JMIR Publications

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  Continuing Medical Education (CME)...

  Oct 20, 2017

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

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  Authors List:

  • Arezoo Ebn Ahmady  
  • Megan Barker  
  • Myra Fahim  
  • Rosa Dragonetti  
  • Peter Selby  

  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.

  • JMIR Med Educ 2017;3(2):e19

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  New Methods and Approaches in Medical...

  Oct 17, 2017

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

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  Authors List:

  • Shikhar H Shah  
  • Maureen D Clark  
  • Kimberly Hu  
  • Jalene A Shoener  
  • Joshua Fogel  
  • William C Kling  
  • James Ronayne  

  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.

  • JMIR Med Educ 2017;3(2):e18

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  Training Tools for Medical Students

  Oct 2, 2017

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

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  Authors List:

  • Terry Judd  
  • Kristine Elliott  

  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.

  • JMIR Med Educ 2017;3(2):e17

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  Design of Educational Technology

  Sep 27, 2017

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

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  Authors List:

  • Selma Omer  
  • Sunhea Choi  
  • Sarah Brien  
  • Marcus Parry  

  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.

  • JMIR Med Educ 2017;3(2):e16

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  Undergraduate Education for Future...

  Sep 11, 2017

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

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  Authors List:

  • Elizabeth Pegg Frates  
  • Ryan C Xiao  
  • Deepa Sannidhi  
  • Yasamina McBride  
  • Tracie McCargo  
  • Theodore A Stern  

  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.

  • JMIR Med Educ 2017;3(2):e14

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  Mobile Approaches to Medical Education

  Sep 5, 2017

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

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  Authors List:

  • Clyde Matava  
  • Anne-Marie Leo  
  • Fahad Alam  

  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.

  • JMIR Med Educ 2017;3(2):e15

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  Social Media in Medical Education

  Aug 4, 2017

  Attitudes of Health Professional Educators Toward the Use of Social Media as a Teaching Tool: Global Cross-Sectional Study

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  Authors List:

  • Karan D'Souza  
  • Lucy Henningham  
  • Runyu Zou  
  • Jessica Huang  
  • Elizabeth O'Sullivan  
  • Jason Last  
  • Kendall Ho  

  Abstract:

  Background: The use of social media in health education has witnessed a revolution within the past decade. Students have already adopted social media informally to share information and supplement their lecture-based learning. Although studies show comparable efficacy and improved engagement when social media is used as a teaching tool, broad-based adoption has been slow and the data on barriers to uptake have not been well documented. Objective: The objective of this study was to assess attitudes of health educators toward social media use in education, examine differences between faculty members who do and do not use social media in teaching practice, and determine contributing factors for an increase in the uptake of social media. Methods: A cross-sectional Web-based survey was disseminated to the faculty of health professional education departments at 8 global institutions. Respondents were categorized based on the frequency of social media use in teaching as “users” and “nonusers.” Users sometimes, often, or always used social media, whereas nonusers never or rarely used social media. Results: A total of 270 health educators (52.9%, n=143 users and 47.0%, n=127 nonusers) were included in the survey. Users and nonusers demonstrated significant differences on perceived barriers and potential benefits to the use of social media. Users were more motivated by learner satisfaction and deterred by lack of technology compatibility, whereas nonusers reported the need for departmental and skill development support. Both shared concerns of professionalism and lack of evidence showing enhanced learning. Conclusions: The majority of educators are open-minded to incorporating social media into their teaching practice. However, both users and nonusers have unique perceived challenges and needs, and engaging them to adapt social media into their educational practice will require previously unreported approaches. Identification of these differences and areas of overlap presents opportunities to determine a strategy to increase adoption.

  • JMIR Med Educ 2017;3(2):e13

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  Continuing Medical Education (CME)...

