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JMIR Medical Education

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

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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 (e.g. open medical education material and software resources that are not yet evaluated but free for others to use/implement). 

In our "Students' Corner", we invite students and trainees in the health professions to submit short essays and viewpoints on all aspects of medical education, but in particular suggestions on how to improve medical education, and suggestions for new technologies, applications and approaches (no article processing fees).

A sister journal of the Journal of Medical Internet Research (JMIR), a leading eHealth journal (Impact Factor 2016: 5.175), 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:

  • Surgical knot tying. Source: US Air Force; Copyright: Benjamin Silva; URL: http://www.af.mil/News/Article-Display/Article/134877/air-force-doctors-perform-alternative-back-surgery/; License: Public Domain (CC0).
    Simulation

    Apr 12, 2018

    Instructional Video and Medical Student Surgical Knot-Tying Proficiency: Randomized Controlled Trial

    Authors List:

    Abstract:

    Background: Many senior medical students lack simple surgical and procedural skills such as knot tying. Objective: The aim of this study was to determine whether viewing a Web-based expert knot-tying training video, in addition to the standard third-year medical student curriculum, will result in more proficient surgical knot tying. Methods: At the start of their obstetrics and gynecology clerkship, 45 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded female pelvic medicine and reconstructive surgery physicians evaluated proficiency with a standard checklist (score range 0-16) and anchored scoring scale (range 0-20); higher numbers represent better skill. Students were then randomized to either (1) expert video (n=26) or (2) nonvideo (n=24) groups. The video group was provided unlimited access to an expert knot-tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated. Results: At initial evaluation, preclerkship cumulative scores (range 0-36) on the standard checklist and anchored scale were not significantly different between the nonvideo and video groups (mean 20.3, SD 7.1 vs mean 20.2, SD 9.2, P=.90, respectively). Postclerkship scores improved in both the nonvideo and video groups (mean 28.4, SD 5.4, P<.001 and mean 28.7, SD 6.5, P=.004, respectively). Increased knot board practice was significantly correlated with higher postclerkship scores on the knot-tying task, but only in the video group (r=.47, P<.05). Conclusions: The addition of a Web-based expert instructional video to a standard curriculum, coupled with knot board practice, appears to have a positive impact on medical student knot-tying proficiency.

  • Source: Flickr; Copyright: DFID; URL: https://www.flickr.com/photos/dfid/16615636819; License: Creative Commons Attribution (CC-BY).
    Graduate and Postgraduate Education...

    Apr 11, 2018

    Jordan Field Epidemiology Training Program: Critical Role in National and Regional Capacity Building

    Authors List:

    Abstract:

    Field Epidemiology Training Programs (FETPs) are 2-year training programs in applied epidemiology, established with the purpose of increasing a country’s capacity within the public health workforce to detect and respond to health threats and develop internal expertise in field epidemiology. The Jordan Ministry of Health, in partnership with the US Centers for Disease Control and Prevention, started the Jordan FETP (J-FETP) in 1998. Since then, it has achieved a high standard of success and has been established as a model for FETPs in the Eastern Mediterranean Region. Here we describe the J-FETP, its role in building the epidemiologic capacity of Jordan’s public health workforce, and its activities and achievements, which have grown the program to be self-sustaining within the Jordan Ministry of Health. Since its inception, the program’s residents and graduates have assisted the country to improve its surveillance systems, including revising the mortality surveillance policy, implementing the use of electronic data reporting, investigating outbreaks at national and regional levels, contributing to noncommunicable disease research and surveillance, and responding to regional emergencies and disasters. J-FETP’s structure and systems of support from the Jordan Ministry of Health and local, regional, and international partners have contributed to the success and sustainability of the J-FETP. The J-FETP has contributed significantly to improvements in surveillance systems, control of infectious diseases, outbreak investigations, and availability of reliable morbidity and mortality data in Jordan. Moreover, the program has supported public health and epidemiology in the Eastern Mediterranean Region. Best practices of the J-FETP can be applied to FETPs throughout the world.

