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JMIR Medical Education

 Technology, innovation and openess in medical education in the information age

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Journal Description

JMIR Medical Education (JME) is a Pubmed-indexed, peer-reviewed journal with focus on technology, innovation and openess in medical education. Another focus is on how to train health professionals in the use of digital tools. We publish original research, reviews, viewpoint and policy papers on innovation and technology in medical education. As an open access journal we have a special interest in open and free tools and digitial learning objects for medical education, and urge authors to make their tools and learning objects freely available (we may also publish them as Multimedia Appendix). We also invite submissions of non-conventional articles (e.g. open medical education material and software resources that are not yet evaluated but free for others to use/implement). 

In our "Students' Corner", we invite students and trainees in the health professions to submit short essays and viewpoints on all aspects of medical education, but in particular suggestions on how to improve medical education, and suggestions for new technologies, applications and approaches (no article processing fees).

A sister journal of the Journal of Medical Internet Research (JMIR), a leading eHealth journal (Impact Factor 2016: 5.175), the scope of JME is broader and includes non-Internet approaches to improve education, training and assessment for medical professionals and allied health professions.

Articles published in JME will be submitted to PubMed and Pubmed Central. JME is open access.

 

Recent Articles:

  • Source: iStock by Getty Images; Copyright: gchutka; URL: https://www.istockphoto.com/photo/negative-test-results-gm186845751-17450331?clarity=false; License: Licensed by the authors.

    Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey...

    Abstract:

    Background: Electronic health record (EHR) use can enhance or undermine the ability of providers to deliver effective, humanistic patient-centered care. Given patient-centered care has been found to positively impact patient health outcomes, it is critical to provide formal education on patient-centered EHR communication skills. Unfortunately, despite increasing worldwide EHR adoption, few institutions educate trainees on EHR communication best practices. Objective: The goal of this research was to develop and deliver mandatory patient-centered EHR training to all incoming housestaff at the University of Chicago. Methods: We developed a brief patient-centered EHR use curriculum highlighting best practices based on a literature search. Training was embedded into required EHR onboarding for all incoming housestaff (interns, residents, and fellows) at the University of Chicago in 2015 and was delivered by institutional Clinical Applications Trainers. An 11-item posttraining survey consisting of ten 5-point Likert scale questions and 1 open-ended question was administered. Responses at the high end of the scale were grouped to dichotomize data. Results: All 158 of the incoming 2015 postgraduate trainees participated in training and completed surveys (158/158, 100.0%). Just over half (86/158, 54.4%) were interns and the remaining were residents and fellows (72/158, 45.6%). One-fifth of respondents (32/158, 20.2%) were primary care trainees (defined as internal medicine, pediatric, and medicine-pediatric trainees), and the remaining 79.7% (126/158) were surgical or specialty trainees. Self-perceived pre- versus posttraining knowledge of barriers, best practices, and ability to implement patient-centered EHR skills significantly increased (3.1 vs 3.9, P<.001 for all). Most felt training was effective (90.5%), should be required (86.7%), and would change future practice as a result (70.9%). The only significant difference between intern and resident/fellow responses was prior knowledge of patient-centered EHR use barriers; interns endorsed higher prior knowledge than resident peers (3.27 vs 2.94 respectively, P=.03). Response comparison of specialty or surgical trainees (n=126) to primary care trainees (n=32) showed no significant differences in prior knowledge of barriers (3.09 vs 3.22, P=.50), of best practices (3.08 vs 2.94, P=.37), or prior ability to implement best practices (3.11 vs 2.84, P=.15). Primary care trainees had larger increases posttraining than surgical/specialty peers in knowledge of barriers (0.8 vs 0.7, P=.62), best practices (1.1 vs 0.8, P=.08), and ability to implement best practices (1.1 vs 0.7, P=.07), although none reached statistical significance. Primary care trainees also rated training as more effective (4.34 vs 4.09, P=.03) and felt training should be required (4.34 vs 4.09, P=.10) and would change their future practice as a result (4.13 vs 3.73, P=.02). Conclusions: Embedding EHR communication skills training into required institutional EHR training is a novel and effective way to teach key EHR skills to trainees. Such training may help ground trainees in best practices and contribute to cultivating an institutional culture of humanistic, patient-centered EHR use.