  Jul 13, 2017

  How Do Clinicians Learn About Knowledge Translation? An Investigation of Current Web-Based Learning Opportunities

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  Authors List:

  • Raechel A Damarell  
  • Jennifer J Tieman  

  Abstract:

  Background: Clinicians are important stakeholders in the translation of well-designed research evidence into clinical practice for optimal patient care. However, the application of knowledge translation (KT) theories and processes may present conceptual and practical challenges for clinicians. Online learning platforms are an effective means of delivering KT education, providing an interactive, time-efficient, and affordable alternative to face-to-face education programs. Objective: This study investigates the availability and accessibility of online KT learning opportunities for health professionals. It also provides an analysis of the types of resources and associated disciplines retrieved by a range of KT synonyms. Methods: We searched a range of bibliographic databases and the Internet (Google advanced option) using 9 KT terms to identify online KT learning resources. To be eligible, resources had to be free, aimed at clinicians, educational in intent, and interactive in design. Each term was searched using two different search engines. The details of the first 100 websites captured per browser (ie, n=200 results per term) were entered into EndNote. Each site was subsequently visited to determine its status as a learning resource. Eligible websites were appraised for quality using the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) tool. Results: We identified 971 unique websites via our multiple search strategies. Of these, 43 were health-related and educational in intent. Once these sites were evaluated for interactivity, a single website matched our inclusion criteria (Dementia Knowledge Translation Learning Centre). Conclusions: KT is an important but complex system of processes. These processes overlap with knowledge, practice, and improvement processes that go by a range of different names. For clinicians to be informed and competent in KT, they require better access to free learning opportunities. These resources should be designed from the viewpoint of the clinician, presenting KT’s multifaceted theories and processes in an engaging, interactive way. This learning should empower clinicians to contextualize and apply KT strategies within their own care settings.

  • JMIR Med Educ 2017;3(2):e12

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  Graduate and Postgraduate Education...

  Jun 12, 2017

  Developing a Curriculum for Information and Communications Technology Use in Global Health Research and Training: A Qualitative Study Among Chinese Health...

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  Authors List:

  • Zhenyu Ma  
  • Li Yang  
  • Lan Yang  
  • Kaiyong Huang  
  • Hongping Yu  
  • Huimin He  
  • Jiaji Wang  
  • Le Cai  
  • Jie Wang  
  • Hua Fu  
  • Lisa Quintiliani  
  • Robert H Friedman  
  • Jian Xiao  
  • Abu S Abdullah  

  Abstract:

  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.

  • JMIR Med Educ 2017;3(1):e11

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  Continuing Medical Education (CME)...

  May 10, 2017

  Development and Assessment of an E-learning Course on Pediatric Cardiology Basics

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  Authors List:

  • Ana Cristina Oliveira  
  • Sandra Mattos  
  • Miguel Coimbra  

  Abstract:

  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.

  • JMIR Med Educ 2017;3(1):e10

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  Social Media in Medical Education

  May 3, 2017

  Erosion of Digital Professionalism During Medical Students’ Core Clinical Clerkships

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  Authors List:

  • Arash Mostaghimi  
  • Aleksandra E Olszewski  
  • Sigall K Bell  
  • David H Roberts  
  • Bradley H Crotty  

  Abstract:

  Background: The increased use of social media, cloud computing, and mobile devices has led to the emergence of guidelines and novel teaching efforts to guide students toward the appropriate use of technology. Despite this, violations of professional conduct are common. Objective: We sought to explore professional behaviors specific to appropriate use of technology by looking at changes in third-year medical students’ attitudes and behaviors at the beginning and conclusion of their clinical clerkships. Methods: After formal teaching about digital professionalism, we administered a survey to medical students that described 35 technology-related behaviors and queried students about professionalism of the behavior (on a 5-point Likert scale), observation of others engaging in the behavior (yes or no), as well as personal participation in the behavior (yes or no). Students were resurveyed at the end of the academic year. Results: Over the year, perceptions of what is considered acceptable behavior regarding privacy, data security, communications, and social media boundaries changed, despite formal teaching sessions to reinforce professional behavior. Furthermore, medical students who observed unprofessional behaviors were more likely to participate in such behaviors. Conclusions: Although technology is a useful tool to enhance teaching and learning, our results reflect an erosion of professionalism related to information security that occurred despite medical school and hospital-based teaching sessions to promote digital professionalism. True alteration of trainee behavior will require a cultural shift that includes continual education, better role models, and frequent reminders for faculty, house staff, students, and staff.

  • JMIR Med Educ 2017;3(1):e9

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  Simulation

  Apr 21, 2017

  Simulation Training: Evaluating the Instructor’s Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training

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  Authors List:

  • Aric Katz  
  • Ronnie Tepper  
  • Avraham Shtub  

  Abstract:

  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.

  • JMIR Med Educ 2017;3(1):e8

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