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Journal Description

JMIR Medical Education (JME) is a Pubmed-indexed, peer-reviewed journal with focus on technology, innovation and openess in medical education. Another focus is on how to train health professionals in the use of digital tools. We publish original research, reviews, viewpoint and policy papers on innovation and technology in medical education. As an open access journal we have a special interest in open and free tools and digitial learning objects for medical education, and urge authors to make their tools and learning objects freely available (we may also publish them as Multimedia Appendix). We also invite submissions of non-conventional articles (eg, 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 2017: 4.671), the scope of JME is broader and includes non-Internet approaches to improve education, training and assessment for medical professionals and allied health professions.

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

 

Recent Articles:

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://mededu.jmir.org/2018/2/e10306/; License: Creative Commons Attribution (CC-BY).
    Viewpoint and Opinions on Innovation...

    Nov 12, 2018

    Electronic Health Records as an Educational Tool: Viewpoint

    Authors List:

    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.

  • Source: Free Stock Photos; Copyright: CDC / Doug Jordan; URL: http://www.freestockphotos.biz/stockphoto/17095; License: Public Domain (CC0).
    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

    Authors List:

    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.

  • A virtual patient to help clinicians practice shared decision making (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://mededu.jmir.org/2018/2/e10088/; License: Creative Commons Attribution (CC-BY).
    Virtual Patients

    Nov 6, 2018

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

    Authors List:

    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.

  • Source: Flickr; Copyright: University of Nottingham; URL: https://www.flickr.com/photos/uonottingham/8447714122; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).
    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...

    Authors List:

    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.

  • Learning Moment interface (montage). Source: The Authors; Copyright: The Authors; URL: http://mededu.jmir.org/2018/2/e10657/; License: Licensed by JMIR.
    Training Tools for Medical Students

    Oct 17, 2018

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

    Authors List:

    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.

  • Source: Pixabay; Copyright: Pexels; URL: https://pixabay.com/en/apple-iphone-smartphone-technology-1281744/; License: Public Domain (CC0).
    Social Media in Medical Education

    Aug 21, 2018

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

    Authors List:

    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.

  • Source: Pixabay; Copyright: rawpixel; URL: https://pixabay.com/en/break-business-cafe-coffee-shop-2642605/; License: Public Domain (CC0).
    Social Media in Medical Education

    Jul 23, 2018

    Expanding Opportunities for Professional Development: Utilization of Twitter by Early Career Women in Academic Medicine and Science

    Authors List:

    Abstract:

    The number of women entering medical school and careers in science is increasing; however, women remain the minority of those in senior faculty and leadership positions. Barriers contributing to the shortage of women in academics and academic leadership are numerous, including a shortage of role models and mentors. Thus, achieving equity in a timelier manner will require more than encouraging women to pursue these fields of study or waiting long enough for those in the pipelines to be promoted. Social media provides new ways to connect and augments traditional forms of communication. These alternative avenues may allow women in academic medicine to obtain the support they are otherwise lacking. In this perspective, we reflect on the role of Twitter as a supplemental method for navigating the networks of academic medicine. The discussion includes the use of Twitter to obtain (1) access to role models, (2) peer-to-peer interactions, and continuous education, and (3) connections with those entering the pipeline—students, trainees, and mentees. This perspective also offers suggestions for developing a Twitter network. By participating in the “Twittersphere,” women in academic medicine may enhance personal and academic relationships that will assist in closing the gender divide.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/woman-medic-and-patient-in-hallway_1815005.htm; License: Licensed by JMIR.
    Continuing Medical Education (CME)...

    Jul 19, 2018

    Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET)

    Authors List:

    Abstract:

    Background: Although most physicians in medical settings have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and nonverbal skills, the ability to recognize and respond to patients’ emotions and the importance of considering the patient’s environment such as culture and social status. How bad news is delivered can have consequences that may affect patients, sometimes over the long term. Objective: This project aimed to develop a Web-based formative self-assessment tool for physicians to practice delivering bad news to minimize the deleterious effects of poor way of breaking bad news about a disease, whatever the disease. Methods: BReaking bAD NEws Tool (BRADNET) items were developed by reviewing existing protocols and recommendations for delivering bad news. We also examined instruments for assessing patient-physician communications and conducted semistructured interviews with patients and physicians. From this step, we selected specific themes and then pooled these themes before consensus was achieved on a good practices communication framework list. Items were then created from this list. To ensure that physicians found BRADNET acceptable, understandable, and relevant to their patients’ condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was used to explore the impact of the items and messages and why and how these messages could change physicians’ relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). Results: The good practices communication framework list comprised 70 specific issues related to breaking bad news pooled into 8 main domains: opening, preparing for the delivery of bad news, communication techniques, consultation content, attention, physician emotional management, shared decision making, and the relationship between the physician and the medical team. After constructing the items from this list, the items were extensively refined to make them more useful to the target audience, and one item was added. BRADNET contains 71 items, each including a question, response options, and a corresponding message, which were divided into 8 domains and assessed with 12 self-assessment sessions. The BRADNET Web-based platform was developed according to the cognitive load theory and the cognitive theory of multimedia learning. Conclusions: The objective of this Web-based assessment tool was to create a “space” for reflection. It contained items leading to self-reflection and messages that introduced recommended communication behaviors. Our approach was innovative as it provided an inexpensive distance-learning self-assessment tool that was manageable and less time-consuming for physicians with often overwhelming schedules.