  • A researcher examining how online lectures have been integrated into medical school curricula (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://mededu.jmir.org/2018/1/e11/; License: Creative Commons Attribution (CC-BY).
    Training Tools for Medical Students

    Apr 10, 2018

    Online Lectures in Undergraduate Medical Education: Scoping Review

    Authors List:

    Abstract:

    Background: The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools—including online lectures—before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes. Objective: The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design. Methods: This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education. Results: In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use. Conclusions: Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential.

  • Residents using the smartphone application on their phone for education. Source: Image created by the Authors; Copyright: The Authors; URL: http://mededu.jmir.org/2018/1/e10/; License: Creative Commons Attribution (CC-BY).
    Mobile Approaches to Medical Education

    Mar 13, 2018

    Improving Internal Medicine Residents’ Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study

    Authors List:

    Abstract:

    Background: Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective: The objective of our study was to assess the improvement in internal medicine residents’ CRC screening knowledge via a pilot approach using a smartphone app. Methods: We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents’ knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. Results: A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. Conclusions: In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents’ knowledge about CRC screening.

  • The interactive multimedia module, featuring a game-based quiz (montage). Source: The Authors / Magic Mockups; Copyright: JMIR Publications; URL: http://mededu.jmir.org/2018/1/e8/; License: Creative Commons Attribution (CC-BY).
    Mobile Approaches to Medical Education

    Mar 8, 2018

    Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology–Head and Neck Surgery Disorders: Pilot Randomized...

    Authors List:

    Abstract:

    Background: The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology–head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. Objective: The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. Methods: This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. Results: Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI −75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change −41, 95% CI −67 to −20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality (difference 1.7, 95% CI 0.1-2.7; P=.03), and hedonic stimulation (difference 1.9, 95% CI 0.3-3.1; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants’ attention but that the nonlinearly arranged materials affected their learning. Conclusions: Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. Trial Registration: ClinicalTrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV)

  • Particip8 app screenshot. Source: Image created by the Authors; Copyright: The Authors; URL: http://mededu.jmir.org/2018/1/e7/; License: Creative Commons Attribution (CC-BY).
    New Resources for Medical Education

    Mar 7, 2018

    Self-Reflected Well-Being via a Smartphone App in Clinical Medical Students: Feasibility Study

    Authors List:

    Abstract:

    Background: Well-being in medical students has become an area of concern, with a number of studies reporting high rates of clinical depression, anxiety, burnout, and suicidal ideation in this population. Objective: The aim of this study was to increase awareness of well-being in medical students by using a smartphone app. The primary objective of this study was to determine the validity and feasibility of the Particip8 app for student self-reflected well-being data collection. Methods: Undergraduate medical students of the Dunedin School of Medicine were recruited into the study. They were asked to self-reflect daily on their well-being and to note what experiences they had encountered during that day. Qualitative data were also collected both before and after the study in the form of focus groups and “free-text” email surveys. All participants consented for the data collected to be anonymously reported to the medical faculty. Results: A total of 29 participants (69%, 20/29 female; 31%, 9/29 male; aged 21-30 years) were enrolled, with overall median compliance of 71% at the study day level. The self-reflected well-being scores were associated with both positive and negative experiences described by the participants, with most negative experiences associated with around 20% lower well-being scores for that day; the largest effect being “receiving feedback that was not constructive or helpful,” and the most positive experiences associated with around 20% higher scores for that day. Conclusions: The study of daily data collection via the Particip8 app was found to be feasible, and the self-reflected well-being scores showed validity against participant’s reflections of experiences during that day.

  • SPOC course [montage]. Source: Image created by the authors; Copyright: The Authors; URL: http://mededu.jmir.org/2018/1/e6/; License: Creative Commons Attribution (CC-BY).
    New Methods and Approaches in Medical...

