internet and email to deliver education interventions to general practitioners (GPs). The treatment of breast cancer may include surgery, radiotherapy, chemotherapy, and/or hormone treatment. These treatments may have acute adverse effects. GPs need more information on the diagnosis and management of specific adverse effects encountered immediately after cancer treatment. Objective: The goal was to evaluate an Internet-based educational program developed for GPs to advise patients with acute adverse effects following breast cancer treatment. Methods: During phase 1, participants viewed 6 video vignettes of actor-patients reporting 1 of 6 acute symptoms following surgery and chemotherapy and/or radiotherapy treatment. GPs indicated their diagnosis and proposed management through an online survey program. They received feedback about each scenario in the form of a specialist clinic letter, as if the patient had been seen at a specialist clinic after they had attended the GP. This letter incorporated extracts from local guidelines on the management of the symptoms presented. This feedback was sent to the GPs electronically on the same survey platform. In phase 2, all GPs were invited to manage similar cases as phase 1. Their proposed management was compared to the guidelines. McNemar test was used to compare data from phases 1 and 2, and logistic regression was used to explore the GP characteristics that were associated with inappropriate case management. Results: A total of 50 GPs participated. Participants were younger and more likely to be female than other GPs in Australia. For 5 of 6 vignettes in phase 1, management was consistent with expert opinion in the minority of cases (6%-46%). Participant demographic characteristics had a variable effect on different management decisions in phase 1. The variables modeled explained 15%-28% of the differences observed. Diagnosis and management improved significantly in phase 2, especially for diarrhea, neutropenia, and seroma sample cases. The proportion of incorrect management responses was reduced to a minimum (25.3%-49.3%) in phase 2. Conclusions: There was evidence that providing feedback by experts on specific cases had an impact on GPs? knowledge about how to appropriately manage acute treatment adverse effects. This educational intervention could be targeted to support the implementation of shared care during cancer treatment. UR - http://www.jmir.org/2014/9/e204/ UR - http://dx.doi.org/10.2196/jmir.3585 UR - http://www.ncbi.nlm.nih.gov/pubmed/25274131 ID - info:doi/10.2196/jmir.3585 ER - TY - JOUR AU - Walsh, Kieran PY - 2014/08/25 TI - Massive Open Online Courses on Health and Medicine: Will They Be Sustainable? JO - J Med Internet Res SP - e197 VL - 16 IS - 8 UR - http://www.jmir.org/2014/8/e197/ UR - http://dx.doi.org/10.2196/jmir.3798 UR - http://www.ncbi.nlm.nih.gov/pubmed/25154793 ID - info:doi/10.2196/jmir.3798 ER - TY - JOUR AU - Liyanagunawardena, Rekha Tharindu AU - Williams, Ann Shirley PY - 2014/08/14 TI - Massive Open Online Courses on Health and Medicine: Review JO - J Med Internet Res SP - e191 VL - 16 IS - 8 KW - eLearning KW - education KW - health education KW - continuing education KW - computer-assisted instruction N2 - Background: Massive open online courses (MOOCs) have become immensely popular in a short span of time. However, there is very little research exploring MOOCs in the discipline of health and medicine. Objective: We aim to provide a review of MOOCs related to health and medicine offered by various MOOC platforms in 2013, by analyzing and comparing the various offerings, their target audience, typical length of course, and credentials offered. We also discuss opportunities and challenges presented by MOOCs in health and medicine. Methods: Health and medicine?related MOOCs were gathered using several methods to ensure the richness and completeness of data. Identified MOOC platform websites were used to gather the lists of offerings. In parallel, these MOOC platforms were contacted to access official data on their offerings. Two MOOC aggregator sites (Class Central and MOOC List) were also consulted to gather data on MOOC offerings. Eligibility criteria were defined to concentrate on the courses that were offered in 2013 and primarily on the subject of health and medicine. All language translations in this paper were done using Google Translate. Results: The search identified 225 courses, of which 98 were eligible for the review. Over half (58%, 57/98) of the MOOCs considered were offered on the Coursera platform, and 94% (92/98) of all the MOOCs were offered in English. Universities offered 90 MOOCs, and the John Hopkins University offered the largest number of MOOCs (12/90). Only three MOOCs were offered by developing countries (China, West Indies, and Saudi Arabia). The duration of MOOCs varied from 3-20 weeks with an average length of 6.7 weeks. On average, MOOCs expected a participant to work on the material for 4.2 hours a week. Verified certificates were offered by 14 MOOCs, while three others offered other professional recognition. Conclusions: The review presents evidence to suggest that MOOCs can be used as a way to provide continuous medical education. It also shows the potential of MOOCs as a means of increasing health literacy among the public. UR - http://www.jmir.org/2014/8/e191/ UR - http://dx.doi.org/10.2196/jmir.3439 UR - http://www.ncbi.nlm.nih.gov/pubmed/25123952 ID - info:doi/10.2196/jmir.3439 ER - TY - JOUR AU - Riley, Jennifer AU - McGowan, Melissa AU - Rozmovits, Linda PY - 2014/06/30 TI - Exploring the Value of Technology to Stimulate Interprofessional Discussion and Education: A Needs Assessment of Emergency Medicine Professionals JO - J Med Internet Res SP - e162 VL - 16 IS - 6 KW - qualitative research KW - interprofessional education KW - technology KW - emergency medicine N2 - Background: The emergency department (ED) is an environment fraught with increasing patient volumes, competing priorities, fluctuating information, and ad hoc interprofessional clinical teams. Limited time is available to reflect on and discuss clinical experiences, policies, or research with others on the involved team. Online resources, such as webcasts and blogs, offer an accessible platform for emergency shift workers to engage in interprofessional discussion and education. Objective: Our objective was to explore the current opportunities for shared learning and discussion and to discover the potential of online resources to foster and facilitate interprofessional education within an academic tertiary emergency department community. Methods: A qualitative study using semistructured interviews was conducted to solicit participants? views of the current culture of IPE in the ED, the potential value of introducing new online resources and technology in support of IPE, and possible barriers to uptake. Participation was voluntary and participants provided verbal informed consent. Results: Online resources discussed included webcasts, interactive discussion forums, websites, and dashboard with links to central repositories. Identified barriers to uptake of new online resources were an unwillingness to ?work? off-shift, a dislike of static one-directional communication, concerns with confidentiality, and the suggestion that new resources would be used by only a select few. Conclusions: Owing to the sensitive dynamics of emergency medicine?and the preference among its professional staff to foster interprofessional discussion and education through personal engagement, in an unhurried, non-stressful environment?introducing and investing in online resources should be undertaken with caution. UR - http://www.jmir.org/2014/6/e162/ UR - http://dx.doi.org/10.2196/jmir.3482 UR - http://www.ncbi.nlm.nih.gov/pubmed/24981597 ID - info:doi/10.2196/jmir.3482 ER - TY - JOUR AU - Antoniou, E. Panagiotis AU - Athanasopoulou, A. Christina AU - Dafli, Eleni AU - Bamidis, D. Panagiotis PY - 2014/06/13 TI - Exploring Design Requirements for Repurposing Dental Virtual Patients From the Web to Second Life: A Focus Group Study JO - J Med Internet Res SP - e151 VL - 16 IS - 6 KW - education KW - medical KW - dental KW - focus groups KW - patient simulation KW - problem-based learning KW - video games N2 - Background: Since their inception, virtual patients have provided health care educators with a way to engage learners in an experience simulating the clinician?s environment without danger to learners and patients. This has led this learning modality to be accepted as an essential component of medical education. With the advent of the visually and audio-rich 3-dimensional multi-user virtual environment (MUVE), a new deployment platform has emerged for educational content. Immersive, highly interactive, multimedia-rich, MUVEs that seamlessly foster collaboration provide a new hotbed for the deployment of medical education content. Objective: This work aims to assess the suitability of the Second Life MUVE as a virtual patient deployment platform