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  New Methods and Approaches in Medical...

  Jun 14, 2019

  Applications and Challenges of Implementing Artificial Intelligence in Medical Education: Integrative Review

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  Authors List:

  • Kai Siang Chan  
  • Nabil Zary  

  Abstract:

  Background: Since the advent of artificial intelligence (AI) in 1955, the applications of AI have increased over the years within a rapidly changing digital landscape where public expectations are on the rise, fed by social media, industry leaders, and medical practitioners. However, there has been little interest in AI in medical education until the last two decades, with only a recent increase in the number of publications and citations in the field. To our knowledge, thus far, a limited number of articles have discussed or reviewed the current use of AI in medical education. Objective: This study aims to review the current applications of AI in medical education as well as the challenges of implementing AI in medical education. Methods: Medline (Ovid), EBSCOhost Education Resources Information Center (ERIC) and Education Source, and Web of Science were searched with explicit inclusion and exclusion criteria. Full text of the selected articles was analyzed using the Extension of Technology Acceptance Model and the Diffusions of Innovations theory. Data were subsequently pooled together and analyzed quantitatively. Results: A total of 37 articles were identified. Three primary uses of AI in medical education were identified: learning support (n=32), assessment of students’ learning (n=4), and curriculum review (n=1). The main reasons for use of AI are its ability to provide feedback and a guided learning pathway and to decrease costs. Subgroup analysis revealed that medical undergraduates are the primary target audience for AI use. In addition, 34 articles described the challenges of AI implementation in medical education; two main reasons were identified: difficulty in assessing the effectiveness of AI in medical education and technical challenges while developing AI applications. Conclusions: The primary use of AI in medical education was for learning support mainly due to its ability to provide individualized feedback. Little emphasis was placed on curriculum review and assessment of students’ learning due to the lack of digitalization and sensitive nature of examinations, respectively. Big data manipulation also warrants the need to ensure data integrity. Methodological improvements are required to increase AI adoption by addressing the technical difficulties of creating an AI application and using novel methods to assess the effectiveness of AI. To better integrate AI into the medical profession, measures should be taken to introduce AI into the medical school curriculum for medical professionals to better understand AI algorithms and maximize its use.

  • JMIR Med Educ 2019;5(1):e13930

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  Mobile Approaches to Medical Education

  Jun 11, 2019

  Impact of an Electronic App on Resident Responses to Simulated In-Flight Medical Emergencies: Randomized Controlled Trial

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  Authors List:

  • Nur-Ain Nadir  
  • Courtney J Cook  
  • Raymond E Bertino  
  • Marc D Squillante  
  • Cameron Taylor  
  • David Dragoo  
  • Gregory S Podolej  
  • Jessica D Svendsen  
  • Jessica L Fish  
  • Jeremy S McGarvey  
  • William F Bond  

  Abstract:

  Background: Health care providers are often called to respond to in-flight medical emergencies, but lack familiarity with expected supplies, interventions, and ground medical control support. Objective: The objective of this study was to determine whether a mobile phone app (airRx) improves responses to simulated in-flight medical emergencies. Methods: This was a randomized study of volunteer, nonemergency resident physician participants who managed simulated in-flight medical emergencies with or without the app. Simulations took place in a mock-up cabin in the simulation center. Standardized participants played the patient, family member, and flight attendant roles. Live, nonblinded rating was used with occasional video review for data clarification. Participants participated in two simulated in-flight medical emergencies (shortness of breath and syncope) and were evaluated with checklists and global rating scales (GRS). Checklist item success rates, key critical action times, GRS, and pre-post simulation confidence in managing in-flight medical emergencies were compared. Results: There were 29 participants in each arm (app vs control; N=58) of the study. Mean percentages of completed checklist items for the app versus control groups were mean 56.1 (SD 10.3) versus mean 49.4 (SD 7.4) for shortness of breath (P=.001) and mean 58 (SD 8.1) versus mean 49.8 (SD 7.0) for syncope (P<.001). The GRS improved with the app for the syncope case (mean 3.14, SD 0.89 versus control mean 2.6, SD 0.97; P=.003), but not the shortness of breath case (mean 2.90, SD 0.97 versus control mean 2.81, SD 0.80; P=.43). For timed checklist items, the app group contacted ground support faster for both cases, but the control group was faster to complete vitals and basic exam. Both groups indicated higher confidence in their postsimulation surveys, but the app group demonstrated a greater increase in this measure. Conclusions: Use of the airRx app prompted some actions, but delayed others. Simulated performance and feedback suggest the app is a useful adjunct for managing in-flight medical emergencies.

  • JMIR Med Educ 2019;5(1):e10955

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  Continuing Medical Education (CME)...

