JMIR Publications

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  Virtual Reality and Augmented Reality...

  Jan 14, 2019

  Use of Smartphone-Based Head-Mounted Display Devices to View a Three-Dimensional Dissection Model in a Virtual Reality Environment: Pilot Questionnaire Study

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  Authors List:

  • Yoshihito Masuoka  
  • Hiroyuki Morikawa  
  • Takashi Kawai  
  • Toshio Nakagohri  

  Abstract:

  Background: Virtual reality (VR) technology has started to gain attention as a form of surgical support in medical settings. Likewise, the widespread use of smartphones has resulted in the development of various medical applications; for example, Google Cardboard, which can be used to build simple head-mounted displays (HMDs). However, because of the absence of observed and reported outcomes of the use of three-dimensional (3D) organ models in relevant environments, we have yet to determine the effects of or issues with the use of such VR technology. Objective: The aim of this paper was to study the issues that arise while observing a 3D model of an organ that is created based on an actual surgical case through the use of a smartphone-based simple HMD. Upon completion, we evaluated and gathered feedback on the performance and usability of the simple observation environment we had created. Methods: We downloaded our data to a smartphone (Galaxy S6; Samsung, Seoul, Korea) and created a simple HMD system using Google Cardboard (Google). A total of 17 medical students performed 2 experiments: an observation conducted by a single observer and another one carried out by multiple observers using a simple HMD. Afterward, they assessed the results by responding to a questionnaire survey. Results: We received a largely favorable response in the evaluation of the dissection model, but also a low score because of visually induced motion sickness and eye fatigue. In an introspective report on simultaneous observations made by multiple observers, positive opinions indicated clear image quality and shared understanding, but displeasure caused by visually induced motion sickness, eye fatigue, and hardware problems was also expressed. Conclusions: We established a simple system that enables multiple persons to observe a 3D model. Although the observation conducted by multiple observers was successful, problems likely arose because of poor smartphone performance. Therefore, smartphone performance improvement may be a key factor in establishing a low-cost and user-friendly 3D observation environment.

  • JMIR Med Educ 2019;5(1):e11921

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  Social Media in Medical Education

  Jan 11, 2019

  The Use of Social Media in Interprofessional Education: Systematic Review

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  Authors List:

  • Audra Rankin  
  • Maria Truskey  
  • Margaret S Chisolm  

  Abstract:

  Background: The implementation of interprofessional education (IPE) activities into health care education is a challenge for many training programs owing to time and location constraints of both faculty and learners. The integration of social media into these IPE activities may provide a solution to these problems. Objective: This review of the published literature aims to identify health care IPE activities using social media. Methods: The authors searched 5 databases (from the beginning coverage date to May 27, 2017) using keywords related to IPE and social media. Teams of 2 authors independently reviewed the search results to identify peer-reviewed, English language papers reporting on IPE activities using social media. They assessed the study quality of identified papers using the Medical Education Research Study Quality Instrument. Results: A total of 8 studies met the review’s inclusion criteria. Of these 8 papers, 3 had single-group, posttest-only study design; 4 had single-group, pre- and posttest design; and 1 had nonrandomized 3-group design. Qualitative and quantitative outcome measures showed mixed results with the majority of student feedback being positive. Conclusions: Despite a need for additional research, this review suggests that the use of social media may aid the implementation of health care IPE.

  • JMIR Med Educ 2019;5(1):e11328

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  Graduate and Postgraduate Education...

  Dec 21, 2018

  Development and Evaluation of a New Security and Privacy Track in a Health Informatics Graduate Program: Multidisciplinary Collaboration in Education

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  Authors List:

  • Leming Zhou  
  • Bambang Parmanto  
  • James Joshi  

  Abstract:

  Background: The widespread application of technologies such as electronic health record systems, mobile health apps, and telemedicine platforms, has made it easy for health care providers to collect relevant data and deliver health care regimens. While efficacious, these new technologies also pose serious security and privacy challenges. Objective: The training program described here aims at preparing well-informed health information security and privacy professionals with enhanced course materials and various approaches. Methods: A new educational track has been built within a health informatics graduate program. Several existing graduate courses have been enhanced with new security and privacy modules. New labs and seminars have been created, and students are being encouraged to participate in research projects and obtain real-world experience from industry partners. Students in this track receive both theoretical education and hands-on practice. Evaluations have been performed on this new track by conducting multiple surveys on a sample of students. Results: We have succeeded in creating a new security track and developing a pertinent curriculum. The newly created security materials have been implemented in multiple courses. Our evaluation indicated that students (N=72) believed that receiving security and privacy training was important for health professionals, the provided security contents were interesting, and having the enhanced security and privacy training in this program was beneficial for their future career. Conclusions: The security and privacy education for health information professionals in this new security track has been significantly enhanced.

  • JMIR Med Educ 2018;4(2):e19

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  Massive Open Online Courses (MOOC)

  Dec 21, 2018

  Cyberincivility in the Massive Open Online Course Learning Environment: Data-Mining Study

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  Authors List:

  • Jennie C De Gagne  
  • Kim Manturuk  
  • Hyeyoung K Park  
  • Jamie L Conklin  
  • Noelle Wyman Roth  
  • Benjamin E Hook  
  • Joanne M Kulka  

  Abstract:

  Background: Cyberincivility is a pervasive issue that demands upfront thinking and can negatively impact one’s personal, professional, social, and educational well-being. Although massive open online courses (MOOCs) environments could be vulnerable to undesirable acts of incivility among students, no study has explored the phenomena of cyberincivility in this learning environment, particularly in a health-related course in which mostly current or eventual health professions students enroll. Objective: This study aimed to analyze the characteristics of text entries posted by students enrolled in a medicine and health care MOOC. The objectives were to (1) examine the prevalence of posts deemed disrespectful, insensitive or disruptive, and inconducive to learning; (2) describe the patterns and types of uncivil posts; and (3) highlight aspects that could be useful for MOOC designers and educators to build a culture of cybercivility in the MOOC environment. Methods: We obtained data from postings in the discussion forums from the MOOC Medical Neuroscience created by a large private university in the southeast region of the United States. After cleaning the dataset, 8705 posts were analyzed, which contained (1) 667 questions that received no responses; (2) 756 questions that received at least one answer; (3) 6921 responses that applied to 756 posts; and (4) 361 responses where the initiating post was unknown. An iterative process of coding, discussion, and revision was conducted to develop a series of a priori codes. Data management and analysis were performed with NVivo 12. Results: Overall, 19 a priori codes were retained from 25 initially developed, and 3 themes emerged from the data—Annoyance, Disruption, and Aggression. Of 8705 posts included in the analysis, 7333 (84.24%) were considered as the absence of uncivil posts and 1043 (11.98%) as the presence of uncivil posts, while 329 (3.78%) were uncodable. Of 1043 uncivil posts analyzed, 466 were coded to >1 a priori codes, which resulted in 1509 instances. Of those 1509 instances, 826 (54.74%) fell into “annoyance”, 648 (42.94%) into “disruption”, and 35 (2.32%) into “aggression”. Of 466 posts that related to >1 a priori codes, 380 were attributed to 2 or 3 themes. Of those 380 posts, 352 (92.6%) overlapped both “annoyance” and “disruption,” 13 (3.4%) overlapped both “disruption” and “aggression,” and 9 (2.4%) overlapped “annoyance” and “aggression,” while 6 (1.6%) intersected all 3 themes. Conclusions: This study reports on the phenomena of cyberincivility in health-related MOOCs toward the education of future health care professionals. Despite the general view that discussion forums are a staple of the MOOC delivery system, students cite discussion forums as a source of frustration for their potential to contain uncivil posts. Therefore, MOOC developers and instructors should consider ways to maintain a civil discourse within discussion forums.

  • JMIR Med Educ 2018;4(2):e12152

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  Medical Education in the Developing...

  Nov 27, 2018

  How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study

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  Authors List:

  • Sandra Barteit  
  • Albrecht Jahn  
  • Annel Bowa  
  • Sigrid Lüders  
  • Gregory Malunga  
  • Clemence Marimo  
  • Sigrid Wolter  
  • Florian Neuhann  

  Abstract:

  Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials. Objective: Our aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training. Methods: The pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data’s adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills. Results: In total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80%) and high agreement (>75%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized. Conclusions: The pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes.