for undergraduate dental education, and to explore the requirements and specifications needed to meaningfully repurpose Web-based virtual patients in MUVEs. Methods: Through the scripting capabilities and available art assets in Second Life, we repurposed an existing Web-based periodontology virtual patient into Second Life. Through a series of point-and-click interactions and multiple-choice queries, the user experienced a specific periodontology case and was asked to provide the optimal responses for each of the challenges of the case. A focus group of 9 undergraduate dentistry students experienced both the Web-based and the Second Life version of this virtual patient. The group convened 3 times and discussed relevant issues such as the group?s computer literacy, the assessment of Second Life as a virtual patient deployment platform, and compared the Web-based and MUVE-deployed virtual patients. Results: A comparison between the Web-based and the Second Life virtual patient revealed the inherent advantages of the more experiential and immersive Second Life virtual environment. However, several challenges for the successful repurposing of virtual patients from the Web to the MUVE were identified. The identified challenges for repurposing of Web virtual patients to the MUVE platform from the focus group study were (1) increased case complexity to facilitate the user?s gaming preconception in a MUVE, (2) necessity to decrease textual narration and provide the pertinent information in a more immersive sensory way, and (3) requirement to allow the user to actuate the solutions of problems instead of describing them through narration. Conclusions: For a successful systematic repurposing effort of virtual patients to MUVEs such as Second Life, the best practices of experiential and immersive game design should be organically incorporated in the repurposing workflow (automated or not). These findings are pivotal in an era in which open educational content is transferred to and shared among users, learners, and educators of various open repositories/environments. UR - http://www.jmir.org/2014/6/e151/ UR - http://dx.doi.org/10.2196/jmir.3343 UR - http://www.ncbi.nlm.nih.gov/pubmed/24927470 ID - info:doi/10.2196/jmir.3343 ER - TY - JOUR AU - Georg, Carina AU - Zary, Nabil PY - 2014/04/10 TI - Web-Based Virtual Patients in Nursing Education: Development and Validation of Theory-Anchored Design and Activity Models JO - J Med Internet Res SP - e105 VL - 16 IS - 4 KW - virtual patient KW - patient simulation KW - nursing education KW - clinical reasoning KW - e-learning, simulation technology N2 - Background: Research has shown that nursing students find it difficult to translate and apply their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as a learning activity that can support nursing students in their learning of scientific knowledge and help them integrate theory and practice. Although VPs are increasingly used in health care education, they still lack a systematic consistency that would allow their reuse outside of their original context. There is therefore a need to develop a model for the development and implementation of VPs in nursing education. Objective: The aim of this study was to develop and evaluate a virtual patient model optimized to the learning and assessment needs in nursing education. Methods: The process of modeling started by reviewing theoretical frameworks reported in the literature and used by practitioners when designing learning and assessment activities. The Outcome-Present State Test (OPT) model was chosen as the theoretical framework. The model was then, in an iterative manner, developed and optimized to the affordances of virtual patients. Content validation was performed with faculty both in terms of the relevance of the chosen theories but also its applicability in nursing education. The virtual patient nursing model was then instantiated in two VPs. The students? perceived usefulness of the VPs was investigated using a questionnaire. The result was analyzed using descriptive statistics. Results: A virtual patient Nursing Design Model (vpNDM) composed of three layers was developed. Layer 1 contains the patient story and ways of interacting with the data, Layer 2 includes aspects of the iterative process of clinical reasoning, and finally Layer 3 includes measurable outcomes. A virtual patient Nursing Activity Model (vpNAM) was also developed as a guide when creating VP-centric learning activities. The students perceived the global linear VPs as a relevant learning activity for the integration of theory and practice. Conclusions: Virtual patients that are adapted to the nursing paradigm can support nursing students? development of clinical reasoning skills. The proposed virtual patient nursing design and activity models will allow the systematic development of different types of virtual patients from a common model and thereby create opportunities for sharing pedagogical designs across technical solutions. UR - http://www.jmir.org/2014/4/e105/ UR - http://dx.doi.org/10.2196/jmir.2556 UR - http://www.ncbi.nlm.nih.gov/pubmed/24727709 ID - info:doi/10.2196/jmir.2556 ER - TY - JOUR AU - Kalz, Marco AU - Lenssen, Niklas AU - Felzen, Marc AU - Rossaint, Rolf AU - Tabuenca, Bernardo AU - Specht, Marcus AU - Skorning, Max PY - 2014/03/19 TI - Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study JO - J Med Internet Res SP - e89 VL - 16 IS - 3 KW - basic life support (BLS) KW - cardiopulmonary resuscitation (CPR) KW - external chest compression (ECC) KW - smartphone apps KW - mobile phone KW - mobile health N2 - Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the perspective of medical experts and end-users. Objective: The study aims to assess the quality of current mobile apps for cardiopulmonary resuscitation (CPR) training and real incident support from expert as well as end-user perspective. Methods: Two independent medical experts evaluated the medical content of CPR apps from the Google Play store and the Apple App store. The evaluation was based on pre-defined minimum medical content requirements according to current Basic Life Support (BLS) guidelines. In a second phase, non-medical end-users tested usability and appeal of the apps that had at least met the minimum requirements. Usability was assessed with the System Usability Scale (SUS); appeal was measured with the self-developed ReactionDeck toolkit. Results: Out of 61 apps, 46 were included in the experts? evaluation. A consolidated list of 13 apps resulted for the following layperson evaluation. The interrater reliability was substantial (kappa=.61). Layperson end-users (n=14) had a high interrater reliability (intraclass correlation 1 [ICC1]=.83, P<.001, 95% CI 0.75-0.882 and ICC2=.79, P<.001, 95% CI 0.695-0.869). Their evaluation resulted in a list of 5 recommendable apps. Conclusions: Although several apps for resuscitation training and real incident support are available, very few are designed according to current BLS guidelines and offer an acceptable level of usability and hedonic quality for laypersons. The results of this study are intended to optimize the development of CPR mobile apps. The app ranking supports the informed selection of mobile apps for training situations and CPR campaigns as well as for real incident support. UR - http://www.jmir.org/2014/3/e89/ UR - http://dx.doi.org/10.2196/jmir.2951 UR - http://www.ncbi.nlm.nih.gov/pubmed/24647361 ID - info:doi/10.2196/jmir.2951 ER - TY - JOUR AU - Renner, Bettina AU - Kimmerle, Joachim AU - Cavael, Dominik AU - Ziegler, Volker AU - Reinmann, Lisa AU - Cress, Ulrike PY - 2014/03/17 TI - Web-Based Apps for Reflection: A Longitudinal Study With Hospital Staff JO - J Med Internet Res SP - e85 VL - 16 IS - 3 KW - computer applications software KW - mobile applications KW - learning KW - education, continuing KW - job satisfaction KW - hospitals KW - longitudinal studies KW - self report N2 - Background: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. Objective: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff?s actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. Methods: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure. Results: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P<.001). Conclusions: The findings provide evidence for an effect of the apps on hospital employees? reflection behavior. Apps that foster reflective learning can increase health care professionals? reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps. UR - http://www.jmir.org/2014/3/e85/ UR - http://dx.doi.org/10.2196/jmir.3040 UR - http://www.ncbi.nlm.nih.gov/pubmed/24637405 ID - info:doi/10.2196/jmir.3040 ER - TY - JOUR AU - Barnett, Stephen AU - Jones, C. Sandra AU - Caton, Tim AU - Iverson, Don AU - Bennett, Sue AU - Robinson, Laura PY - 2014/03/12 TI - Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study JO - J Med Internet Res SP - e83 VL - 16 IS - 3 KW - community of practice KW - virtual community of practice KW - general practice