  • Source: Pixabay; Copyright: StockSnap; URL: https://pixabay.com/en/mobile-phone-gadget-apple-2598295/; License: Public Domain (CC0).
    Social Media in Medical Education

    Jul 13, 2018

    How an Environment of Stress and Social Risk Shapes Student Engagement With Social Media as Potential Digital Learning Platforms: Qualitative Study

    Authors List:

    Abstract:

    Background: Social media has been increasingly used as a learning tool in medical education. Specifically, when joining university, students often go through a phase of adjustment, and they need to cope with various challenges such as leaving their families and friends and trying to fit into a new environment. Research has shown that social media helps students to connect with old friends and to establish new relationships. However, managing friendships on social media might intertwine with the new learning environment that shapes students’ online behaviors. Especially, when students perceive high levels of social risks when using social media, they may struggle to take advantage of the benefits that social media can provide for learning. Objective: This study aimed to develop a model that explores the drivers and inhibitors of student engagement with social media during their university adjustment phase. Methods: We used a qualitative method by interviewing 78 undergraduate students studying medical courses at UK research-focused universities. In addition, we interviewed 6 digital technology experts to provide additional insights into students’ learning behaviors on social media. Results: Students’ changing relationships and new academic environment in the university adjustment phase led to various factors that affected their social media engagement. The main drivers of social media engagement were maintaining existing relationships, building new relationships, and seeking academic support. Simultaneously, critical factors that inhibited the use of social media for learning emerged, namely, collapsed online identity, uncertain group norms, the desire to present an ideal self, and academic competition. These inhibitors led to student stress when managing their social media accounts, discouraged them from actively engaging on social media, and prevented the full exploitation of social media as an effective learning tool. Conclusions: This study identified important drivers and inhibitors for students to engage with social media platforms as learning tools. Although social media supported students to manage their relationships and support their learning, the interaction of critical factors, such as collapsed online identity, uncertain group norms, the desire to present an ideal self, and academic competition, caused psychological stress and impeded student engagement. Future research should explore how these inhibitors can be removed to reduce students’ stress and to increase the use of social media for learning. More specifically, such insights will allow students to take full advantage of being connected, thus facilitating a richer learning experience during their university life.

  • Source: Freepik; Copyright: Teerawut Masawat; URL: https://www.freepik.com/free-photo/doctor-writing-a-prescription_977807.htm; License: Licensed by JMIR.
    Specialist Training for Doctors

    Jun 15, 2018

    Resident and Attending Physicians’ Perceptions of Patient Access to Provider Notes: Comparison of Perceptions Prior to Pilot Implementation

    Authors List:

    Abstract:

    Background: As electronic health records have become a more integral part of a physician’s daily life, new electronic health record tools will continue to be rolled out to trainees. Patient access to provider notes is becoming a more widespread practice because this has been shown to increase patient empowerment. Objective: In this analysis, we compared differences between resident and attending physicians’ perceptions prior to implementation of patient access to provider notes to facilitate optimal use of electronic health record features and as a potential for patient empowerment. Methods: This was a single-site study within an academic internal medicine program. Prior to implementation of patient access to provider notes, we surveyed resident and attending physicians to assess differences in perceptions of this new electronic health record tool using an open access survey provided by OpenNotes. Results: We surveyed 37% (20/54 total) of resident physicians and obtained a 100% response rate and 72% (31/44 total) of attending physicians. Similarities between the groups included concerns about documenting sensitive topics and anticipation of improved patient engagement. Compared with attending physicians, resident physicians were more concerned about litigation, discussing weight, offending patients, and communicated less overall with patients through electronic health record. Conclusions: Patient access to provider notes has the potential to empower patients but concerns of the resident physicians need to be validated and addressed prior to its utilization.

  • A medical student viewing the Human Body Block resource page of the CU School of Medicine Wiki (montage). Source: University of Colorado / Placeit.net; Copyright: The Authors; URL: http://mededu.jmir.org/2018/1/e16/; License: Creative Commons Attribution (CC-BY).
    Student/Learners Perceptions and...