  • JMIR Med Educ 2018;4(2):e10222

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  Student/Learners Perceptions and...

  Nov 26, 2018

  Assessing the Impact of Video-Based Assignments on Health Professions Students’ Social Presence on Web: Case Study

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  Authors List:

  • Jennie C De Gagne  
  • Sang S Kim  
  • Ellen R Schoen  
  • Hyeyoung K Park  

  Abstract:

  Background: Web-based education is one of the leading learning pedagogies in health professions education. Students have access to a multitude of opinions, knowledge, and resources on Web, but communication among students in Web-based courses is complicated. Technology adds a filter that makes it difficult to decipher the emotions behind words or read nonverbal cues. This is a concern because students benefit more from Web-based classes when they have a high perception of social presence. To enhance social presence on Web, we planned to use video-based assignments (VBAs) that encourage students to interact with each other. Objective: This case study examines the impact of VBAs on health professions students and their experiences with the technology. This study aims to provide information to the growing body of literature about strategies to develop social presence on Web. Methods: A total of 88 students from various nursing programs participated in the study. While the control group comprised 36 students who submitted only written-based assignments (WBAs), the experimental group of 52 students submitted VBAs besides WBAs. No enrolled student had previously participated in the course, and there were no repeaters in either of the groups. Both groups participated in a weekly survey comprising 4 open-ended questions and 3 Likert items on a scale of 1-5 (1=strongly disagree and 5=strongly agree). The social presence questionnaire assessed by the experimental group comprised 16 items and a 5-point Likert scale in which higher scores represented higher levels of social presence. While quantitative data were analyzed using descriptive statistics, qualitative responses were analyzed using content analysis. Results: No significant differences were noted between the groups regarding the program (F1,87=0.36, P=.54). Regarding students’ engagement, no statistically significant difference was observed between the 2 groups (t14=0.96, P=.35). However, the experimental group’s average score for engagement was slightly higher (4.29 [SD 0.11]) than that of the control group (4.21 [SD 0.14]). Comparison of the total number of responses to the weekly engagement survey revealed 88.0% (287/326) as either strongly agree or agree in the control group, whereas 93.1% (525/564) in the experimental group. No statistically significant difference was observed between VBAs and WBAs weeks (t6=1.40, P=.21) in the experimental group. Most students reported a positive experience using VBAs, but technical issues were barriers to embracing this new approach to learning. Conclusions: This study reveals that social presence and engagement are positively associated with student learning and satisfaction in Web-based courses. Suggestions are offered to enhance social presence on Web that could generate better learning outcomes and students’ experiences.

  • JMIR Med Educ 2018;4(2):e11390

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  Viewpoint and Opinions on Innovation...

  Nov 12, 2018

  Electronic Health Records as an Educational Tool: Viewpoint

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  Authors List:

  • Yacob Habboush  
  • Robert Hoyt  
  • Sary Beidas  

  Abstract:

  Background: Electronic health records (EHRs) have been adopted by most hospitals and medical offices in the United States. Because of the rapidity of implementation, health care providers have not been able to leverage the full potential of the EHR for enhancing clinical care, learning, and teaching. Physicians are spending an average of 49% of their working hours on EHR documentation, chart review, and other indirect tasks related to patient care, which translates into less face time with patients. Objective: The purpose of this article is to provide a preliminary framework to guide the use of EHRs in teaching and evaluation of residents. Methods: First we discuss EHR educational capabilities that have not been reviewed in sufficient detail in the literature and expand our discussion for each educational activity with examples. We emphasize quality improvement of clinical notes as a basic foundational skill using a spreadsheet-based application as an assessment tool. Next, we integrate the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and Milestones (CCMs) framework with the Reporter-Interpreter-Manager-Educator (RIME) model to expand our assessments of other areas of resident performance related to EHR use. Finally, we discuss how clinical utility, clinical outcome, and clinical reasoning skills can be assessed in the EHR. Results: We describe a pilot conceptual framework—CCM framework—to guide and demonstrate the use of the EHR for education in a clinical setting. Conclusions: As EHRs and other supporting technologies evolve, medical educators should continue to look for new opportunities within the EHR for education. Our framework is flexible to allow adaptation and use in most training programs. Future research should assess the validity of such methods on trainees’ education.