KW - family physician KW - training KW - medical graduate KW - education KW - social media N2 - Background: GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation. Objective: The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation. Methods: The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation. Results: Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%). Conclusions: The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context. UR - http://www.jmir.org/2014/3/e83/ UR - http://dx.doi.org/10.2196/jmir.3083 UR - http://www.ncbi.nlm.nih.gov/pubmed/24622292 ID - info:doi/10.2196/jmir.3083 ER - TY - JOUR AU - Kononowicz, A. Andrzej AU - Narracott, J. Andrew AU - Manini, Simone AU - Bayley, J. Martin AU - Lawford, V. Patricia AU - McCormack, Keith AU - Zary, Nabil PY - 2014/01/23 TI - A Framework for Different Levels of Integration of Computational Models Into Web-Based Virtual Patients JO - J Med Internet Res SP - e23 VL - 16 IS - 1 KW - computer simulation KW - computer-assisted instruction KW - education, medical KW - medical informatics applications N2 - Background: Virtual patients are increasingly common tools used in health care education to foster learning of clinical reasoning skills. One potential way to expand their functionality is to augment virtual patients? interactivity by enriching them with computational models of physiological and pathological processes. Objective: The primary goal of this paper was to propose a conceptual framework for the integration of computational models within virtual patients, with particular focus on (1) characteristics to be addressed while preparing the integration, (2) the extent of the integration, (3) strategies to achieve integration, and (4) methods for evaluating the feasibility of integration. An additional goal was to pilot the first investigation of changing framework variables on altering perceptions of integration. Methods: The framework was constructed using an iterative process informed by Soft System Methodology. The Virtual Physiological Human (VPH) initiative has been used as a source of new computational models. The technical challenges associated with development of virtual patients enhanced by computational models are discussed from the perspectives of a number of different stakeholders. Concrete design and evaluation steps are discussed in the context of an exemplar virtual patient employing the results of the VPH ARCH project, as well as improvements for future iterations. Results: The proposed framework consists of four main elements. The first element is a list of feasibility features characterizing the integration process from three perspectives: the computational modelling researcher, the health care educationalist, and the virtual patient system developer. The second element included three integration levels: basic, where a single set of simulation outcomes is generated for specific nodes in the activity graph; intermediate, involving pre-generation of simulation datasets over a range of input parameters; advanced, including dynamic solution of the model. The third element is the description of four integration strategies, and the last element consisted of evaluation profiles specifying the relevant feasibility features and acceptance thresholds for specific purposes. The group of experts who evaluated the virtual patient exemplar found higher integration more interesting, but at the same time they were more concerned with the validity of the result. The observed differences were not statistically significant. Conclusions: This paper outlines a framework for the integration of computational models into virtual patients. The opportunities and challenges of model exploitation are discussed from a number of user perspectives, considering different levels of model integration. The long-term aim for future research is to isolate the most crucial factors in the framework and to determine their influence on the integration outcome. UR - http://www.jmir.org/2014/1/e23/ UR - http://dx.doi.org/10.2196/jmir.2593 UR - http://www.ncbi.nlm.nih.gov/pubmed/24463466 ID - info:doi/10.2196/jmir.2593 ER - TY - JOUR AU - Salminen, Helena AU - Zary, Nabil AU - Björklund, Karin AU - Toth-Pal, Eva AU - Leanderson, Charlotte PY - 2014/01/06 TI - Virtual Patients in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning JO - J Med Internet Res SP - e3 VL - 16 IS - 1 KW - virtual patients KW - clinical reasoning KW - reflection KW - primary care KW - medical education N2 - Background: Primary care is an integral part of the medical curriculum at Karolinska Institutet, Sweden. It is present at every stage of the students? education. Virtual patients (VPs) may support learning processes and be a valuable complement in teaching communication skills, patient-centeredness, clinical reasoning, and reflective thinking. Current literature on virtual patients lacks reports on how to design and use virtual patients with a primary care perspective. Objective: The objective of this study was to create a model for a virtual patient in primary care that facilitates medical students? reflective practice and clinical reasoning. The main research question was how to design a virtual patient model with embedded process skills suitable for primary care education. Methods: The VP model was developed using the Open Tufts University Sciences Knowledgebase (OpenTUSK) virtual patient system as a prototyping tool. Both the VP model and the case created using the developed model were validated by a group of 10 experienced primary care physicians and then further improved by a work group of faculty involved in the medical program. The students? opinions on the VP were investigated through focus group interviews with 14 students and the results analyzed using content analysis. Results: The VP primary care model was based on a patient-centered model of consultation modified according to the Calgary-Cambridge Guides, and the learning outcomes of the study program in medicine were taken into account. The VP primary care model is based on Kolb?s learning theories and consists of several learning cycles. Each learning cycle includes a didactic inventory and then provides the student with a concrete experience (video, pictures, and other material) and preformulated feedback. The students? learning process was visualized by requiring the students to expose their clinical reasoning and reflections in-action in every learning cycle. Content analysis of the focus group interviews showed good acceptance of the model by students. The VP was regarded as an intermediate learning activity and a complement to both the theoretical and the clinical part of the education, filling out gaps in clinical knowledge. The content of the VP case was regarded as authentic and the students appreciated the immediate feedback. The students found the structure of the model interactive and easy to follow. The students also reported that the VP case supported their self-directed learning and reflective ability. Conclusions: We have built a new VP model for primary care with embedded communication training and iterated learning cycles that in pilot testing showed good acceptance by students, supporting their self-directed learning and reflective thinking. UR - http://www.jmir.org/2014/1/e3/ UR - http://dx.doi.org/10.2196/jmir.2616 UR - http://www.ncbi.nlm.nih.gov/pubmed/24394603 ID - info:doi/10.2196/jmir.2616 ER - TY - JOUR AU - Short, E. Camille AU - Vandelanotte, Corneel AU - Dixon, W. Marcus AU - Rosenkranz, Richard AU - Caperchione, Cristina AU - Hooker, Cindy AU - Karunanithi, Mohan AU - Kolt, S. Gregory AU - Maeder, Anthony AU - Ding, Hang AU - Taylor, Pennie AU - Duncan, J. Mitch PY - 2014/01/03 TI - Examining Participant Engagement in an Information Technology-Based Physical Activity and Nutrition Intervention for Men: The Manup Randomized Controlled Trial JO - JMIR Res Protoc SP - e2 VL - 3 IS - 1 KW - qualitative KW - intervention KW - physical activity KW - retention KW - technology KW - website KW - engagement N2 - Background: Males experience a shorter life expectancy and higher rates of chronic diseases compared to their female counterparts. To improve health outcomes among males, interventions specifically developed for males that target their health behaviors are needed. Information technology (IT)-based interventions may be a promising intervention approach in this population group, however, little is known about how to maximize engagement and retention in Web-based programs. Objective: The current study sought to explore attributes hypothesized to influence user engagement among a subsample of participants from the ManUp study, a randomized controlled trial testing the efficacy of an interactive Web-based intervention for promoting physical activity and nutrition among middle-aged males. Methods: Semistructured interviews were conducted and audiotaped with 20 of the ManUp participants. Interview questions were based on a conceptual model of engagement and centered on why participants took part in the study, what they liked and did not like about the intervention they received, and how they think the intervention could be improved. Interview recordings were transcribed and coded into themes. Results: There were five themes that were identified in the study. These themes were: (1) users? motives, (2) users? desired outcomes, (3) users? positive experiences, (4) users? negative emotions, and (5) attributes desired by user. Conclusions: There is little research in the field that has explored user experiences in human-computer interactions and how such experiences may relate to engagement, especially among males. Although not conclusive, the current study provides some insight into what personal attributes of middle-aged males (such as their key motives and goals for participating) and attributes of the intervention materials (such as usability, control, and interactivity) may impact on user engagement in this group. These findings will be helpful for informing the design and implementation of future health behavior interventions for males. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6M4lBlvCA). UR - http://www.researchprotocols.org/2014/1/e2/ UR - http://dx.doi.org/10.2196/resprot.2776 UR - http://www.ncbi.nlm.nih.gov/pubmed/24389361 ID - info:doi/10.2196/resprot.2776 ER - TY - JOUR AU - Zakaria, Nasriah AU - Jamal, Amr AU - Bisht, Shekhar AU - Koppel, Cristina PY - 2013/11/27 TI - Embedding a Learning Management System Into an Undergraduate Medical Informatics Course in Saudi Arabia: Lessons Learned JO - Med 2.0 SP - e13 VL - 2 IS - 2 KW - medical education KW - medical informatics KW - learning management systems (LMS) N2 - Background: Public universities in Saudi Arabia today are making substantial investments in e-learning as part of their educational system, especially in the implementation of learning management systems (LMS). To our knowledge, this is the first study conducted in Saudi Arabia exploring medical students? experience with an LMS, particularly as part of a medical informatics course. Objective: This study investigates students? use of various features of the LMS embedded in a recently implemented medical informatics course. Methods: A mixed methodology approach was employed. Survey questionnaires were distributed to all third year medical informatics students at the end of the course. In addition, two focus group sessions were conducted with twelve students. A thematic analysis of the focus group was performed. Results: A total of 265 third year medical student surveys (167/265, 63% male and 98/265, 37% female) were completed and analyzed. Overall, 50.6% (134/265) of the students agreed that the course was well planned and up-to-date, had clearly stated objectives and clear evaluation methods, appropriate course assignment, and that the LMS offered easy navigation. Most of the students rated the course as good/fair overall. In general, females were 10.4% more likely to prefer the LMS, as revealed by higher odd ratios (odds ratio [OR] 1.104, 95% CI 0.86-1.42) compared to males. Survey results showed that students? use of LMS tools increased after taking the course compared to before taking the course. The full model containing all items were statistically significant (?225=69.52, P<.001, n=243), indicating that the model was able to distinguish between students who had positive attitudes towards LMS and those who did not. The focus group, however, revealed that the students used social networking for general use rather than learning purposes, but they were using other Internet resources and mobile devices for learning. Male students showed a higher preference for using technology in general to enhance learning activities. Overall, medical student attitudes towards the LMS were generally positive. Students also wanted a reminder and notification tool to help them stay updated with course events. Interestingly, a subset of students had been running a parallel LMS of their own that has features worth exploring and could be integrated with an official LMS in the future. Conclusions: To our knowledge, this was the first time that an LMS was used in a medical informatics course. Students showed interest in adapting various LMS tools to enhance their learning and gained more knowledge through familiarity with the tool. Researching an official LMS also revealed the existence of a parallel student-created LMS. This could allow teacher-led and student-led platforms to be integrated in the future for an enhanced student-centered experience. UR - http://www.medicine20.com/2013/2/e13/ UR - http://dx.doi.org/10.2196/med20.2735 UR - http://www.ncbi.nlm.nih.gov/pubmed/25075236 ID - info:doi/10.2196/med20.2735 ER - TY - JOUR AU - Chen, He-Ming AU - Hu, Zhong-Kai AU - Zheng, Xiao-Lin AU - Yuan, Zhao-Shun AU - Xu, Zhao-Bin AU - Yuan, Ling-Qing AU - Perez, Jesus Vinicio A. De AU - Yuan, Ke AU - Orcholski, Mark AU - Liao, Xiao-Bo PY - 2013/11/21 TI - Effectiveness of YouTube as a Source of Medical Information on Heart Transplantation JO - Interact J Med Res SP - e28 VL - 2 IS - 2 KW - heart transplantation KW - Internet KW - medical informatics KW - online videos KW - YouTube KW - e-learning N2 - Background: In this digital era, there is a growing tendency to use the popular Internet site YouTube as a new electronic-learning (e-learning) means for continuing medical education. Heart transplantation (HTx) remains the most viable option for patients with end-stage heart failure or severe coronary artery disease. There are plenty of freely accessible YouTube videos providing medical information about HTx. Objective: The aim of the present study is to determine the effectiveness of YouTube as an e-learning source on HTx. Methods: In order to carry out this study, YouTube was searched for videos uploaded containing surgical-related information using the four keywords: (1) ?heart transplantation?, (2) ?cardiac transplantation?, (3) ?heart transplantation operation?, and (4) ?cardiac transplantation operation?. Only videos in English (with comments or subtitles in English language) were included. Two experienced cardiac surgeons watched each video (N=1800) and classified them as useful, misleading, or recipients videos based on the HTx-relevant information. The kappa statistic was used to measure interobserver variability. Data was analyzed according to six types of YouTube characteristics including ?total viewership?, ?duration?, ?source?, ?days since upload?, ?scores? given by the viewers, and specialized information contents of the videos. Results: A total of 342/1800 (19.00%) videos had relevant information about HTx. Of these 342 videos, 215 (62.8%) videos had useful information about specialized knowledge, 7/342 (2.0%) were found to be misleading, and 120/342 (35.1%) only concerned recipients? individual issues. Useful videos had 56.09% of total viewership share (2,175,845/3,878,890), whereas misleading had 35.47% (1,375,673/3,878,890). Independent user channel videos accounted for a smaller proportion (19% in total numbers) but might have a wider impact on Web viewers, with the highest mean views/day (mean 39, SD 107) among four kinds of channels to distribute HTx-related information. Conclusions: YouTube videos on HTx benefit medical professionals by providing a substantial amount of information. However, it is a time-consuming course to find high-quality videos. More authoritative videos by trusted sources should be posted for dissemination of reliable information. With an improvement of ranking system and content providers in future, YouTube, as a freely accessible outlet, will help to meet the huge informational needs of medical staffs and promote medical education on HTx. UR - http://www.i-jmr.org/2013/2/e28/ UR - http://dx.doi.org/10.2196/ijmr.2669 UR - http://www.ncbi.nlm.nih.gov/pubmed/24263225 ID - info:doi/10.2196/ijmr.2669 ER - TY - JOUR AU - Azer, A. Samy AU - AlGrain, A. Hala AU - AlKhelaif, A. Rana AU - AlEshaiwi, M. Sarah PY - 2013/11/13 TI - Evaluation of the Educational Value of YouTube Videos About Physical Examination of the Cardiovascular and Respiratory Systems JO - J Med Internet Res SP - e241 VL - 15 IS - 11 KW - YouTube KW - learning resources KW - medical education KW - cardiovascular system physical examination KW - respiratory system physical examination KW - medical curriculum KW - clinical skills KW - self-directed learning KW - competency N2 - Background: A number of studies have evaluated the educational contents of videos on YouTube. However, little analysis has been done on videos about physical examination. Objective: This study aimed to analyze YouTube videos about physical examination of the cardiovascular and respiratory systems. It was hypothesized that the educational standards of videos on YouTube would vary significantly. Methods: During the period from November 2, 2011 to December 2, 2011, YouTube was searched by three assessors for videos covering the clinical examination of the cardiovascular and respiratory systems. For each