    Jun 14, 2018

    Taking Constructivism One Step Further: Post Hoc Analysis of a Student-Created Wiki

    Authors List:

    Abstract:

    Background: Wiki platform use has potential to improve student learning by improving engagement with course material. A student-created wiki was established to serve as a repository of study tools for students in a medical school curriculum. There is a scarcity of information describing student-led creation of wikis in medical education. Objective: The aim is to characterize website traffic of a student-created wiki and evaluate student perceptions of usage via a short anonymous online survey. Methods: Website analytics were used to track visitation statistics to the wiki and a survey was distributed to assess ease of use, interest in contributing to the wiki, and suggestions for improvement. Results: Site traffic data indicated high usage, with a mean of 315 (SD 241) pageviews per day from July 2011 to March 2013 and 74,317 total user sessions. The mean session duration was 1.94 (SD 1.39) minutes. Comparing Fall 2011 to Fall 2012 sessions revealed a large increase in returning visitors (from 12,397 to 20,544, 65.7%) and sessions via mobile devices (831 to 1560, 87.7%). The survey received 164 responses; 88.0% (162/184) were aware of the wiki at the time of the survey. On average, respondents felt that the wiki was more useful in the preclinical years (mean 2.73, SD 1.25) than in the clinical years (mean 1.88, SD 1.12; P<.001). Perceived usefulness correlated with the percent of studying for which the respondent used electronic resources (Spearman ρ=.414, P<.001). Conclusions: Overall, the wiki was a highly utilized, although informal, part of the curriculum with much room for improvement and future exploration.

  • Medical student studying online material in radiology course. Source: UC Riverside School of Medicine; Copyright: UC Riverside School of Medicine; URL: http://mededu.jmir.org/2018/1/e14/; License: Creative Commons Attribution (CC-BY).
    Training Tools for Medical Students

    May 18, 2018

    An Internet-Based Radiology Course in Medical School: Comparison of Academic Performance of Students on Campus Versus Those With Absenteeism Due to Residency...

    Authors List:

    Abstract:

    Background: Imaging and its optimal use are imperative to the practice of medicine, yet many students don’t receive a formal education in radiology. Concurrently, students look for ways to take time away from medical school for residency interviewing. Web-based instruction provides an opportunity to combine these imperatives using online modalities. Objective: A largely Web-based course in radiology during the 4th year of medical school was evaluated both for its acceptance to students who needed to be away from campus for interviews, and its effectiveness on a nationally administered standardized test. Methods: All students were placed into a structured program utilizing online videos, online modules, online textbook assignments, and live interactive online lectures. Over half of the course could be completed away from campus. The Alliance of Medical Student Educators in Radiology test exam bank was used as a final exam to evaluate medical knowledge. Results: Positive student feedback included the freedom to travel for interviews, hands-on ultrasound training, interactive teaching sessions, and quality Web-based learning modules. Negative feedback included taking quizzes in-person, a perceived outdated online textbook, and physically shadowing hospital technicians. Most students elected to take the course during the interview months of October through January. The Alliance of Medical Student Educators in Radiology final exam results (70.5%) were not significantly different than the national cohort (70%) who took the course in-person. Test scores from students taking the course during interview travel months were not significantly different from students who took the course before (P=.30) or after (P=.34) the interview season. Conclusions: Students desire to learn radiology and often choose to do so when they need to be away from campus during the fall of their 4th year of study to accomplish their residency interviews. Web-based education in radiology allows students’ interview traveling and radiology course objectives to be successfully met without adversely affecting the outcomes on a nationally normed examination in radiology. A curriculum that includes online content and live Web-based teleconference access to faculty can accomplish both imperatives.

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  • Increasing access to medical training with 3D printing: The endotracheal intubation model

    Date Submitted: Oct 28, 2018

    Open Peer Review Period: Nov 3, 2018 - Dec 29, 2018

    Background: Endotracheal intubation (ETI) is a crucial life-saving procedure, where greater than two failed attempts can lead to further complications or even death. Like all technical skills, ETI req...

    Background: Endotracheal intubation (ETI) is a crucial life-saving procedure, where greater than two failed attempts can lead to further complications or even death. Like all technical skills, ETI requires sufficient practice to perform adequately. Currently, the models used to practice ETI are expensive, and therefore, difficult to access, particularly in the developing world and in settings that lack a dedicated simulation centre. Objective: The objective is to improve access to ETI training by creating a comparable, yet cost-effective simulation model producible by 3D printers. Methods: Open source mesh files of relevant anatomy from BodyParts3D were modified through 3D modelling programs, Meshlab and Blender. Several prototypes with varying filaments were tried to optimize the ETI simulation. Results: We have created the novel 3D-printed Endotracheal Intubation Model for learners at all levels to practice this airway management skill at negligible costs compared to current simulation models. It is an open source design available for all medical trainees. Conclusions: Revolutions in cost and ease of use has allowed home and even desktop 3D printers to become widespread. Therefore, open-source access to the Endotracheal Intubation Model will improve accessibility to medical training in the hopes of optimizing patient care.