  • JMIR Med Educ 2018;4(2):e10306

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  New Methods and Approaches in Medical...

  Nov 7, 2018

  Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy

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  Authors List:

  • Sidra Zafar  
  • Yacob Habboush  
  • Sary Beidas  

  Abstract:

  Background: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework is a validated evaluation tool used to assess the quality of scientific publications. It helps in enhancing clinicians’ decision-making process and supports production of informed healthy policy. Objective: The purpose of this report was two-fold. First, we reviewed the interpretation of observational studies. The second purpose was to share or provide an example using the GRADE criteria. Methods: To illustrate the use of the GRADE framework to assess publications, we selected a study evaluating the risk of spontaneous abortion (SAB) after influenza vaccine administration. Results: Since 2004, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practice have recommended influenza vaccination of pregnant women. Previous studies have not found an association between influenza vaccination and SAB. However, in a recent case-control study by Donahue et al, a correlation with SAB in women who received the H1N1 influenza vaccine was identified. For women who received H1N1–containing vaccine in the previous and current influenza season, the adjusted odds ratio (aOR) for SAB was 7.7 (95% CI, 2.2-27.3), while the aOR for women not vaccinated in the previous season but vaccinated in the current season was 1.3 (95% CI, 0.7-2.7). Conclusions: Our goal is to enable the readers to critique published literature using appropriate evaluation tools such as GRADE.

  • JMIR Med Educ 2018;4(2):e10347

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  Virtual Patients

  Nov 6, 2018

  Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool

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  Authors List:

  • Simon Jacklin  
  • Neal Maskrey  
  • Stephen Chapman  

  Abstract:

  Background: Shared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this. Objective: The objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design. Methods: We employed a multistep design process drawing on patient and expert involvement. Results: A virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience. Conclusions: It is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity.

  • JMIR Med Educ 2018;4(2):e10088

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  Viewpoint and Opinions on Innovation...

  Oct 25, 2018

  Blending Gagne’s Instructional Model with Peyton’s Approach to Design an Introductory Bioinformatics Lesson Plan for Medical Students: Proof-of-Concept...

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  Authors List:

  • Richa Tambi  
  • Riad Bayoumi  
  • Peter Lansberg  
  • Yajnavalka Banerjee  

  Abstract:

  Background: With the rapid integration of genetics into medicine, it has become evident that practicing physicians as well as medical students and clinical researchers need to be updated on the fundamentals of bioinformatics. To achieve this, the following gaps need to be addressed: a lack of defined learning objectives for “Bioinformatics for Medical Practitioner” courses, an absence of a structured lesson plan to disseminate the learning objectives, and no defined step-by-step strategy to teach the essentials of bioinformatics in the medical curriculum. Objective: The objective of this study was to address these gaps to design a streamlined pedagogical strategy for teaching basics of bioinformatics in the undergraduate medical curriculum. Methods: The established instructional design strategies employed in medical education—Gagne’s 9 events of instruction—were followed with further contributions from Peyton’s four-step approach to design a structured lesson plan in bioinformatics. Results: First, we defined the specifics of bioinformatics that a medical student or health care professional should be introduced to use this knowledge in a clinical context. Second, we designed a structured lesson plan using a blended approach from both Gagne’s and Peyton’s instructional models. Lastly, we delineated a step-by-step strategy employing free Web-based bioinformatics module, combining it with a clinical scenario of familial hypercholesterolemia to disseminate the defined specifics of bioinformatics. Implementation of Schon’s reflective practice model indicated that the activity was stimulating for the students with favorable outcomes regarding their basic training in bioinformatics. Conclusions: To the best of our knowledge, the present lesson plan is the first that outlines an effective dissemination strategy for integrating introductory bioinformatics into a medical curriculum. Further, the lesson plan blueprint can be used to develop similar skills in workshops, continuing professional development, or continuing medical education events to introduce bioinformatics to practicing physicians.