video, the following information was collected: title, authors, duration, number of viewers, and total number of days on YouTube. Using criteria comprising content, technical authority, and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-useful videos. Results: A total of 1920 videos were screened. Only relevant videos covering the examination of adults in the English language were identified (n=56). Of these, 20 were found to be relevant to cardiovascular examinations and 36 to respiratory examinations. Further analysis revealed that 9 provided useful information on cardiovascular examinations and 7 on respiratory examinations: scoring mean 14.9 (SD 0.33) and mean 15.0 (SD 0.00), respectively. The other videos, 11 covering cardiovascular and 29 on respiratory examinations, were not useful educationally, scoring mean 11.1 (SD 1.08) and mean 11.2 (SD 1.29), respectively. The differences between these two categories were significant (P<.001 for both body systems). The concordance between the assessors on applying the criteria was 0.89, with a kappa score >.86. Conclusions: A small number of videos about physical examination of the cardiovascular and respiratory systems were identified as educationally useful; these videos can be used by medical students for independent learning and by clinical teachers as learning resources. The scoring system utilized by this study is simple, easy to apply, and could be used by other researchers on similar topics. UR - http://www.jmir.org/2013/11/e241/ UR - http://dx.doi.org/10.2196/jmir.2728 UR - http://www.ncbi.nlm.nih.gov/pubmed/24225171 ID - info:doi/10.2196/jmir.2728 ER - TY - JOUR AU - Kistler, Michael AU - Bonaretti, Serena AU - Pfahrer, Marcel AU - Niklaus, Roman AU - Büchler, Philippe PY - 2013/11/12 TI - The Virtual Skeleton Database: An Open Access Repository for Biomedical Research and Collaboration JO - J Med Internet Res SP - e245 VL - 15 IS - 11 KW - medical informatics KW - Internet KW - image processing KW - computer-assisted KW - demographic analysis KW - statistical models N2 - Background: Statistical shape models are widely used in biomedical research. They are routinely implemented for automatic image segmentation or object identification in medical images. In these fields, however, the acquisition of the large training datasets, required to develop these models, is usually a time-consuming process. Even after this effort, the collections of datasets are often lost or mishandled resulting in replication of work. Objective: To solve these problems, the Virtual Skeleton Database (VSD) is proposed as a centralized storage system where the data necessary to build statistical shape models can be stored and shared. Methods: The VSD provides an online repository system tailored to the needs of the medical research community. The processing of the most common image file types, a statistical shape model framework, and an ontology-based search provide the generic tools to store, exchange, and retrieve digital medical datasets. The hosted data are accessible to the community, and collaborative research catalyzes their productivity. Results: To illustrate the need for an online repository for medical research, three exemplary projects of the VSD are presented: (1) an international collaboration to achieve improvement in cochlear surgery and implant optimization, (2) a population-based analysis of femoral fracture risk between genders, and (3) an online application developed for the evaluation and comparison of the segmentation of brain tumors. Conclusions: The VSD is a novel system for scientific collaboration for the medical image community with a data-centric concept and semantically driven search option for anatomical structures. The repository has been proven to be a useful tool for collaborative model building, as a resource for biomechanical population studies, or to enhance segmentation algorithms. UR - http://www.jmir.org/2013/11/e245/ UR - http://dx.doi.org/10.2196/jmir.2930 UR - http://www.ncbi.nlm.nih.gov/pubmed/24220210 ID - info:doi/10.2196/jmir.2930 ER - TY - JOUR AU - Papadopoulos, Lazaros AU - Pentzou, Afroditi-Evaggelia AU - Louloudiadis, Konstantinos AU - Tsiatsos, Thrasyvoulos-Konstantinos PY - 2013/10/29 TI - Design and Evaluation of a Simulation for Pediatric Dentistry in Virtual Worlds JO - J Med Internet Res SP - e240 VL - 15 IS - 10 KW - virtual patient KW - virtual world KW - pediatric dentistry KW - simulation KW - Second Life KW - OpenSim KW - communication KW - tell-show-do KW - behavior management N2 - Background: Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world?s pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning. Objective: The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry. Methods: A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents? interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared. Results: A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool. Conclusions: This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques. UR - http://www.jmir.org/2013/10/e240/ UR - http://dx.doi.org/10.2196/jmir.2651 UR - http://www.ncbi.nlm.nih.gov/pubmed/24168820 ID - info:doi/10.2196/jmir.2651 ER - TY - JOUR AU - Albrecht, Urs-Vito AU - Folta-Schoofs, Kristian AU - Behrends, Marianne AU - von Jan, Ute PY - 2013/08/20 TI - Effects of Mobile Augmented Reality Learning Compared to Textbook Learning on Medical Students: Randomized Controlled Pilot Study JO - J Med Internet Res SP - e182 VL - 15 IS - 8 KW - problem-based learning KW - cellular phone KW - education KW - medical KW - emotions N2 - Background: By adding new levels of experience, mobile Augmented Reality (mAR) can significantly increase the attractiveness of mobile learning applications in medical education. Objective: To compare the impact of the heightened realism of a self-developed mAR blended learning environment (mARble) on learners to textbook material, especially for ethically sensitive subjects such as forensic medicine, while taking into account basic psychological aspects (usability and higher level of emotional involvement) as well as learning outcomes (increased learning efficiency). Methods: A prestudy was conducted based on a convenience sample of 10 third-year medical students. The initial emotional status was captured using the ?Profile of Mood States? questionnaire (POMS, German variation); previous knowledge about forensic medicine was determined using a 10-item single-choice (SC) test. During the 30-minute learning period, the students were randomized into two groups: the first group consisted of pairs of students, each equipped with one iPhone with a preinstalled copy of mARble, while the second group was provided with textbook material. Subsequently, both groups were asked to once again complete the POMS questionnaire and SC test to measure changes in emotional state and knowledge gain. Usability as well as pragmatic and hedonic qualities of the learning material was captured using AttrakDiff2 questionnaires. Data evaluation was conducted anonymously. Descriptive statistics for the score in total and the subgroups were calculated before and after the intervention. The scores of both groups were tested against each other using paired and unpaired signed-rank tests. An item analysis was performed for the SC test to objectify difficulty and selectivity. Results: Statistically significant, the mARble group (6/10) showed greater knowledge gain than the control group (4/10) (Wilcoxon z=2.232, P=.03). The item analysis of the SC test showed a difficulty of P=0.768 (s=0.09) and a selectivity of RPB=0.2. For mARble, fatigue (z=2.214, P=.03) and numbness (z=2.07, P=.04) decreased with statistical significance when comparing pre- and post-tests. Vigor rose slightly, while irritability did not increase significantly. Changes in the control group were insignificant. Regarding hedonic quality (identification, stimulation, attractiveness), there were significant differences between mARble (mean 1.179, CI ?0.440 to 0.440) and the book chapter (mean ?0.982, CI ?0.959 to 0.959); the pragmatic quality mean only differed slightly. Conclusions: The mARble group performed considerably better regarding learning efficiency; there are hints for activating components of the mAR concept that may serve to fascinate the participants and possibly boost interest in the topic for the remainder of the class. While the small sample size reduces our study?s conclusiveness, its design seems appropriate for determining the effects of interactive eLearning material with respect to emotions, learning efficiency, and hedonic and pragmatic qualities using a larger group. Trial Registration: German Clinical Trial Register (DRKS), DRKS-ID: DRKS00004685; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004685. UR - http://www.jmir.org/2013/8/e182/ UR - http://dx.doi.org/10.2196/jmir.2497 UR - http://www.ncbi.nlm.nih.gov/pubmed/23963306 ID - info:doi/10.2196/jmir.2497 ER - TY - JOUR AU - Spreckelsen, Cord AU - Finsterer, Sonja AU - Cremer, Jan AU - Schenkat, Hennig PY - 2013/08/15 TI - Can Social Semantic Web Techniques Foster Collaborative Curriculum Mapping In Medicine? JO - J Med Internet Res SP - e169 VL - 15 IS - 8 KW - curriculum mapping KW - medical education KW - Semantic Web KW - Social Web N2 - Background: Curriculum mapping, which is aimed at the systematic realignment of the planned, taught, and learned curriculum, is considered a challenging and ongoing effort in medical education. Second-generation curriculum managing systems foster knowledge management processes including curriculum mapping in order to give comprehensive support to learners, teachers, and administrators. The large quantity of custom-built software in this field indicates a shortcoming of available IT tools and standards. Objective: The project reported here aims at the systematic adoption of techniques and standards of the Social Semantic Web to implement collaborative curriculum mapping for a complete medical model curriculum. Methods: A semantic MediaWiki (SMW)-based Web application has been introduced as a platform for the elicitation and revision process of the Aachen Catalogue of Learning Objectives (ACLO). The semantic wiki uses a domain model of the curricular context and offers structured (form-based) data entry, multiple views, structured querying, semantic indexing, and commenting for learning objectives (?LOs?). Semantic indexing of learning objectives relies on both a controlled vocabulary of international medical classifications (ICD, MeSH) and a folksonomy maintained by the users. An additional module supporting the global checking of consistency complements the semantic wiki. Statements of the Object Constraint Language define the consistency criteria. We evaluated the application by a scenario-based formative usability study, where the participants solved tasks in the (fictional) context of 7 typical situations and answered a questionnaire containing Likert-scaled items and free-text questions. Results: At present, ACLO contains roughly 5350 operational (ie, specific and measurable) objectives acquired during the last 25 months. The wiki-based user interface uses 13 online forms for data entry and 4 online forms for flexible searches of LOs, and all the forms are accessible by standard Web browsers. The formative usability study yielded positive results (median rating of 2 (?good?) in all 7 general usability items) and produced valuable qualitative feedback, especially concerning navigation and comprehensibility. Although not asked to, the participants (n=5) detected critical aspects of the curriculum (similar learning objectives addressed repeatedly and missing objectives), thus proving the system?s ability to support curriculum revision. Conclusions: The SMW-based approach enabled an agile implementation of computer-supported knowledge management. The approach, based on standard Social Semantic Web formats and technology, represents a feasible and effectively applicable compromise between answering to the individual requirements of curriculum management at a particular medical school and using proprietary systems. UR - http://www.jmir.org/2013/8/e169/ UR - http://dx.doi.org/10.2196/jmir.2623 UR - http://www.ncbi.nlm.nih.gov/pubmed/23948519 ID - info:doi/10.2196/jmir.2623 ER - TY - JOUR AU - Schulz, Peter AU - Sagheb, Keyvan AU - Affeldt, Harald AU - Klumpp, Hannah AU - Taylor, Kathy AU - Walter, Christian AU - Al-Nawas, Bilal PY - 2013/08/14 TI - Acceptance of E-Learning Devices by Dental Students JO - Med 2.0 SP - e6 VL - 2 IS - 2 KW - e-learning activity KW - computer KW - tablet PC KW - smartphone, Internet N2 - Background: E-Learning programs and their corresponding devices are increasingly employed to educate dental students during their clinical training. Objective: Recent progress made in the development of e-learning software as well as in hardware (computers, tablet PCs, smartphones) caused us to more closely investigate into the habits of dental students in dealing with these learning techniques. Methods: Dental students during their clinical training attended a survey compiled in cooperation with biostatisticians. The questionnaire probands were asked to complete based on previous surveys of similar subjects, allowing single as well as multiple answers. The data, which were obtained with respect to the learning devices students commonly employ, were compared with their internet learning activities. Results: The e-learning devices utilized are of heterogeneous brands. Each student has access to at least one hardware type suitable for e-learning. All students held mobile devices, about 90 percent employed laptops, and about 60 percent possess smartphones. Unexceptional all participants of the survey acknowledged an unlimited internet access. In contrast, only 16 percent of students utilized tablet PCs. A detailed analysis of the survey outcome reveals that an increasing use of mobile devices (tablet PC, smartphone) facilitates internet learning activities while at the same time utilization of computers (desktop, laptop) declines. Conclusions: Dental students overwhelmingly accept e-learning during their clinical training. Students report outstanding preconditions to conduct e-learning as both their access to hardware and to the internet is excellent. Less satisfying is the outcome of our survey regarding the utilization of e-learning programs. Depending of the hardware employed only one-third to barely one-half of students comprise learning programs. UR - http://www.medicine20.com/2013/2/e6/ UR - http://dx.doi.org/10.2196/med20.2767 UR - http://www.ncbi.nlm.nih.gov/pubmed/25075241 ID - info:doi/10.2196/med20.2767 ER - TY - JOUR AU - Budrionis, Andrius AU - Augestad, Magne Knut AU - Patel, RH Hiten AU - Bellika, Gustav Johan PY - 2013/07/25 TI - An Evaluation Framework for Defining the Contributions of Telestration in Surgical Telementoring JO - Interact J Med Res SP - e14 VL - 2 IS - 2 KW - telementoring KW - telestration KW - annotation KW - impact KW - benefits KW - theoretical models KW - evaluation framework N2 - Background: An increasing quantity of research in the domain of telemedicine show a growing popularity and acceptance of care over distance systems among both clinicians and patients. We focus on telementoring solutions, developed for providing remote guidance to less experienced surgeons. Telestration is often regarded as an extra functionality of some telementoring systems. However, we advocate that telestration must be viewed as a core feature of telementoring due to its advantages. Objective: To analyze and define concepts, parameters, and measurement procedures to evaluate the impact of using telestration while telementoring. Methods: A systematic review of research dealing with telestration during remote guidance sessions was performed by querying three major online research databases (MEDLINE, Association of Computing Machinery, and Institute of Electrical and Electronics Engineers) using a predefined set of keywords (?laparoscopy?, ?annotate?, ?telestrate?, ?telestration?, ?annotation?, ?minimally invasive?, and ?MIS?). Results: The keyword-based search identified 117 papers. Following the guidelines for performing a systematic review, only 8 publications were considered relevant for the final study. Moreover, a gap in research defining the impacts of telestration during telementoring was identified. To fill this niche, a framework for analyzing, reporting, and measuring the impacts of telestration was proposed. Conclusions: The presented framework lays the basics for the structured analysis and reporting of telestration applied to telementoring systems. It is the first step toward building an evidence knowledge base documenting the advantages of live video content annotation and supporting the presented connections between the concepts. UR - http://www.i-jmr.org/2013/2/e14/ UR - http://dx.doi.org/10.2196/ijmr.2611 UR - http://www.ncbi.nlm.nih.gov/pubmed/23887078 ID - info:doi/10.2196/ijmr.2611 ER - TY - JOUR AU - Schwarz, Daniel AU - ?toura?, Petr AU - Komenda, Martin AU - Harazim, Hana AU - Kosinová, Martina AU - Gregor, Jakub AU - H?lek, Richard AU - Smékalová, Olga AU - K?ikava, Ivo AU - ?toudek, Roman AU - Du?ek, Ladislav PY - 2013/07/08 TI - Interactive Algorithms for Teaching and Learning Acute Medicine in the Network of Medical Faculties MEFANET JO - J Med Internet Res SP - e135 VL - 15 IS - 7 KW - medical education KW - patient simulation KW - algorithms KW - students KW - community networks KW - problem-based learning KW - serious games KW - survey N2 - Background: Medical Faculties Network (MEFANET) has established itself as the authority for setting standards for medical educators in the Czech Republic and Slovakia, 2 independent countries with similar languages that once comprised a federation and that still retain the same curricular structure for medical education. One of the basic goals of the network is to advance medical teaching and learning with the use of modern information and communication