  • Development and Evaluation of the Online Addiction Medicine Certificate: A Free Novel Program in a Canadian Setting

    Date Submitted: Oct 10, 2018

    Open Peer Review Period: Oct 25, 2018 - Dec 20, 2018

    Background: Despite the enormous burden of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evidence-based addiction care and treatment modalities. Thi...

    Background: Despite the enormous burden of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evidence-based addiction care and treatment modalities. This is partly due to a persistent lack of accessible, specialized training in addiction medicine. In response, a new online certificate in addiction medicine has been established in Vancouver, Canada, free of charge to participants globally. Objective: To evaluate and examine changes in knowledge acquisition among health care professionals before and after completion of an online certificate in addiction medicine. Methods: Learners enrolled in a 17-module certificate program and completed pre- and post- knowledge tests using online multiple-choice questionnaires. Knowledge acquisition was then evaluated using a repeated measures t-test of mean test scores before and after the online course. Following certificate completion, a subset of learners completed online course evaluation form. Results: Of the total 6985 participants who registered for the online course between May 15, 2017 and February 22, 2018, 3466 (49.6%) completed the online pre-test questionnaire. A total of 1010 participants completed the full course, achieving the required 70% scores. Participants self-reported working in a broad range of health-related fields, including nursing (371), medicine (92), counselling or social work (69), community health (44), and pharmacy (34). The median graduation year was 2010 (n = 363, interquartile range 2002-2015). Knowledge of addiction medicine increased significantly post-certificate (mean difference 28.21; 95% Confidence Interval 27.32-29.10; p<0.001). Physicians scored significantly higher on the pre-test than any other health discipline (p<0.01), while the greatest improvement in scores was seen in the counselling professions (p<0.05) and community outreach (p<0.01). Conclusions: This free, online, open-access certificate in addiction medicine was found to improve knowledge of learners from a variety of disciplines and backgrounds. Scaling up “low threshold” learning opportunities may further advance addiction medicine training, thereby helping to narrow the evidence-to-practice gap.

  • Telemedicine and Undergraduate Medical Education: Lessons in Capacity Building

    Date Submitted: Oct 16, 2018

    Open Peer Review Period: Oct 25, 2018 - Dec 20, 2018

    Background: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the healthcare environment are serving to fuel this growth into the future....

    Background: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the healthcare environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing healthcare expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States in order to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. Objective: To collect and outline the current experiences and learnings that have been generated as medical schools have sought to implement telemedicine capacity-building into undergraduate medical education. Methods: A mixed-methods review was performed, starting with a literature review via SCOPUS and an outreach effort utilizing telemedicine curriculum data gathered by the LCME. This outreach included seventy institutions and yielded seven interviews, four peer-reviewed research papers, six online documents, and three completed survey responses. Results: There is an emerging, rich international body of learning being generated in the field of telemedicine training in undergraduate medical education. The integration of telemedicine-based lessons, ethics case-studies, clinical rotations, and even tele-assessments, are being found to offer great value for medical schools and their students. Most medical students find such training to be a valuable component of their preclinical and clinical education for a variety of reasons, which include fostering greater familiarity with telemedicine and increased comfort with applying telemedical approaches in their future careers. Conclusions: These competencies are increasingly important in tackling the challenges facing healthcare in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited.

  • Thrombolysis For Early Post Renal Transplant Myocardial Infarction – A Case Report

    Date Submitted: Oct 3, 2018

    Open Peer Review Period: Oct 6, 2018 - Dec 1, 2018

    Introduction: Cardiovascular disease is a major cause of morbidity and is now the leading cause of death in patients with renal transplants. We report a case of acute myocardial infarction three weeks...

    Introduction: Cardiovascular disease is a major cause of morbidity and is now the leading cause of death in patients with renal transplants. We report a case of acute myocardial infarction three weeks post renal transplant. Case Report: A 45 year old male renal transplant renal transplant recipient presented three weeks post-transplant with acute chest pain, hypotension and atrial fibrillation. He was found to have Infero-posterior wall myocardial infarction. He was thrombolysed with Tenectaplase, and developed a perinephric hematoma six hours later. He underwent transfusions and pigtail drainage of the hematoma. The hematoma resolved, and he was started on dual anti-platelets with stable renal function. Conclusion: Thrombolysis in the early post-transplant period is considered a very high risk procedure. Our case illustrates the use of the thrombolytic therapy in the early post transplant period and successful management of the attendant complications.

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