JMIR Publications

JMIR Medical Education

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


Journal Description

JMIR Medical Education (JME) is a new 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 2015: 4.532), 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:

  • Photo credit: (cc) Some rights reserved by Alexander Kachkaev via FlickR, licensed under Creative Commons Attribution 2.0.

    Does Academic Blogging Enhance Promotion and Tenure? A Survey of US and Canadian Medicine and Pediatric Department Chairs


    Background: Electronic educational (e-learning) technology usage continues to grow. Many medical journals operate companion blogs (an application of e-learning technology) that enable rapid dissemination of scientific knowledge and discourse. Faculty members participating in promotion and tenure academic tracks spend valuable time and effort contributing, editing, and directing these medical journal blogs. Objective: We sought to understand whether chairs of medicine and pediatric departments acknowledge blog authorship as academic achievement. Methods: The authors surveyed 267 chairs of US and Canadian medicine and pediatric departments regarding their attitudes toward the role of faculty participation in e-learning and blogging in the promotion and tenure process. The survey completion rate was 22.8% (61/267). Results: A majority of respondents (87%, 53/61) viewed educational scholarship as either important or very important for promotion. However, only 23% (14/61) perceived importance to faculty effort in producing content for journal-based blogs. If faculty were to participate in blog authorship, 72% (44/61) of surveyed chairs favored involvement in a journal-based versus a society-based or a personal (nonaffiliated) blog. We identified a “favorable group” of chairs (19/59, 32%), who rated leadership roles in e-learning tools as important or very important, and an “unfavorable group” of chairs (40/59, 68%), who rated leadership roles in e-learning tools as somewhat important or not important. The favorable group were more likely to be aware of faculty bloggers within their departments (58%, 11/19 vs 25%, 10/40), viewed serving on editorial boards of e-learning tools more favorably (79%, 15/19 vs 31%, 12/39), and were more likely to value effort spent contributing to journal-based blogs (53%, 10/19 vs 10%, 4/40). Conclusions: Our findings demonstrate that although the majority of department chairs value educational scholarship, only a minority perceive value in faculty blogging effort.

  • Student use ICT in medical education. Image source and copyright: the authors.

    Health Sciences Students’ Self-Assessment of Information and Communication Technology Skills and Attitude Toward e-Learning


    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.

  • Source and Copyright: the authors; license to use under CC-3.0.

    A Critical Review of Mechanical Ventilation Virtual Simulators: Is It Time to Use Them?


    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.

  • Medical and Health Education. Image sourced and copyright owned by authors Jean Christophe Rusatira et al.

    Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps


    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.

  • Asklepian from a Roman Aesculapian temple and caduceus from a Florentine sculpture. (a) Tiber Island, Rome 2004 [2]. The arrow indicates the travertine ship’s prow, which is seen in (b,c); (b,c) Asklepian carved into the travertine ship’s prow from the 1st century BCE at the site of an Aesculapian temple [2], 300 m from the current-day Ospedale Fatebenefratelli (photo by author, 2008); (d) Bronze by Gianbologna, Mercurio (Mercury, the Roman name for Hermes), 1580, Museo Nazionale del Bargello, Florence, Italy (excerpt of photo by author, 2013).

    Branding Asklepios and the Traditional and Variant Serpent Symbol Display Among Health Professional Schools in the United States, Puerto Rico, and Canada: A...


    Background: History supports the staff and single serpent, the asklepian, as the symbol of healing and medicine, yet its confusion with the caduceus (a winged staff with two snakes wrapped around it) persists. No population-based information on serpent symbol use exists. Objective: To determine the prevalence of asklepian and caduceus display among Internet images of medical and health professional schools’ emblems, and to compare asklepian and caduceus display between medical and health professional schools, examining the effects of school longevity and geographic location on symbol display. Methods: This cross-sectional survey examined Internet websites and Google Images associated with medical and other health professional schools in the United States, Puerto Rico, and Canada from 2013 to 2015. The primary outcome was display of a traditional or variant asklepian or caduceus among current and past emblems in Google Images. Odds ratios (ORs) and 95% confidence intervals for the comparison of medical versus other health professional schools were calculated by logistic regression. Differences among schools' longevity were assessed with Student's t-tests and linear regression. Results: Among images of current and past emblems of 482 schools—159 medical schools and 323 health professional schools—107 (22.2%) emblems displayed only the traditional, and 205 (42.5%) any, asklepian. Adjusting for geographic region and longevity, medical schools were 59% less likely than health professional schools to display the traditional asklepian (OR 0.41, 95% CI 0.24-0.71, P=.001), and were 7.7 times more likely than health professional schools to display the traditional caduceus. Medical schools were 8% less likely than health professional schools to display any asklepian (OR 0.92, 95% CI 0.62-1.38, P=.70), and were 3.3 times more likely than health professional schools to display any caduceus. Conclusions: Schools’ preference of the asklepian over the caduceus confirmed historical origins. Less asklepian and more caduceus display by medical schools suggests an educational opportunity for the medical profession to define for itself and the public the correct symbol of an interdisciplinary mission of healing.