technologies. Objective: We present the education portal AKUTNE.CZ as an important part of the MEFANET?s content. Our focus is primarily on simulation-based tools for teaching and learning acute medicine issues. Methods: Three fundamental elements of the MEFANET e-publishing system are described: (1) medical disciplines linker, (2) authentication/authorization framework, and (3) multidimensional quality assessment. A new set of tools for technology-enhanced learning have been introduced recently: Sandbox (works in progress), WikiLectures (collaborative content authoring), Moodle-MEFANET (central learning management system), and Serious Games (virtual casuistics and interactive algorithms). The latest development in MEFANET is designed for indexing metadata about simulation-based learning objects, also known as electronic virtual patients or virtual clinical cases. The simulations assume the form of interactive algorithms for teaching and learning acute medicine. An anonymous questionnaire of 10 items was used to explore students? attitudes and interests in using the interactive algorithms as part of their medical or health care studies. Data collection was conducted over 10 days in February 2013. Results: In total, 25 interactive algorithms in the Czech and English languages have been developed and published on the AKUTNE.CZ education portal to allow the users to test and improve their knowledge and skills in the field of acute medicine. In the feedback survey, 62 participants completed the online questionnaire (13.5%) from the total 460 addressed. Positive attitudes toward the interactive algorithms outnumbered negative trends. Conclusions: The peer-reviewed algorithms were used for conducting problem-based learning sessions in general medicine (first aid, anesthesiology and pain management, emergency medicine) and in nursing (emergency medicine for midwives, obstetric analgesia, and anesthesia for midwifes). The feedback from the survey suggests that the students found the interactive algorithms as effective learning tools, facilitating enhanced knowledge in the field of acute medicine. The interactive algorithms, as a software platform, are open to academic use worldwide. The existing algorithms, in the form of simulation-based learning objects, can be incorporated into any educational website (subject to the approval of the authors). UR - http://www.jmir.org/2013/7/e135/ UR - http://dx.doi.org/10.2196/jmir.2590 UR - http://www.ncbi.nlm.nih.gov/pubmed/23835586 ID - info:doi/10.2196/jmir.2590 ER - TY - JOUR AU - Barnett, Stephen AU - Jones, C. Sandra AU - Bennett, Sue AU - Iverson, Don AU - Bonney, Andrew PY - 2013/05/10 TI - Perceptions of Family Physician Trainees and Trainers Regarding the Usefulness of a Virtual Community of Practice JO - J Med Internet Res SP - e92 VL - 15 IS - 5 KW - community of practice KW - virtual community of practice KW - general practice KW - family physician KW - training KW - education KW - medical graduate KW - social media N2 - Background: Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training. Objective: This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable. Methods: A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia?s 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4). Results: Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network. Conclusions: General practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness. UR - http://www.jmir.org/2013/5/e92/ UR - http://dx.doi.org/10.2196/jmir.2555 UR - http://www.ncbi.nlm.nih.gov/pubmed/23666237 ID - info:doi/10.2196/jmir.2555 ER - TY - JOUR AU - Maloney, Stephen AU - Chamberlain, Michael AU - Morrison, Shane AU - Kotsanas, George AU - Keating, L. Jennifer AU - Ilic, Dragan PY - 2013/01/16 TI - Health Professional Learner Attitudes and Use of Digital Learning Resources JO - J Med Internet Res SP - e7 VL - 15 IS - 1 KW - Information storage and retrieval KW - Medical Informatics KW - Education, professional N2 - Background: Web-based digital repositories allow educational resources to be accessed efficiently and conveniently from diverse geographic locations, hold a variety of resource formats, enable interactive learning, and facilitate targeted access for the user. Unlike some other learning management systems (LMS), resources can be retrieved through search engines and meta-tagged labels, and content can be streamed, which is particularly useful for multimedia resources. Objective: The aim of this study was to examine usage and user experiences of an online learning repository (Physeek) in a population of physiotherapy students. The secondary aim of this project was to examine how students prefer to access resources and which resources they find most helpful. Methods: The following data were examined using an audit of the repository server: (1) number of online resources accessed per day in 2010, (2) number of each type of resource accessed, (3) number of resources accessed during business hours (9 am to 5 pm) and outside business hours (years 1-4), (4) session length of each log-on (years 1-4), and (5) video quality (bit rate) of each video accessed. An online questionnaire and 3 focus groups assessed student feedback and self-reported experiences of Physeek. Results: Students preferred the support provided by Physeek to other sources of educational material primarily because of its efficiency. Peak usage commonly occurred at times of increased academic need (ie, examination times). Students perceived online repositories as a potential tool to support lifelong learning and health care delivery. Conclusions: The results of this study indicate that today?s health professional students welcome the benefits of online learning resources because of their convenience and usability. This represents a transition away from traditional learning styles and toward technological learning support and may indicate a growing link between social immersions in Internet-based connections and learning styles. The true potential for Web-based resources to support student learning is as yet unknown. UR - http://www.jmir.org/2013/1/e7/ UR - http://dx.doi.org/10.2196/jmir.2094 UR - http://www.ncbi.nlm.nih.gov/pubmed/23324800 ID - info:doi/10.2196/jmir.2094 ER - TY - JOUR AU - Creutzfeldt, Johan AU - Hedman, Leif AU - Heinrichs, LeRoy AU - Youngblood, Patricia AU - Felländer-Tsai, Li PY - 2013/01/14 TI - Cardiopulmonary Resuscitation Training in High School Using Avatars in Virtual Worlds: An International Feasibility Study JO - J Med Internet Res SP - e9 VL - 15 IS - 1 KW - Serious games KW - virtual learning environments KW - MMVW KW - avatars KW - students KW - cardiopulmonary resuscitation KW - patient simulation KW - self-efficacy KW - concentration N2 - Background: Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today?s youth (ie, the digital native generation). Objective: Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. Methods: In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. Results: The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use. Conclusions: By using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training. UR - http://www.jmir.org/2013/1/e9/ UR - http://dx.doi.org/10.2196/jmir.1715 UR - http://www.ncbi.nlm.nih.gov/pubmed/23318253 ID - info:doi/10.2196/jmir.1715 ER - TY - JOUR AU - Edirippulige, Sisira AU - Smith, C. Anthony AU - Armfield, R. Nigel AU - Bensink, Mark AU - Wootton, Richard PY - 2012/12/18 TI - Student Perceptions of a Hands-on Practicum to Supplement an Online eHealth Course JO - J Med Internet Res SP - e182 VL - 14 IS - 6 KW - Telemedicine KW - Remote consultation KW - Education and training KW - curriculum N2 - Background: Since 2000, the Centre for Online Health (COH) at The University of Queensland has offered a range of online eHealth courses at the undergraduate and postgraduate level. While online learning has a number of advantages, in some domains, it can present some challenges to the development of practical skills and experience. Objective: To assess students? perceptions of the value of an eHealth practicum. Methods: To supplement our online learning program, we introduced an eHealth practicum component that aimed to expose students to a range of clinically relevant learning experiences. Subsequently, by means of a questionnaire, student perceptions of the practicum were assessed. Results: Over two semesters, a total of 66 students participated in the eHealth practicum, and questionnaire responses were very positive. The majority of students agreed that the practicum allowed them to gain necessary skills in eHealth applications (59%) and provided them with an opportunity to explore ways of using different eHealth tools for the delivery of health care at a distance (62%). Conclusions: The study shows that a practical component in eHealth teaching was well received by students. While online teaching is appropriate for providing knowledge, the opportunity to develop practical skills may encourage students to use eHealth techniques in their future