  • Screenshot of the e-learning module. Source: Image created by the authors; Copyright: The Authors; URL: http://mededu.jmir.org/2017/2/e24/; License: Creative Commons Attribution (CC-BY).

    An E-Learning Module to Improve Nongenetic Health Professionals’ Assessment of Colorectal Cancer Genetic Risk: Feasibility Study

    Abstract:

    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.

  • Source: Flickr; Copyright: Sydney Uni; URL: https://www.flickr.com/photos/sydneyuni/7001513971; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    A Survey of Medical Oncology Training in Australian Medical Schools: Pilot Study

    Abstract:

    Background: Oncology is a rapidly evolving field with continuous advancements in the diagnosis and treatment of cancer. Therefore, it is important that medical students are provided with the knowledge and experience required to care for oncology patients and enable them to diagnose and manage toxicities of novel therapeutic agents. Objective: This study was performed to understand the medical students’ perspective of the oncology education provided in universities across Australia and identify areas of education that could potentially be modified or improved to ultimately attract more students to a career in oncology. Methods: This pilot cross-sectional study consisted of an 18-question survey that was submitted online to medical students in their final year and interns rotating to the Tamworth Hospital. Results: The survey was completed by 94 fifth-year medical students and interns. Oncology was taught both theoretically and clinically for 68% (63/93) of participants, and 48% (44/92) had an exclusive oncology rotation. Both theoretical and clinical oncology assessments were conducted for only 21% (19/92) of participants. Overall, 42% (38/91) of participants were satisfied with their oncology education, and 78% (40/51) were dissatisfied with the number of oncology teaching hours. The importance of a career in oncology was rated as low by 46% (41/90) of participants. Conclusions: This pilot study indicates that there are potential areas to improve oncology teaching in Australian universities. The majority of surveyed students were dissatisfied with the number of teaching hours they receive in oncology. More global assessment of students and/or interns from other Australian institutes may yield further useful information.

  • Source: Storyblocks.com; Copyright: Footage Firm; URL: https://www.storyblocks.com/stock-image/medical-student-working-with-pad-on-the-conference-rticuedq_wj6gv70et; License: Licensed by the authors.

    The Perceptions of Medical School Students and Faculty Toward Obesity Medicine Education: Survey and Needs Analysis

    Abstract:

    Background: Recent trends in obesity show that over two-thirds of US adults are considered at least overweight (body mass index, BMI≥25 kg/m2) and of those, about one-third are categorized as obese (BMI≥30 kg/m2). Physicians can address the health impacts of obesity; yet research has suggested that physicians-in-training frequently fail to recognize obesity, are not properly educated regarding treatment options, and spend relatively little clinic time treating obesity. Medical school is a unique opportunity to address this area of need so that the doctors of tomorrow are prepared to treat obesity appropriately. Objectives: The objective of this study was to determine perceptions of where clinical training for medical students on the topic of obesity and its treatment should improve and expand so that we could address the needs identified in a computerized clinical simulation. Methods: We conducted a literature review, as well as a needs analysis with medical school students (N=17) and faculty (N=12). Literature review provided an overview of the current state of the field. Students provided input on their current needs, learning preferences, and opinions. Faculty provided feedback on current training and their perceptions of future needs. Results: Most students were familiar with obesity medicine from various courses where obesity medicine was a subtopic, most frequently in Biochemistry or Nutrition, Endocrinology, and Wellness courses. Student knowledge about basic skills, such as measuring waist circumference, varied widely. About half of the students did not feel knowledgeable about recommending weight loss treatments. Most students did not feel prepared to provide interventions for patients in various categories of overweight/obesity, patients with psychosocial issues, obesity-related comorbidities, or failed weight loss attempts. However, most students did feel that it was their role as health professionals to provide these interventions. Faculty rated the following topics as most important to supplement the curriculum: patient-centered treatment of weight, bringing up the topic of weight, discussing weight and well-being, discussing the relationship between weight and comorbidities, and physician role with overweight or obese patients. Conclusions: A review of the literature as well as surveyed medical students and faculty identified a need for supplementation of the current obesity medicine curriculum in medical schools. Specific needed topics and skills were identified.