  Jun 7, 2019

  Evidence-Based Physical Therapy Practice in the State of Kuwait: A Survey of Attitudes, Beliefs, Knowledge, Skills, and Barriers

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  Authors List:

  • Hesham N Alrowayeh  
  • Ali J Buabbas  
  • Talal A Alshatti  
  • Fatemah M AlSaleh  
  • Jawad F Abulhasan  

  Abstract:

  Background: Evidence-based practice (EBP) is necessary to improve the practice of physical therapy. However, a lack of knowledge and skills among physical therapists and the presence of barriers may hinder the implementation of EBP in the State of Kuwait. Objective: The objectives of this study were to extensively (1) investigate attitudes toward EBP, (2) assess the current level of knowledge and skills necessary for EBP, and (3) identify the barriers to EBP among physical therapists in the State of Kuwait. Methods: The following methods were used: (1) a previously validated self-reported questionnaire and (2) a face-to-face semistructured interview. The questionnaire, which was distributed to 200 physical therapists, examined the attitudes and beliefs of physical therapists about EBP; the interest in and motivation to engage in EBP; educational background, knowledge, and skills related to accessing and interpreting information; the level of attention to and use of the literature; access to and availability of information to promote EBP; and the perceived barriers to using EBP. The interview explored the factors that promote or discourage EBP. Descriptive statistics and logistic regression analyses were used. Results: Of the 200 nonrandomly distributed questionnaires, 92% (184/200) were completed and returned. In general, the physical therapists had positive attitudes, beliefs, and interests in EBP. Their educational background, knowledge, and skills related to assessing and interpreting information were well-founded. The top 3 barriers included insufficient time (59.2%, 109/184), lack of information resources (49.4%, 91/184), and inapplicability of the research findings to the patient population (40.7%, 75/184). Conclusions: EBP lacks support from superiors at work. Thus, identifying methods and strategies to support physical therapists in adopting EBP in the State of Kuwait is necessary.

  • JMIR Med Educ 2019;5(1):e12795

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  Training Tools for Medical Students

  May 28, 2019

  YouTube Videos as a Source of Information About Immunology for Medical Students: Cross-Sectional Study

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  Authors List:

  • Jef Van den Eynde  
  • Alexander Crauwels  
  • Philip Georg Demaerel  
  • Lisa Van Eycken  
  • Dominique Bullens  
  • Rik Schrijvers  
  • Jaan Toelen  

  Abstract:

  Background: The use of the internet as a source of information has grown exponentially in the last decade. YouTube is currently the second most visited website and a major Web-based educational resource for medical students. Objective: The aim of this study was to evaluate the quality, accuracy, and attractiveness of the information acquired from YouTube videos about 2 central concepts in immunology. Methods: YouTube videos posted before August 27, 2018 were searched using selected keywords related to either antigen presentation or immunoglobulin gene rearrangement. Video characteristics were recorded, and the Video Power Index (VPI) was calculated. Videos were assessed using 5 validated scoring systems: understandability and attractiveness, reliability, content and comprehensiveness, global quality score (GQS), and a subjective score. Videos were categorized by educational usefulness and by source. Results: A total of 82 videos about antigen presentation and 70 about immunoglobulin gene rearrangement were analyzed. Videos had a mean understandability and attractiveness score of 6.57/8 and 5.84/8, content and comprehensiveness score of 9.84/20 and 5.84/20, reliability score of 1.65/4 and 1.53/4, GQS of 3.38/5 and 2.76/5, and subjective score of 2.00/3 and 2.00/3, respectively. The organized channels group tended to have the highest VPI and GQS. Conclusions: YouTube can provide medical students with some useful information about immunology, although content wise it cannot substitute textbooks and academic courses. Students and teachers should be aware of the educational quality of available videos if they intend to use them in the context of blended learning.

  • JMIR Med Educ 2019;5(1):e12605

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  Evaluation of Medical Education

  May 24, 2019

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

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  Authors List:

  • Lauren Renee Gorfinkel  
  • Amanda Giesler  
  • Huiru Dong  
  • Evan Wood  
  • Nadia Fairbairn  
  • Jan Klimas  

  Abstract:

  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 because of 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: The objective of this study was to evaluate and examine changes in knowledge acquisition among health care professionals before and after the completion of an online certificate in addiction medicine. Methods: Learners enrolled in a 17-module certificate program and completed pre- and postknowledge 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 the certificate completion, a subset of learners completed the 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 (49.62%) completed the online pretest questionnaire. A total of 1010 participants completed the full course, achieving the required 70% scores. TThe participants self-reported working in a broad range of health-related fields, including nursing (n=371), medicine (n=92), counseling or social work (n=69), community health (n=44), and pharmacy (n=34). The median graduation year was 2010 (n=363, interquartile range 2002-2015). Knowledge of the addiction medicine increased significantly postcertificate (mean difference 28.21; 95% CI 27.32 to 29.10; P<.001). Physicians scored significantly higher on the pretest than any other health discipline, whereas the greatest improvement in scores was seen in the counseling professions and community outreach. Conclusions: This free, online, open-access certificate in addiction medicine appeared 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.