    Mar 5, 2018

    The Impact of a Small Private Online Course as a New Approach to Teaching Oncology: Development and Evaluation

    Authors List:

    Abstract:

    Background: Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. Objective: The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). Methods: A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants’ satisfaction rate through a questionnaire and the success of the SPOC by participants’ completion, success, and commitment rates. Results: Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients’ associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7% (90/446) had an independent medical practice, 38.5% (140/446) worked in a public institution, and 36.8% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9% (384/446) thought they had learned new information, 90.8% (405/446) felt their expectations were met, and 90.4% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51% (559/1574), the success rate was 71.47% (1025/1574), and the commitment rate was 64.67% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants. Conclusions: SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students’ expectations.

  • Learners' peer interaction. Source: Image created by the Authors; Copyright: The Authors; URL: http://mededu.jmir.org/2018/1/e4/; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).
    Virtual Patients

    Feb 27, 2018

    Increasing Reasoning Awareness: Video Analysis of Students’ Two-Party Virtual Patient Interactions

    Authors List:

    Abstract:

    Background: Collaborative reasoning occurs in clinical practice but is rarely developed during education. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases and thus stimulate active learning. Peer settings during VP sessions are believed to have benefits in terms of reasoning but have received scant attention in the literature. Objective: The objective of this study was to thoroughly investigate interactions during medical students’ clinical reasoning in two-party VP settings. Methods: An in-depth exploration of students’ interactions in dyad settings of VP sessions was performed. For this purpose, two prerecorded VP sessions lasting 1 hour each were observed, transcribed in full, and analyzed. The transcriptions were analyzed using thematic analysis, and short clips from the videos were selected for subsequent analysis in relation to clinical reasoning and clinical aspects. Results: Four categories of interactions were identified: (1) task-related dialogue, in which students negotiated a shared understanding of the task and strategies for information gathering; (2) case-related insights and perspectives were gained, and the students consolidated and applied preexisting biomedical knowledge into a clinical setting; (3) clinical reasoning interactions were made explicit. In these, hypotheses were followed up and clinical examples were used. The researchers observed interactions not only between students and the VP but also (4) interactions with other resources, such as textbooks. The interactions are discussed in relation to theories of clinical reasoning and peer learning. Conclusions: The dyad VP setting is conducive to activities that promote analytic clinical reasoning. In this setting, components such as peer interaction, access to different resources, and reduced time constraints provided a productive situation in which the students pursued different lines of reasoning.

  • Source: US Army; Copyright: Corey Toye; URL: https://www.army.mil/article/151759/leaders_go_suits_to_scrubs_to_improve_patient_care; License: Public Domain (CC0).
    Evaluation of Medical Education

    Feb 26, 2018

    Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study

    Authors List:

    Abstract:

    Background: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Objective: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. Methods: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. Results: Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. Conclusions: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool’s effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future.

  • Source: Pixabay; Copyright: StockSnap; URL: https://pixabay.com/en/youtube-iphone-smartphone-mobile-2617510/; License: Public Domain (CC0).
    New Methods and Approaches in Medical...

    Feb 12, 2018

    Medical YouTube Videos and Methods of Evaluation: Literature Review

    Authors List:

    Abstract:

    Background: Online medical education has relevance to public health literacy and physician efficacy, yet it requires a certain standard of reliability. While the internet has the potential to be a viable medical education tool, the viewer must be able to discern which information is reliable. Objective: Our aim was to perform a literature review to determine and compare the various methods used when analyzing YouTube videos for patient education efficacy, information accuracy, and quality. Methods: In November 2016, a comprehensive search within PubMed and Embase resulted in 37 included studies. Results: The review revealed that each video evaluation study first established search terms, exclusion criteria, and methods to analyze the videos in a consistent manner. The majority of the evaluators devised a scoring system, but variations were innumerable within each study’s methods. Conclusions: In comparing the 37 studies, we found that overall, common steps were taken to evaluate the content. However, a concrete set of methods did not exist. This is notable since many patients turn to the internet for medical information yet lack the tools to evaluate the advice being given. There was, however, a common aim of discovering what health-related content the public is accessing, and how credible that material is.