  • Source:, CC0 Public Domain.

    Students' Perceptions of and Experiences With Educational Technology: A Survey


    Background: It is generally assumed that incoming students in medical education programs will be better equipped for the “digital age” given their younger age and an educational upbringing in which technology was seemingly omnipresent. In particular, many assume that today's medical students are more likely to hold positive attitudes and increased comfortability with technology and possess greater information technology (IT) skills. Objective: The purpose of this study was to compare responses of incoming veterinary medical students to a series of IT-related questions contained in a common questionnaire over the course of a 10-year period (2005-2015) to discern whether students’ attitudes have improved and uses and comfortability with technology have increased as anticipated. Methods: A survey measuring attitudes and preferences, computing experience, and technology ownership was administered each year for the past 10 years to incoming veterinary medical students at a large veterinary school in the United States. Students' responses to survey items were compared at 3 data points (2005, 2010, and 2015). Results: Today's incoming veterinary medical students tend to indicate the same desire to improve skills using spreadsheets and web page design as incoming students from 10 years ago. It seems that despite technological advances and increased exposure to such applications and skills, there remains a challenge for students to “keep up” with the ever evolving technology. Moreover, although students continue to report they are very comfortable with using a computer (and related devices), many use their computers as typewriters or word processors, as opposed to a means for performing more advanced computing functions. Conclusions: In general, today's medical students are not expert computer users as many assume. Despite an upbringing in a digitized world, many students still lack many basic computing skills.

  • Source:, Creative Commons 2.0 Licensed.

    Exploring Student Preconceptions of Readiness for Remote-Online Case-Based Learning: A Case Study


    Background: Case-based learning (CBL) is an educational approach where students work in small, collaborative groups to solve problems. Web-conferencing software provides a platform to present information and share concepts that are vital to CBL. Previous studies have found that participants were resistant to change associated with implementing e-learning; however, strategies to reduce this resistance have not been explored. Objective: This study was designed to explore student preconceptions and understanding of remote-online case-based learning (RO-CBL). Methods: The study took place during the Bachelor of Physiotherapy program at Monash University, Victoria, Australia, in 2013. The entire third-year cohort (n=73) was invited to participate. The primary outcome of interest was students’ preconceptions of RO-CBL, collected via pre- and posttraining surveys. Results: Of the 73 students, 66 completed both surveys (attrition rate 9.6%). Three key themes relevant to student preconceptions of RO-CBL emerged: flexibility in time and location of CBL, readiness or hesitation to change to a Web-based format, and the value of training in RO-CBL that included a demonstration and trial run. Thirty-four percent of the participants were hesitant to move to an online format. Conclusions: This study explored students’ preconceptions of Web-based learning and evaluated the change in students’ attitudes after training. The results suggest that educational designers should not assume that students are confident and competent in applying these technologies to professional educational activities. By identifying students’ needs before implementation, training sessions can be designed to target these needs, and improve the understanding of RO-CBL and how it works in practice. This may reduce resistance to change, enhance students’ satisfaction, and ultimately improve the learning experience.

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    Student Response to Remote-Online Case-Based Learning: A Qualitative Study


    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.

  • Clinician using Google Glass in his field of vision.

