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  Continuing Medical Education (CME)...

  Apr 18, 2019

  Motivating HIV Providers in Vietnam to Learn: A Mixed-Methods Analysis of a Mobile Health Continuing Medical Education Intervention

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  Authors List:

  • Anna Larson Williams  
  • Andrew Hawkins  
  • Lora Sabin  
  • Nafisa Halim  
  • Bao Le Ngoc  
  • Viet Ha Nguyen  
  • Tam Nguyen  
  • Rachael Bonawitz  
  • Christopher Gill  

  Abstract:

  Background: The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])–based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants. Objective: The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants’ views of the intervention. We also developed an explanatory framework for future trial replication. Methods: At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education. Results: A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians’ decision to engage in higher learning, or “lateral learning,” including the participant’s availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context. Conclusions: Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention’s impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education. Trial Registration: ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743

  • JMIR Med Educ 2019;5(1):e12058

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  Training Tools for Medical Students

  Apr 12, 2019

  Supporting Students With Electronic Health Record–Embedded Learning Aids: A Mixed-Methods Study

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  Authors List:

  • Sanne Peters  
  • Geraldine Clarebout  
  • Bert Aertgeerts  
  • Jimmie Leppink  
  • Ann Roex  

  Abstract:

  Background: Students often perceive workplace-based learning as disconnected from what they learn in medical school. Interventions that deal with this issue regularly involve feedback and/or learning aids. Feedback has frequently been encouraged in previous research, whereas the use of aids is less understood. Objective: This study aims to investigate the added value of learning aids in making the connection and enhancing the transfer of learning between medical school and workplace-based learning. Methods: First-year students in postgraduate general practice training participated in a mixed-methods study. Within a quasi-experimental design, two conditions were investigated: (1) students having access to electronic health record (EHR)–embedded learning aids and feedback and (2) students only receiving feedback. Semistructured interviews were conducted and analyzed according to the thematic analysis approach. Results: Forty-four students participated in this study. No significant difference was found between the two conditions (t42=–0.511, P=.61, 95% CI –4.86 to 2.90). Nevertheless, students used the aids frequently and found them useful. Given that the aids were familiar to students and contained practice-based instructions in an easily accessible format, they were perceived as feasible to use during workplace-based learning. They also appeared to stimulate transfer of learning, self-confidence, reflection, and interaction between student and supervisor. Conclusions: Access to EHR-embedded learning aids offers additional support during, but also before and after, patient encounters. The aids can be easily implemented into workplace-based learning.

  • JMIR Med Educ 2019;5(1):e11351

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  Undergraduate Education for Allied...

  Apr 11, 2019

  Development and Evaluation of a Hybrid Course in Clinical Virology at a Faculty of Pharmacy in Lille, France

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  Authors List:

  • Anne Goffard  
  • Pascal Odou  
  • El Moukhtar Aliouat  
  • Cécile-Marie Aliouat-Denis  
  • Christophe Carnoy  
  • Bertrand Décaudin  
  • Cuny Damien  
  • Mounira Hamoudi  
  • Claire Pinçon  
  • Katia Quelennec  
  • Sebastien Zanetti  
  • Pierre Ravaux  
  • Annie Standaert  

  Abstract:

  Background: During their studies, pharmacy students must acquire the specific skills in clinical virology required for their subsequent professional practice. Recent experiments on teaching and learning in higher education have shown that hybrid courses strengthen the students’ commitment to learning and enable high-quality knowledge acquisition. Objective: This study concerned the design and deployment of a hybrid course that combines face-to-face and Web-based instruction in clinical virology for fourth-year pharmacy students. The study’s objectives were to (1) measure the students’ level of involvement in the course, (2) gauge their interest in this type of learning, and (3) highlight any associated difficulties. Methods: The study included 194 fourth-year pharmacy students from the Lille Faculty of Pharmacy (University of Lille, Lille, France) between January and June 2017. The students followed a hybrid course comprising an online learning module and 5 tutorial sessions in which professional situations were simulated. The learning module and 3 online evaluation sessions were delivered via the Moodle learning management system. Each tutorial session ended with an evaluation. The number of Moodle log-ins, the number of views of learning resources, and the evaluation marks were recorded. The coefficient for the correlation between the marks in the online evaluation and those in the tutorials was calculated. The students’ opinions and level of satisfaction were evaluated via a course questionnaire. Results: The course’s learning resources and Web pages were viewed 21,446 and 3413 times, respectively. Of the 194 students, 188 (96.9%) passed the course (ie, marks of at least 10 out of 20). There was a satisfactory correlation between the marks obtained in the online evaluations and those obtained after the tutorials. The course met the students’ expectations in 53.2% of cases, and 57.4% of the students stated that they were able to work at their own pace. Finally, 26.6% of the students stated that they had difficulty organizing their work around this hybrid course. Conclusions: Our results showed that pharmacy students were strongly in favor of a hybrid course. The levels of attendance and participation were high. However, teachers must be aware that some students will encounter organizational difficulties.