  • Using a virtual patient to improve clinical reasoning. Source: Flickr; Copyright: WOCinTech Chat; URL: https://www.flickr.com/photos/wocintechchat/22543243101; License: Creative Commons Attribution (CC-BY).

    A Clinical Reasoning Tool for Virtual Patients: Design-Based Research Study

    Abstract:

    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.

  • Source: Pixabay; Copyright: Gerd Altmann; URL: https://pixabay.com/en/wikipedia-books-encyclopedia-1802614/; License: Public Domain (CC0).

    Comparison of the Impact of Wikipedia, UpToDate, and a Digital Textbook on Short-Term Knowledge Acquisition Among Medical Students: Randomized Controlled...

    Abstract:

    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, ηg2=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.

  • Source: Pixabay; Copyright: Foundry Co; URL: https://pixabay.com/en/african-american-computer-technology-869673/; License: Public Domain (CC0).

    Evaluation of Web-Based Continuing Professional Development Courses: Aggregate Mixed-Methods Model

    Abstract:

    Background: Many continuing professional development (CPD) Web-based programs are not explicit about underlying theory and fail to demonstrate impact. Objective: The aim of this study was to develop and apply an aggregate mixed-methods evaluation model to describe the paradigm, theoretical framework, and methodological approaches used to evaluate a CPD course in tobacco dependence treatment, the Training Enhancement in Applied Cessation Counseling and Health (TEACH) project. Methods: We evaluated the effectiveness of the 5-week TEACH Web-based Core Course in October 2015. The model of evaluation was derived using a critical realist lens to incorporate a dimension of utilitarian to intuitionist approaches. In addition, we mapped our findings to models described by Fitzpatrick et al, Moore et al, and Kirkpatrick. We used inductive and deductive approaches for thematic analysis of qualitative feedback and dependent samples t tests for quantitative analysis. Results: A total of 59 participants registered for the course, and 48/59 participants (81%) completed all course requirements. Quantitative analysis indicated that TEACH participants reported (1) high ratings (4.55/5, where 5=best/excellent) for instructional content and overall satisfaction of the course (expertise and consumer-oriented approach), (2) a significant increase (P ˂.001) in knowledge and skills (objective-oriented approach), and (3) high motivation (78.90% of participants) to change and sustain practice change (management-oriented approach). Through the intuitionist lens, inductive and deductive qualitative thematic analysis highlighted three central themes focused on (1) knowledge acquisition, (2) recommendations to enhance learning for future participants, and (3) plans for practice change in the formative assessment, and five major themes emerged from the summative assessment: (1) learning objectives, (2) interprofessional collaboration, (3) future topics of relevance, (4) overall modification, and (5) overall satisfaction. Conclusions: In the current aggregate model to evaluate CPD Web-based training, evaluators have been influenced by different paradigms, theoretical lenses, methodological approaches, and data collection methods to address and respond to different needs of stakeholders impacted by the training outcomes.

  • Source: Dreamstime; Copyright: Vetkit; URL: https://www.dreamstime.com/stock-photo-doctor-usa-flag-clipboard-background-image55947958#res8183909; License: Licensed by the authors.

    Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study

    Abstract:

    Background: There is a dearth of advocacy training in graduate medical education in the United States. To address this void, the Legislative Education and Advocacy Development (LEAD) course was developed as an interprofessional experience, partnering a cohort of pediatrics residents, fourth-year medical students, and public health students to be trained in evidence-informed health policy making. Objective: The objective of our study was to evaluate the usefulness and acceptability of a service-based legislative advocacy course. Methods: We conducted a pilot study using a single-arm pre-post study design with 10 participants in the LEAD course. The course’s didactic portion taught learners how to define policy problems, research the background of the situation, brainstorm solutions, determine evaluation criteria, develop communication strategies, and formulate policy recommendations for state legislators. Learners worked in teams to create and present policy briefs addressing issues submitted by participating Illinois State legislators. We compared knowledge and attitudes of learners from pre- and postcourse surveys. We obtained qualitative feedback from legislators and pediatric residency directors. Results: Self-reported understanding of the health care system increased (mean score from 4 to 3.3, P=.01), with answers scored from 1=highly agree to 5=completely disagree. Mean knowledge-based scores improved (6.8/15 to 12.0/15 correct). Pediatric residency program directors and state legislators provided positive feedback about the LEAD course. Conclusions: Promising results were demonstrated for the LEAD approach to incorporate advocacy training into graduate medical education.

  • Source: Pixabay; Copyright: StartupStockPhotos; URL: https://pixabay.com/en/student-typing-keyboard-text-woman-849826/; License: Public Domain (CC0).

    Selection and Use of Online Learning Resources by First-Year Medical Students: Cross-Sectional Study

    Abstract:

    Background: Medical students have access to a wide range of learning resources, many of which have been specifically developed for or identified and recommended to them by curriculum developers or teaching staff. There is an expectation that students will access and use these resources to support their self-directed learning. However, medical educators lack detailed and reliable data about which of these resources students use to support their learning and how this use relates to key learning events or activities. Objective: The purpose of this study was to comprehensively document first-year medical student selection and use of online learning resources to support their bioscience learning within a case-based curriculum and assess these data in relation to our expectations of student learning resource requirements and use. Methods: Study data were drawn from 2 sources: a survey of student learning resource selection and use (2013 cohort; n=326) and access logs from the medical school learning platform (2012 cohort; n=337). The paper-based survey, which was distributed to all first-year students, was designed to assess the frequency and types of online learning resources accessed by students and included items about their perceptions of the usefulness, quality, and reliability of various resource types and sources. Of 237 surveys returned, 118 complete responses were analyzed (36.2% response rate). Usage logs from the learning platform for an entire semester were processed to provide estimates of first-year student resource use on an individual and cohort-wide basis according to method of access, resource type, and learning event. Results: According to the survey data, students accessed learning resources via the learning platform several times per week on average, slightly more often than they did for resources from other online sources. Google and Wikipedia were the most frequently used nonuniversity sites, while scholarly information sites (eg, online journals and scholarly databases) were accessed relatively infrequently. Students were more likely to select learning resources based on the recommendation of peers than of teaching staff. The overwhelming majority of the approximately 70,000 resources accessed by students via the learning platform were lecture notes, with each accessed an average of 167 times. By comparison, recommended journal articles and (online) textbook chapters were accessed only 49 and 31 times, respectively. The number and type of learning resources accessed by students through the learning platform was highly variable, with a cluster analysis revealing that a quarter of students accessed very few resources in this way. Conclusions: Medical students have easy access to a wide range of quality learning resources, and while some make good use of the learning resources recommended to them, many ignore most and access the remaining ones infrequently. Learning analytics can provide useful measures of student resource access through university learning platforms but fails to account for resources accessed via external online sources or sharing of resources using social media.

  • Source: The University of Southampton / Placeit.net; Copyright: JMIR Publications; URL: http://mededu.jmir.org/2017/2/e16/; License: Creative Commons Attribution (CC-BY).