  • JMIR Med Educ 2019;5(1):e12474

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  Viewpoint and Opinions on Innovation...

  May 6, 2019

  Not Just a Medical Student: Delivering Medical Education Through a Short Video Series on Social Media

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  Authors List:

  • Nadine Abbas  
  • Utkarsh Ojha  

  Abstract:

  “Not Just a Medical Student” is an innovative bite-size medical education video series founded and hosted on social media. Its primary aim is to inspire tomorrow’s doctors to be creative while engaging and informing them with the latest innovations, technology, and conferences within various specialties. To our knowledge, these themes are scarcely covered in the structured medical curriculum. Created and launched in August 2017, “Not Just a Medical Student” quickly gained traction; with over 1000 followers on Facebook and a rapidly increasing number of views, it reached the medical community across the globe. The video series features a trailblazer in virtual reality surgery and its potential impact on the evolution of medical education, reviewing future medical technology apps, such as Touch Surgery, and reporting on the latest medical education and health apps. The series engaged in topical medico-politics at the British Medical Association House and reported on global health issues and innovations at the Royal Society of Medicine Conference. The video series has further received several national awards including the Association and Study of Medical Education (ASME) Educator Innovator 2017 award, runner up to the Zeshan Qureshi Outstanding Contribution to Medical Education Award, and the Alternative Docs National Social Media Influencer award. The concept has been presented at international conferences (eg, the Healthcare Leadership Academy conference) and gained international recognition upon personal invitation at the Norwegian Annual Junior Doctors Conference. With the rise of the social media generation, innovative methods to inspire, engage, and inform students contributing to the continuous evolution of medical education should be encouraged and further explored.

  • JMIR Med Educ 2019;5(1):e11971

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  Continuing Medical Education (CME)...

  Apr 22, 2019

  Exploring Care Providers’ Perceptions and Current Use of Telehealth Technology at Work, in Daily Life, and in Education: Qualitative and Quantitative Study

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  Authors List:

  • Hyeyoung Hah  
  • Deana Goldin  

  Abstract:

  Background: A telehealth technology education curriculum designed to integrate information technology and telecommunication well has great potential to prepare care providers for health care delivery across space, time, and social and cultural barriers. It is important to assess the readiness level of care providers to use and maximize the benefits of telehealth technology in the health care delivery process. Therefore, this study explored care providers’ existing experience using technology in various use contexts and compared their familiarity with telehealth technology’s relevant features. Objective: This study’s objective was to explore care providers’ familiarity with using technology in different settings and their perceptions of telehealth-driven care performance to lay a foundation for the design of an effective telehealth education program. Methods: The study used quantitative and qualitative analyses. The online survey included four items that measured care providers’ perceptions of care performance when using telehealth technology. Advanced practice registered nurse students rated each item on a 7-point Likert scale, ranging from 1 (“strongly disagree”) to 7 (“strongly agree”). They also responded to three open-ended questions about what kinds of health information technology they use at work, after work, and in their current educational program. Results: A total of 109 advanced practice registered nurse students responded to the online survey and open-ended questionnaire. Most indicated that using telehealth technology enhances care performance (mean 5.67, median 6.0, SD 1.36), helps make their care tasks more effective (mean 5.73, median 6.0, SD 1.30), improves the quality of performing care tasks (mean 5.71, median 6.0, SD 1.30), and decreases error in communicating and sharing information with others (mean 5.35, median 6.0, SD 1.53). In addition, our qualitative analyses revealed that the students used the electronic health records technology primarily at work, combined with clinical decision support tools for medication and treatment management. Outside work, they primarily used video-text communication tools and were exposed to some telehealth technology in their education setting. Further, they believe that use of nonhealth technology helps them use health information technology to access health information, confirm their diagnoses, and ensure patient safety. Conclusions: This research highlights the importance of identifying care providers’ existing experience of using technology to better design a telehealth technology education program. By focusing explicitly on the characteristics of care providers’ existing technology use in work, nonwork, and educational settings, we found a potential consistency between practice and education programs in care providers’ requirements for technology use, as well as areas of focus to complement their frequent use of nonhealth technologies that resemble telehealth technology. Health policymakers and practitioners need to provide compatible telehealth education programs tailored to the level of care providers’ technological familiarity in both their work and nonwork environments.

  • JMIR Med Educ 2019;5(1):e13350

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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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