  • JMIR Med Educ 2019;5(1):e10766

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  Training Tools for Medical Students

  Apr 9, 2019

  Increasing Access to Medical Training With Three-Dimensional Printing: Creation of an Endotracheal Intubation Model

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  Authors List:

  • Lily Park  
  • Steven Price-Williams  
  • Alireza Jalali  
  • Kashif Pirzada  

  Abstract:

  Background: Endotracheal intubation (ETI) is a crucial life-saving procedure, where more than 2 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 center. Objective: This study aimed to improve access to ETI training by creating a comparable yet cost-effective simulation model producible by 3-dimensional (3D) printers. Methods: Open-source mesh files of relevant anatomy from BodyParts3D were modified through the 3D modeling programs Meshlab (ISTI-CNR) and Blender (Blender Foundation). Several prototypes with varying filaments were tried to optimize the ETI simulation. Results: We have created the novel 3D-printed pediatric ETI model for learners at all levels to practice this airway management skill at negligible costs compared with current simulation models. It is an open-source design available for all medical trainees. Conclusions: Revolutions in cost and ease of use have allowed home and even desktop 3D printers to become widespread. Therefore, open-source access to the ETI model will improve accessibility to medical training in the hopes of optimizing patient care.

  • JMIR Med Educ 2019;5(1):e12626

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  New Methods and Approaches in Medical...

  Apr 8, 2019

  Telemedicine Training in Undergraduate Medical Education: Mixed-Methods Review

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  Authors List:

  • Shayan Waseh  
  • Adam P Dicker  

  Abstract:

  Background: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care 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 health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. Objective: The aim of this review was 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: We performed a mixed-methods review, starting with a literature review via Scopus, tracking with Excel, and an email outreach effort utilizing telemedicine curriculum data gathered by the Liaison Committee on Medical Education. This outreach included 70 institutions and yielded 7 interviews, 4 peer-reviewed research papers, 6 online documents, and 3 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 teleassessments 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 health care in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited.

  • JMIR Med Educ 2019;5(1):e12515

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  New Methods and Approaches in Medical...

  Apr 8, 2019

  Faculty and Student Interaction in an Online Master’s Course: Survey and Content Analysis

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  Authors List:

  • Christopher Aylwin  

  Abstract:

  Background: The provision of online educational courses has soared since the creation of the World Wide Web, with most universities offering some degree of distance-based programs. The social constructivist pedagogy is widely accepted as the framework to provide education, but it largely relies on the face-to-face presence of students and faculty to foster a learning environment. The concern with online courses is that this physical interaction is removed, and therefore learning may be diminished. Objective: The Community of Inquiry (CoI) is a framework designed to support the educational experience of such courses. This study aims to examine the characteristics of the CoI across the whole of an entirely online master’s course. Methods: This research used a case study method, using a convergent parallel design to study the interactions described by the CoI model in an online master’s program. The MSc program studied is a postgraduate medical degree for doctors or allied health professionals. Different data sources were used to corroborate this dataset including content analysis of both asynchronous and synchronous discussion forums. Results: This study found that a CoI can be created within the different learning activities of the course. The discussion forums integral to online courses are a rich source of interaction, with the ability to promote social interaction, teaching presence, and cognitive learning. Conclusions: The results show that meaningful interaction between faculty and student can be achieved in online courses, which is important to ensure deep learning and reflection.

  • JMIR Med Educ 2019;5(1):e10464

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  Reviews in Medical Education

  Apr 5, 2019

  How We Evaluate Postgraduate Medical E-Learning: Systematic Review

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  Authors List:

  • Robert de Leeuw  
  • Anneloes de Soet  
  • Sabine van der Horst  
  • Kieran Walsh  
  • Michiel Westerman  
  • Fedde Scheele  

  Abstract:

  Background: Electronic learning (e-learning) in postgraduate medical education has seen a rapid evolution; however, we tend to evaluate it only on its primary outcome or learning aim, whereas its effectiveness also depends on its instructional design. We believe it is important to have an overview of all the methods currently used to evaluate e-learning design so that the preferred method may be identified and the next steps needed to continue to evaluate postgraduate medical e-learning may be outlined. Objective: This study aimed to identify and compare the outcomes and methods used to evaluate postgraduate medical e-learning. Methods: We performed a systematic literature review using the Web of Science, PubMed, Education Resources Information Center, and Cumulative Index of Nursing and Allied Health Literature databases. Studies that used postgraduates as participants and evaluated any form of e-learning were included. Studies without any evaluation outcome (eg, just a description of e-learning) were excluded. Results: The initial search identified 5973 articles, of which we used 418 for our analysis. The types of studies were trials, prospective cohorts, case reports, and reviews. The primary outcomes of the included studies were knowledge, skills, and attitude. A total of 12 instruments were used to evaluate a specific primary outcome, such as laparoscopic skills or stress related to training. The secondary outcomes mainly evaluated satisfaction, motivation, efficiency, and usefulness. We found 13 e-learning design methods across 19 studies (4% 19/418). The methods evaluated usability, motivational characteristics, and the use of learning styles or were based on instructional design theories, such as Gagne’s instructional design, the Heidelberg inventory, Kern’s curriculum development steps, and a scale based on the cognitive load theory. Finally, 2 instruments attempted to evaluate several aspects of a design, based on the experience of creating e-learning. Conclusions: Evaluating the effect of e-learning design is complicated. Given the diversity of e-learning methods, there are many ways to carry out such an evaluation, and probably, many ways to do so correctly. However, the current literature shows us that we have yet to reach any form of consensus about which indicators to evaluate. There is a great need for an evaluation tool that is properly constructed, validated, and tested. This could be a more homogeneous way to compare the effects of e-learning and for the authors of e-learning to continue to improve their product.

  • JMIR Med Educ 2019;5(1):e13128

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  Massive Open Online Courses (MOOC)

  Apr 2, 2019

  Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study

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  Authors List:

  • Abrar Alturkistani  
  • Azeem Majeed  
  • Josip Car  
  • David Brindley  
  • Glenn Wells  
  • Edward Meinert  

  Abstract:

  Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark’s method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners’ experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology.

  • JMIR Med Educ 2019;5(1):e10982

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  Continuing Medical Education (CME)...

  Mar 28, 2019

  Health Care Providers’ Profiles and Evaluations of a Statewide Online Education Program for Dissemination of Clinical Evidence on HIV, Hepatitis C Virus,...

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  Authors List:

  • Dongwen Wang  
  • Meredith Abrams  

  Abstract:

  Background: Timely and effective dissemination of the latest clinical evidence to health care providers is essential for translating biomedical research into routine patient care. Online platforms offer unique opportunities for dissemination of medical knowledge. Objective: In this study, we report the profiles of health care providers participating in the New York State HIV-HCV-STD Clinical Education Initiative online program and their evaluations of the online continuing professional development courses. Methods: We compiled professional and personal background information of the clinicians who completed at least one online course. We collected their self-reported program evaluation data with regard to the course content, format, knowledge increase, and impact on clinical practice. Results: We recorded a total of 4363 completions of 88 online courses by 1976 unique clinicians during a 12-month study period. The clinicians’ background was diverse in terms of demographics, education levels, professional disciplines, practice years, employment settings, caseloads, and clinical services. The evaluation of online courses was very positive (usefulness/relevance, 91.08%; easy comprehension, 89.09%; knowledgeable trainer, 92.00%; appropriate format, 84.35%; knowledge increase, 48.52%; intention to use knowledge, 85.26%; and plan to change practice, 21.98%). Comparison with the reference data indicated that the online program successfully reached out to the primary care communities. Both the younger generation and the senior health care providers were attracted to the online program. High-quality multimedia resources, flexibility of access, ease of use, and provision of continuing professional development credits contributed to the initial success of this online clinical education program. Conclusions: We have successfully characterized a diverse group of clinicians participating in a statewide online continuing professional development program. The evaluation has shown effective use of online resources to disseminate clinical evidence on HIV, hepatitis C virus, and sexually transmitted disease to primary care clinicians.

  • JMIR Med Educ 2019;5(1):e10722

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  Social Media in Medical Education

  Mar 25, 2019

  Augmenting Flexnerism Via Twitterism: Need for Integrating Social Media Application in Blueprinting Pedagogical Strategies for Undergraduate Medical Education

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  Authors List:

  • Yajnavalka Banerjee  
  • Richa Tambi  
  • Mandana Gholami  
  • Alawi Alsheikh-Ali  
  • Riad Bayoumi  
  • Peter Lansberg  

  Abstract:

  Background: Flexnerism, or “competency-based medical education,” advocates that formal analytic reasoning, the kind of rational thinking fundamental to the basic sciences, especially the natural sciences, should be the foundation of physicians’ intellectual training. The complexity of 21st century health care requires rethinking of current (medical) educational paradigms. In this “Millennial Era,” promulgation of the tenets of Flexnerism in undergraduate medical education requires a design and blueprint of innovative pedagogical strategies, as the targeted learners are millennials (designated as generation-Y medical students). Objective: The aim of this proof-of-concept study was to identify the specific social media app platforms that are selectively preferred by generation-Y medical students in undergraduate medical education. In addition, we aimed to explore if these preferred social media apps can be used to design an effective pedagogical strategy in order to disseminate course learning objectives in the preclinical phase of a spiral curriculum. Methods: A cross-sectional survey was conducted by distributing a 17-item questionnaire among the first- and second-year medical students in the preclinical phase at the Mohammed Bin Rashid University of Medicine and Health Science. Results: The study identified YouTube and WhatsApp as the social media app platforms preferred by generation-Y medical students in undergraduate medical education. This study also identified the differences between female and male generation-Y medical students in terms of the use of social media apps in medical education, which we believe will assist instructors in designing pedagogical strategies to integrate social media apps. In addition, we determined the perceptions of generation-Y medical students on the implementation of social media apps in medical education. The pedagogical strategy designed using social media apps and implemented in the Biochemistry course was well accepted by generation-Y medical students and can be translated to any course in the preclinical phase of the medical curriculum. Moreover, the identified limitations of this study provide an understanding of the gaps in research in the integration of social media apps in a medical curriculum catering to generation-Y medical students. Conclusions: 21st century medical education requires effective use of social media app platforms to augment competency-based medical education: Augmentation of Flexnerism in the current scenario is possible only by the adaptation of Twitterism.

  • JMIR Med Educ 2019;5(1):e12403

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  Undergraduate Education for Future...

  Mar 22, 2019

  Computer Programming: Should Medical Students Be Learning It?

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  Authors List:

  • Caroline E Morton  
  • Susan F Smith  
  • Tommy Lwin  
  • Michael George  
  • Matt Williams  

  Abstract:

  Background: The ability to construct simple computer programs (coding) is being progressively recognized as a life skill. Coding is now being taught to primary-school children worldwide, but current medical students usually lack coding skills, and current measures of computer literacy for medical students focus on the use of software and internet safety. There is a need to train a cohort of doctors who can both practice medicine and engage in the development of useful, innovative technologies to increase efficiency and adapt to the modern medical world. Objective: The aim of the study was to address the following questions: (1) is it possible to teach undergraduate medical students the basics of computer coding in a 2-day course? (2) how do students perceive the value of learning computer coding at medical school? and (3) do students see computer coding as an important skill for future doctors? Methods: We developed a short coding course to teach self-selected cohorts of medical students basic coding. The course included a 2-day introduction on writing software, discussion of computational thinking, and how to discuss projects with mainstream computer scientists, and it was followed on by a 3-week period of self-study during which students completed a project. We explored in focus groups (FGs) whether students thought that coding has a place in the undergraduate medical curriculum. Results: Our results demonstrate that medical students who were complete novices at coding could be taught enough to be able to create simple, usable clinical programs with 2 days of intensive teaching. In addition, 6 major themes emerged from the FGs: (1) making sense of coding, (2) developing the students’ skill set, (3) the value of coding in medicine, research, and business, (4) role of teaching coding in medical schools, (5) the concept of an enjoyable challenge, and (6) comments on the course design. Conclusions: Medical students can acquire usable coding skills in a weekend course. They valued the teaching and identified that, as well as gaining coding skills, they had acquired an understanding of its potential both for their own projects and in health care delivery and research. They considered that coding skills teaching should be offered as an optional part of the medical curriculum.

  • JMIR Med Educ 2019;5(1):e11940

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  Mobile Approaches to Medical Education

  Feb 14, 2019

  Video-Based Communication Assessment: Development of an Innovative System for Assessing Clinician-Patient Communication

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  Authors List:

  • Kathleen M Mazor  
  • Ann M King  
  • Ruth B Hoppe  
  • Annie O Kochersberger  
  • Jie Yan  
  • Jesse D Reim  

  Abstract:

  Good clinician-patient communication is essential to provide quality health care and is key to patient-centered care. However, individuals and organizations seeking to improve in this area face significant challenges. A major barrier is the absence of an efficient system for assessing clinicians’ communication skills and providing meaningful, individual-level feedback. The purpose of this paper is to describe the design and creation of the Video-Based Communication Assessment (VCA), an innovative, flexible system for assessing and ultimately enhancing clinicians’ communication skills. We began by developing the VCA concept. Specifically, we determined that it should be convenient and efficient, accessible via computer, tablet, or smartphone; be case based, using video patient vignettes to which users respond as if speaking to the patient in the vignette; be flexible, allowing content to be tailored to the purpose of the assessment; allow incorporation of the patient’s voice by crowdsourcing ratings from analog patients; provide robust feedback including ratings, links to highly rated responses as examples, and learning points; and ultimately, have strong psychometric properties. We collected feedback on the concept and then proceeded to create the system. We identified several important research questions, which will be answered in subsequent studies. The VCA is a flexible, innovative system for assessing clinician-patient communication. It enables efficient sampling of clinicians’ communication skills, supports crowdsourced ratings of these spoken samples using analog patients, and offers multifaceted feedback reports.

  • JMIR Med Educ 2019;5(1):e10400

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