    Log In to Experiential Learning Theory: Supporting Web-Based Faculty Development

    Abstract:

    Background: For an increasingly busy and geographically dispersed faculty, the Faculty of Medicine at the University of Southampton, United Kingdom, developed a range of Web-based faculty development modules, based on Kolb’s experiential learning cycle, to complement the faculty’s face-to-face workshops. Objective: The objective of this study was to assess users’ views and perceptions of the effectiveness of Web-based faculty development modules based on Kolb’s experiential learning cycle. We explored (1) users’ satisfaction with the modules, (2) whether Kolb’s design framework supported users’ learning, and (3) whether the design principle impacts their work as educators. Methods: We gathered data from users over a 3-year period using evaluation surveys built into each of the seven modules. Quantitative data were analyzed using descriptive statistics, and responses to open-ended questions were analyzed using content analysis. Results: Out of the 409 module users, 283 completed the survey (69.1% response rate). Over 80% of the users reported being satisfied or very satisfied with seven individual aspects of the modules. The findings suggest a strong synergy between the design features that users rated most highly and the key stages of Kolb’s learning cycle. The use of simulations and videos to give the users an initial experience as well as the opportunity to “Have a go” and receive feedback in a safe environment were both considered particularly useful. In addition to providing an opportunity for reflection, many participants considered that the modules would enhance their roles as educators through: increasing their knowledge on various education topics and the required standards for medical training, and improving their skills in teaching and assessing students through practice and feedback and ultimately increasing their confidence. Conclusions: Kolb’s theory-based design principle used for Web-based faculty development can support faculty to improve their skills and has impact on their role as educators. Grounding Web-based training in learning theory offers an effective and flexible approach for faculty development.

  • American College of Lifestyle Medicine homepage (montage). Source: American College of Lifestyle Medicine / Placeit.net; Copyright: JMIR Publications; URL: http://mededu.jmir.org/2017/2/e14/; License: Creative Commons Attribution (CC-BY).

    A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes

    Abstract:

    Background: Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits. Objective: To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School. Methods: The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a “coach approach” to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling. Results: The course was well-received, earning a ranking of 4.9/5 at the school. Conclusions: A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.

  • Laryngoscope blades for intubation. Source: Wikimedia Commons; Copyright: Sasata; URL: https://en.wikipedia.org/wiki/File:Macintosh_Blades.jpg; License: Creative Commons Attribution (CC-BY).

    Mobile Apps for Teaching Intubation: Scoping Review and Critical Analysis in eLearning

    Abstract:

    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.

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  • Sustaining an Online Learning Community for Internal Medicine Sub-interns Across Sites via an Enterprise Microblogging Platform

    Date Submitted: Jan 11, 2018

    Open Peer Review Period: Jan 12, 2018 - Mar 9, 2018

    Background: Although the Clerkship Directors in Internal Medicine (CDIM) has created a core subinternship curriculum, the traditional experiential subinternship may not expose students to all topics....

    Background: Although the Clerkship Directors in Internal Medicine (CDIM) has created a core subinternship curriculum, the traditional experiential subinternship may not expose students to all topics. Furthermore, academic institutions often use multiple clinical training sites for the student clerkship experience. Objective: We aimed to sustain an online learning community across geographically disparate sites via enterprise microblogging to increase subintern exposure to CDIM’s curriculum. Methods: Internal medicine sub-interns utilized Yammer®, a HIPAA-secure enterprise microblogging platform, to post questions, images, and index conversations for searching. Sub-interns were required to submit 4 posts and participate in 4 discussions during their rotation. Faculty reinforced key points, answered questions, and monitored HIPAA compliance. Results: Fifty-six medical students rotated on an internal medicine subinternship from July 2014-June 2016. Eighty-four percent of the students returned the post-rotation survey. Over the first 3 months, 100% of CDIM curriculum topics were covered. Compared to the pilot year, the scale-up year demonstrated a significant increase in number of students with >10 posts (scale-up 49% versus pilot year 19%; p=.03) and perceived educational experience (58% scale-up versus 14% pilot year; p=.006). Very few students (6%) noted privacy concerns, but fewer students in the scale-up year found Yammer® a safe learning environment. Conclusions: Supplementing the sub-internship clinical experience with an enterprise microblogging platform increased sub-internship exposure to required curricular topics and was well-received. Future work should address concerns of safe learning environment.