    Feasibility of Augmented Reality in Clinical Simulations: Using Google Glass With Manikins


    Background: Studies show that students who use fidelity-based simulation technology perform better and have higher retention rates than peers who learn in traditional paper-based training. Augmented reality is increasingly being used as a teaching and learning tool in a continual effort to make simulations more realistic for students. Objective: The aim of this project was to assess the feasibility and acceptability of using augmented reality via Google Glass during clinical simulation scenarios for training health science students. Methods: Students performed a clinical simulation while watching a video through Google Glass of a patient actor simulating respiratory distress. Following participation in the scenarios students completed two surveys and were questioned if they would recommend continued use of this technology in clinical simulation experiences. Results: We were able to have students watch a video in their field of vision of a patient who mimicked the simulated manikin. Students were overall positive about the implications for being able to view a patient during the simulations, and most students recommended using the technology in the future. Overall, students reported perceived realism with augmented reality using Google Glass. However, there were technical and usability challenges with the device. Conclusions: As newer portable and consumer-focused technologies become available, augmented reality is increasingly being used as a teaching and learning tool to make clinical simulations more realistic for health science students. We found Google Glass feasible and acceptable as a tool for augmented reality in clinical simulations.

  • Image Source: Social-network-communities-image.jpg, courtesy of Surendar Kumar B, [Creative Commons Attribution-Share Alike 4.0 International],, via

    The Significance of Kinship for Medical Education: Reflections on the Use of a Bespoke Social Network to Support Learners’ Professional Identities


    Background: Social media can support and sustain communities much better than previous generations of learning technologies, where institutional barriers undermined any initiatives for embedding formal and informal learning. Some of the many types of social media have already had an impact on student learning, based on empirical evidence. One of these, social networking, has the potential to support communication in formal and informal spaces. Objective: In this paper we report on the evaluation of an institutional social network—King's Social Harmonisation Project (KINSHIP)—established to foster an improved sense of community, enhance communication, and serve as a space to model digital professionalism for students at King’s College London, United Kingdom. Methods: Our evaluation focused on a study that examined students’ needs and perceptions with regard to the provision of a cross-university platform. Data were collected from students, including those in the field of health and social care, in order to recommend a practical way forward to address current needs in this area. Results: The findings indicate that the majority of the respondents were positive about using a social networking platform to develop their professional voice and profiles. Results suggest that timely promotion of the platform, emphasis on interface and learning design, and a clear identity are required in order to gain acceptance as the institutional social networking site. Conclusions: Empirical findings in this study project an advantage of an institutional social network such a KINSHIP over other social networks (eg, Facebook) because access is limited to staff and students and the site is mainly being used for academic purposes.

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    Developing a Curriculum to Promote Professionalism for Medical Students Using Social Media: Pilot of a Workshop and Blog-Based Intervention


    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.

  • Semantic indexing. TOC Image created by Cord Spreckelsen and can be used under cc-by 4.0.

    Semantic Indexing of Medical Learning Objects: Medical Students' Usage of a Semantic Network


    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.

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  • An analysis of 2.3 million participations in the CME program of a general medical journal: suitability, user characteristics, and evaluation by readers

    Date Submitted: May 31, 2016

    Open Peer Review Period: May 31, 2016 - Jul 26, 2016

    Background: Doctors frequently use continuing medical education (CME) in journals. Little is known, however, on the evaluation of journal CME by the readers and on user as well as participation charac...

    Background: Doctors frequently use continuing medical education (CME) in journals. Little is known, however, on the evaluation of journal CME by the readers and on user as well as participation characteristics. Deutsches Ärzteblatt (DÄ), the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. It therefore provides a unique opportunity to analyze a journal CME program directed at an entire population of doctors. Objective: To analyze key sociodemographic characteristics of participants, frequency and temporal distributions of participations, detection of distinct clusters of participants, how doctors rate the CME articles, how successful they were in answering simple multiple choice questions, and whether the articles are suitable to a general medical audience. 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: 128.398 doctors (55% male, median age class 40 to 49 years) took part 2.339.802 times (mean: 16478 participations/article). Depending on the year between 12% and 16% of all doctors in the country participated at least once. The CME program was disproportionally popular with doctors in private practice, and many participations took place in the early mornings and evenings (45%) as well as over the weekend (28%). Participation by specialty ranked: internal medicine (18.3%) > family medicine (16.4%) > anaesthesiology (10%) > surgery (7.1%). Cluster analysis revealed three groups, one of which comprised of only women, with two thirds working in private practice. Participants rated the CME articles as intelligible to a wider medical audience, and filling clinically relevant knowledge gaps. Almost 80% of the sample gave the CME articles very good or good marks. 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 doctors in private practice and those who want to participate from their homes and on weekends. While many doctors emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts on professional performance and patient outcomes.