  • A disaster site. Source: The Authors; Copyright: Emily Ying Yang Chan; URL: https://www.flickr.com/photos/95598235@N05/20460133143/in/album-72157657673451358/; License: Creative Commons Attribution (CC-BY).
    Continuing Medical Education (CME)...

    Jan 26, 2018

    A Web-Based Course on Public Health Principles in Disaster and Medical Humanitarian Response: Survey Among Students and Faculty

    Authors List:

    Abstract:

    Background: Web-based public health courses are becoming increasingly popular. “Public Health Principles in Disaster and Medical Humanitarian Response” is a unique Web-based course in Hong Kong. This course aimed to fill a public health training gap by reaching out to postgraduates who are unable to access face-to-face learning. Objective: The aim of this paper was to use a structured framework to objectively evaluate the effectiveness of a Web-based course according to Greenhalgh et al’s quality framework and the Donabedian model to make recommendations for program improvement. Methods: An interim evaluation of the first cohort of students in 2014 was conducted according to the Donabedian model and a quality framework by Greenhalgh et al using objective and self-reported data. Results: Students who registered for the first cohort (n=1152) from June 16, 2014 to December 15, 2014 (6 months) were surveyed. Two tutors and the course director were interviewed. The Web-based course was effective in using technology to deliver suitable course materials and assessment and to enhance student communication, support, and learning. Of the total number of students registered, 59.00% (680/1152) were nonlocal, originating from 6 continents, and 72.50% (835/1152) possessed a bachelor’s or postgraduate degree. The completion rate was 20.00% (230/1152). The chi-square test comparing students who completed the course with dropouts showed no significant difference in gender (P=.40), age (P=.98), occupation (P=.43), or qualification (P=.17). The cost (HK $272 per student) was lower than that of conducting a face-to-face course (HK $4000 per student). Conclusions: The Web-based course was effective in using technology to deliver a suitable course and reaching an intended audience. It had a higher completion rate than other Web-based courses. However, sustainable sources of funding may be needed to maintain the free Web-based course.

  • Source: iStock by Getty Images; Copyright: gchutka; URL: https://www.istockphoto.com/photo/negative-test-results-gm186845751-17450331?clarity=false; License: Licensed by the authors.
    New Methods and Approaches in Medical...

    Jan 4, 2018

    Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey...

    Authors List:

    Abstract:

    Background: Electronic health record (EHR) use can enhance or undermine the ability of providers to deliver effective, humanistic patient-centered care. Given patient-centered care has been found to positively impact patient health outcomes, it is critical to provide formal education on patient-centered EHR communication skills. Unfortunately, despite increasing worldwide EHR adoption, few institutions educate trainees on EHR communication best practices. Objective: The goal of this research was to develop and deliver mandatory patient-centered EHR training to all incoming housestaff at the University of Chicago. Methods: We developed a brief patient-centered EHR use curriculum highlighting best practices based on a literature search. Training was embedded into required EHR onboarding for all incoming housestaff (interns, residents, and fellows) at the University of Chicago in 2015 and was delivered by institutional Clinical Applications Trainers. An 11-item posttraining survey consisting of ten 5-point Likert scale questions and 1 open-ended question was administered. Responses at the high end of the scale were grouped to dichotomize data. Results: All 158 of the incoming 2015 postgraduate trainees participated in training and completed surveys (158/158, 100.0%). Just over half (86/158, 54.4%) were interns and the remaining were residents and fellows (72/158, 45.6%). One-fifth of respondents (32/158, 20.2%) were primary care trainees (defined as internal medicine, pediatric, and medicine-pediatric trainees), and the remaining 79.7% (126/158) were surgical or specialty trainees. Self-perceived pre- versus posttraining knowledge of barriers, best practices, and ability to implement patient-centered EHR skills significantly increased (3.1 vs 3.9, P<.001 for all). Most felt training was effective (90.5%), should be required (86.7%), and would change future practice as a result (70.9%). The only significant difference between intern and resident/fellow responses was prior knowledge of patient-centered EHR use barriers; interns endorsed higher prior knowledge than resident peers (3.27 vs 2.94 respectively, P=.03). Response comparison of specialty or surgical trainees (n=126) to primary care trainees (n=32) showed no significant differences in prior knowledge of barriers (3.09 vs 3.22, P=.50), of best practices (3.08 vs 2.94, P=.37), or prior ability to implement best practices (3.11 vs 2.84, P=.15). Primary care trainees had larger increases posttraining than surgical/specialty peers in knowledge of barriers (0.8 vs 0.7, P=.62), best practices (1.1 vs 0.8, P=.08), and ability to implement best practices (1.1 vs 0.7, P=.07), although none reached statistical significance. Primary care trainees also rated training as more effective (4.34 vs 4.09, P=.03) and felt training should be required (4.34 vs 4.09, P=.10) and would change their future practice as a result (4.13 vs 3.73, P=.02). Conclusions: Embedding EHR communication skills training into required institutional EHR training is a novel and effective way to teach key EHR skills to trainees. Such training may help ground trainees in best practices and contribute to cultivating an institutional culture of humanistic, patient-centered EHR use.