  • YouTube as an Educational Resource in Medical Education: A Scoping Review

    Date Submitted: Dec 13, 2017

    Open Peer Review Period: Dec 14, 2017 - Feb 8, 2018

    Background: Video has been a powerful teaching and learning tool in medical education, enabling knowledge, skill and attitude formation in a variety of areas and reaching learners with various learnin...

    Background: Video has been a powerful teaching and learning tool in medical education, enabling knowledge, skill and attitude formation in a variety of areas and reaching learners with various learning and communication styles. The millennial generation has grown up with video at their fingertips at any time and any place, and social networking sites such as YouTube enable the sharing of video amongst a vast online community. YouTube has emerged as a growing educational resource for both learners and medical educators. However, the usefulness of YouTube in supporting teaching and learning across the continuum of medical education has not been explored in detail. Given the increasing usage of YouTube in medical education, a review of the literature on YouTube and its utilization in medical education could inform more effective adoption and usage by institutions, educators, practitioners and learners. Objective: To explore the use of YouTube across the medical education continuum. Methods: A scoping review of the literature was performed. PubMed, ERIC and CINAHL were searched for literature on YouTube usage for medical education purposes published between 2005 and 2017 using a combination of search terms. Articles were screened using a defined set of inclusion criteria. Key items of information from each paper were collated using a data extraction tool and common themes from the literature were identified via thematic analysis. Results: Of the 113 articles initially identified in the literature search, 31 met inclusion criteria. Results show that a large number of YouTube videos exist across a variety of medical topic areas. However, only a small number of studies have evaluated the effectiveness of YouTube as an educational intervention and these are largely limited to learner satisfaction only. YouTube does offer the opportunity for educators to share videos and for learners to access a wide array of video materials. However, a majority of studies involving the assessment of content quality suggest that YouTube videos may be an inadequate source of information for learning due to the high variability of content. A key limitation in many of these studies was that searches were mainly restricted to publicly available video content. Conclusions: There is a paucity of research and evaluative work surrounding the use of YouTube as an educational resource across the medical education continuum. The quality of the content on YouTube is highly variable due to a lack of peer-review. Further evaluation of the effective integration of YouTube in medical education would inform further understanding and future practice.

  • Improving Internal Medicine Residents' Colo-Rectal Cancer (CRC) Screening Knowledge via Smart Phone Application: A Novel Approach

    Date Submitted: Dec 11, 2017

    Open Peer Review Period: Dec 12, 2017 - Feb 6, 2018

    Background: Colo-Rectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in US is not getting the CRC screeni...

    Background: Colo-Rectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in US is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective: To improve internal medicine residents' CRC screening knowledge via novel approach of developing and publishing a smart phone application. Methods: A questionnaire was designed based on CRC screening guidelines of ACS, ACG and USPSTF. The questionnaire was emailed via SurveyMonkey link to all the residents of internal medicine department. The responses were analyzed after 4 weeks. Then a smart phone application was designed and was published on Play Store and App Store for android users and i phone users respectively. The survey was repeated, and the responses were compared with the previous one. Pearson Chi square test and the fisher exact test was applied to look for statistical significance. Results: 50 residents completed the first survey and 41 completed the second survey after publication of the application. Some of the areas of CRC screening which showed statistically significant improvement (P value < 0.05) included age to start CRC screening in African Americans, ordering preventive tests first, identification of CRC screening tests, identification of preventive and detection methods, positive tests to be followed by colonoscopy, follow up after colonoscopy findings and CRC surveillance in diseases. Conclusions: In this modern era of smart phones and gadgets, developing a smartphone based application or educational tool is a novel idea and can help in improving the knowledge of residents about colorectal cancer screening.

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