  • JMIR Med Educ 2018;4(2):e11122

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  Training Tools for Medical Students

  Oct 17, 2018

  A Novel Web-Based Experiential Learning Platform for Medical Students (Learning Moment): Qualitative Study

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  Authors List:

  • Alexander Y Sheng  
  • Andrew Chu  
  • Dea Biancarelli  
  • Mari-Lynn Drainoni  
  • Ryan Sullivan  
  • Jeffrey I Schneider  

  Abstract:

  Background: Experiential learning plays a critical role in learner development. Kolb’s 4-part experiential learning model consists of concrete experience, reflective observation, abstract conceptualization, and active experimentation in a recurring cycle. Most clinical environments provide opportunities for experiences and active experimentation but rarely offer structured means for reflection and abstract conceptualization that are crucial for learners to learn through experience. We created Learning Moment, a novel Web-based educational tool that integrates principles of asynchronous learning and learning portfolios to fulfill the reflection and abstract conceptualization aspects of Kolb’s learning cycle in the modern clinical learning environment. Medical students log concise clinical “pearls” in the form of “learning moments” for reflection, review, and sharing with peers in a community of practice. Objective: We sought to evaluate learners’ experiences with Learning Moment via a qualitative study. Methods: We employed purposive sampling to recruit medical students who used Learning Moment during their rotation. We conducted 13 semistructured interviews (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. Results: A total of 13 students (five in their third year of medical school and eight in their fourth year) voluntarily participated in our qualitative interviews. Five of the 13 (38%) students intended to pursue emergency medicine as their chosen field of specialty. The median number of “learning moments” logged by these students is 6. From our analysis, three key themes emerged relating to the perceived impact of Learning Moment on student learning: (1) logging “learning moments” enhanced memorization, (2) improved learning through reflection, and (3) sharing of knowledge and experiences in a community of practice. Conclusions: Learning Moment was successfully implemented into the educational infrastructure in our department. Students identified three mechanisms by which the application optimizes experiential learning, including enabling the logging of “learning moments” to promote memorization, encouraging reflection to facilitate learning, and fostering the sharing of knowledge and experiences within a community of practice. The Learning Moment concept is potentially scalable to other departments, disciplines, and institutions as we seek to optimize experiential learning ecosystems for all trainees.

  • JMIR Med Educ 2018;4(2):e10657

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  Social Media in Medical Education

  Aug 21, 2018

  Enterprise Microblogging to Augment the Subinternship Clinical Learning Experience: A Proof-of-Concept Quality Improvement Study

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  Authors List:

  • Irsk Anderson  
  • Oliver Hulland  
  • Jeanne M Farnan  
  • Wei Wei Lee  
  • Debra Milton  
  • Vineet M Arora  

  Abstract:

  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: The objective of this study was to sustain a Web-based learning community across geographically disparate sites via enterprise microblogging to increase subintern exposure to the CDIM curriculum. Methods: Internal medicine subinterns used Yammer, a Health Insurance Portability and Accountability Act (HIPAA)–secure enterprise microblogging platform, to post questions, images, and index conversations for searching. The subinterns were asked to submit 4 posts and participate in 4 discussions during their rotation. Faculty reinforced key points, answered questions, and monitored HIPAA compliance. Results: In total, 56 medical students rotated on an internal medicine subinternship from July 2014 to June 2016. Of them, 84% returned the postrotation survey. Over the first 3 months, 100% of CDIM curriculum topics were covered. Compared with the pilot year, the scale-up year demonstrated a significant increase in the number of students with >10 posts (scale-up year 49% vs pilot year 19%; P=.03) and perceived educational experience (58% scale-up year vs 14% pilot year; P=.006). Few students (6%) noted privacy concerns, but fewer students in the scale-up year found Yammer to be a safe learning environment. Conclusions: Supplementing the subinternship clinical experience with an enterprise microblogging platform increased subinternship exposure to required curricular topics and was well received. Future work should address concerns about safe learning environment.

  • JMIR Med Educ 2018;4(2):e18

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