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  • The Video-Based Communication Assessment: An Innovative System for Assessing Clinician-Patient Communication

    Date Submitted: Mar 14, 2018

    Open Peer Review Period: Mar 14, 2018 - May 9, 2018

    Background: Good clinician-patient communication is essential to quality health care, and key to patient centered care. However, individuals and organizations seeking to improve in this area face sign...

    Background: Good clinician-patient communication is essential to quality health care, and 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. Objective: Our objective was to design and create the Video-Based Communication Assessment (VCA™), an innovative, flexible online system for assessing and ultimately enhancing clinicians’ communication skills. Methods: We began by elaborating a vision of the VCA. Specifically, we determined that the assessment system should be: 1) convenient and efficient, accessible via computer, tablet or smartphone; 2) case-based, using video patient vignettes to which users respond as if speaking to the patient in the vignette; 3) flexible, allowing content to be tailored to the purpose of the assessment; 4) incorporate the patient’s voice by crowdsourcing ratings from analog patients; 5) provide robust feedback including ratings, links to highly rated responses (i.e., exemplars), and learning points; and 6) ultimately have strong psychometric properties. We collected feedback on the concept and then proceeded to develop the system. We identified several important research questions which will be answered in subsequent studies. Results: The VCA is not a single, immutable assessment, but rather an assessment system that can be adapted and tailored to assess a variety of communication skills. Much like standardized patient-based assessments where case content is varied depending on the purpose of the assessment, VCA vignettes can be created to assess specific skills. For example, one set of VCA vignettes could be created to assess skill in providing information in a general medicine outpatient context, while another set of vignettes could be created to assess skill in disclosing medical errors. Our goal in creating the first set of VCA vignettes was to assess communication skills broadly, using clinical situations that would be familiar and relevant to providers from a variety of backgrounds. Conclusions: 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, and multi-faceted feedback reports.

  • Use of GRADE for Journal Club to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy

    Date Submitted: Mar 8, 2018

    Open Peer Review Period: Mar 12, 2018 - May 7, 2018

    The purpose of this report is two-fold. First, we review the interpretation of observational studies from the standpoint of an internal medicine journal club format. A Second purpose is to share/provi...

    The purpose of this report is two-fold. First, we review the interpretation of observational studies from the standpoint of an internal medicine journal club format. A Second purpose is to share/provide an example using the GRADE criteria. GRADE is a validated tool used to quantitively assess the overall quality of a study. To illustrate, we selected a study assessing the risk of spontaneous abortion (SAB) after influenza vaccine administration. Since 2004, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practice (ACIP) 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.J. et al, a correlation for SAB in women who received the H1N1 influenza vaccine was identified. This correlation was observed in the first 28 days after influenza vaccine administration. Our goal is to enable our learners to critique the published literature using appropriate evaluation tools.

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