practices. UR - http://www.jmir.org/2012/6/e182/ UR - http://dx.doi.org/10.2196/jmir.2029 UR - http://www.ncbi.nlm.nih.gov/pubmed/23246840 ID - info:doi/10.2196/jmir.2029 ER - TY - JOUR AU - Battulga, Bayanmunkh AU - Konishi, Takeshi AU - Tamura, Yoko AU - Moriguchi, Hiroki PY - 2012/07/09 TI - The Effectiveness of an Interactive 3-Dimensional Computer Graphics Model for Medical Education JO - Interact J Med Res SP - e2 VL - 1 IS - 2 KW - Medical education KW - electronic health information KW - interactive 3D CG KW - educational effectiveness KW - Web-based learning management system KW - satellite network N2 - Background: Medical students often have difficulty achieving a conceptual understanding of 3-dimensional (3D) anatomy, such as bone alignment, muscles, and complex movements, from 2-dimensional (2D) images. To this end, animated and interactive 3-dimensional computer graphics (3DCG) can provide better visual information to users. In medical fields, research on the advantages of 3DCG in medical education is relatively new. Objective: To determine the educational effectiveness of interactive 3DCG. Methods: We divided 100 participants (27 men, mean (SD) age 17.9 (0.6) years, and 73 women, mean (SD) age 18.1 (1.1) years) from the Health Sciences University of Mongolia (HSUM) into 3DCG (n = 50) and textbook-only (control) (n = 50) groups. The control group used a textbook and 2D images, while the 3DCG group was trained to use the interactive 3DCG shoulder model in addition to a textbook. We conducted a questionnaire survey via an encrypted satellite network between HSUM and Tokushima University. The questionnaire was scored on a 5-point Likert scale from strongly disagree (score 1) to strongly agree (score 5). Results: Interactive 3DCG was effective in undergraduate medical education. Specifically, there was a significant difference in mean (SD) scores between the 3DCG and control groups in their response to questionnaire items regarding content (4.26 (0.69) vs 3.85 (0.68), P = .001) and teaching methods (4.33 (0.65) vs 3.74 (0.79), P < .001), but no significant difference in the Web category. Participants also provided meaningful comments on the advantages of interactive 3DCG. Conclusions: Interactive 3DCG materials have positive effects on medical education when properly integrated into conventional education. In particular, our results suggest that interactive 3DCG is more efficient than textbooks alone in medical education and can motivate students to understand complex anatomical structures. UR - http://www.i-jmr.org/2012/2/e2/ UR - http://dx.doi.org/10.2196/ijmr.2172 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611759 ID - info:doi/10.2196/ijmr.2172 ER - TY - JOUR AU - Maloney, Stephen AU - Haas, Romi AU - Keating, L. Jenny AU - Molloy, Elizabeth AU - Jolly, Brian AU - Sims, Jane AU - Morgan, Prue AU - Haines, Terry PY - 2012/04/02 TI - Breakeven, Cost Benefit, Cost Effectiveness, and Willingness to Pay for Web-Based Versus Face-to-Face Education Delivery for Health Professionals JO - J Med Internet Res SP - e47 VL - 14 IS - 2 KW - Economics KW - education KW - training programs KW - teaching methods KW - performance N2 - Background: The introduction of Web-based education and open universities has seen an increase in access to professional development within the health professional education marketplace. Economic efficiencies of Web-based education and traditional face-to-face educational approaches have not been compared under randomized controlled trial conditions. Objective: To compare costs and effects of Web-based and face-to-face short courses in falls prevention education for health professionals. Methods: We designed two short courses to improve the clinical performance of health professionals in exercise prescription for falls prevention. One was developed for delivery in face-to-face mode and the other for online learning. Data were collected on learning outcomes including participation, satisfaction, knowledge acquisition, and change in practice, and combined with costs, savings, and benefits, to enable a break-even analysis from the perspective of the provider, cost-effectiveness analysis from the perspective of the health service, and cost-benefit analysis from the perspective of the participant. Results: Face-to-face and Web-based delivery modalities produced comparable outcomes for participation, satisfaction, knowledge acquisition, and change in practice. Break-even analysis identified the Web-based educational approach to be robustly superior to face-to-face education, requiring a lower number of enrollments for the program to reach its break-even point. Cost-effectiveness analyses from the perspective of the health service and cost-benefit analysis from the perspective of the participant favored face-to-face education, although the outcomes were contingent on the sensitivity analysis applied (eg, the fee structure used). Conclusions: The Web-based educational approach was clearly more efficient from the perspective of the education provider. In the presence of relatively equivocal results for comparisons from other stakeholder perspectives, it is likely that providers would prefer to deliver education via a Web-based medium. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12610000135011; http://www.anzctr.org.au/trial_view.aspx?id=335135 (Archived by WebCite at http://www.webcitation.org/668POww4L) UR - http://www.jmir.org/2012/2/e47/ UR - http://dx.doi.org/10.2196/jmir.2040 UR - http://www.ncbi.nlm.nih.gov/pubmed/22469659 ID - info:doi/10.2196/jmir.2040 ER - TY - JOUR AU - Hansen, Margaret AU - Oosthuizen, George AU - Windsor, John AU - Doherty, Iain AU - Greig, Samuel AU - McHardy, Karina AU - McCann, Lloyd PY - 2011/03/01 TI - Enhancement of Medical Interns' Levels of Clinical Skills Competence and Self-Confidence Levels via Video iPods: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e29 VL - 13 IS - 1 KW - Medical education KW - healthcare KW - mobile technology KW - urinary catheterisation N2 - Background: Designing and delivering evidence-based medical practice for students requires careful consideration from medical science educators. Social Web (Web 2.0) applications are a part of today?s educational technology milieu; however, empirical research is lacking to support the impact of interactive Web 2.0 mobile applications on medical educational outcomes. Objectives: The aim of our study was to determine whether instructional videos provided by iPod regarding female and male urinary catheter insertion would increase students? confidence levels and enhance skill competencies. Methods: We conducted a prospective study with medical trainee intern (TI) participants: 10 control participants (no technological intervention) and 11 intervention participants (video iPods). Before taking part in a skills course, they completed a questionnaire regarding previous exposure to male and female urinary catheterization and their level of confidence in performing the skills. Directly following the questionnaire, medical faculty provided a 40-minute skills demonstration in the Advanced Clinical Skills Centre (ACSC) laboratory at the University of Auckland, New Zealand. All participants practiced the skills following the demonstrations and were immediately evaluated by the same faculty using an assessment rubric. Following the clinical skill evaluation, participants completed a postcourse questionnaire regarding skill confidence levels. At the end of the skills course, the intervention group were provided video iPods and viewed a male and a female urinary catheterization video during the next 3 consecutive months. The control group did not receive educational technology interventions during the 3-month period. At the end of 3 months, participants completed a follow-up questionnaire and a clinical assessment of urinary catheterization skills at the ACSC lab. Results: The results indicate a decline in skill competency over time among the control group for both male and female catheterizations, whereas the competency level was stable among the experimental group for both procedures. Interaction results for competency scores indicate a significant level by group and time (P = .03) and procedure and group (P = .02). The experimental group?s confidence level for performing the female catheterization procedure differed significantly over time (P < .001). Furthermore, confidence scores in performing female catheterizations increased for both groups over time. However, the confidence levels for both groups in performing the male catheterization decreased over time. Conclusions: Video iPods offer a novel pedagogical approach to enhance medical students? medical skill competencies and self-confidence levels. The outcomes illustrate a need for further investigation in order to generalize to the medical school population. UR - http://www.jmir.org/2011/1/e29/ UR - http://dx.doi.org/10.2196/jmir.1596 UR - http://www.ncbi.nlm.nih.gov/pubmed/21447471 ID - info:doi/10.2196/jmir.1596 ER -