@Article{info:doi/10.2196/60790, author="Martinez, Jacob and Cordero, I. Jacquelin and Whitney, Meagan and LaRoche, L. Katie and Frietze, Gabriel and Moya, M. Eva and Gosselink, Kristin", title="Web-Based Human Papillomavirus Education and Professional Skills Intervention for Health Care Providers: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="3", volume="14", pages="e60790", keywords="human papillomavirus", keywords="randomized controlled trial", keywords="HPV knowledge", keywords="HPV vaccine", keywords="health care provider", keywords="provider recommendations", keywords="communication strategies", keywords="Hispanic", abstract="Background: ?The human papillomavirus (HPV) vaccine is an effective way to prevent HPV and its associated cancers. Provider recommendation has been shown to be one of the most successful strategies for increasing the uptake of the HPV vaccine; however, more training and resources are needed to help boost health care providers' confidence and communication skills in recommending the HPV vaccine to their patients, particularly in underserved Hispanic communities where vaccination rates among all ages are lower. Objective: ?This study aims to compare HPV educational and professional skills intervention effectiveness on improving provider recommendations and patient communication strategies with health care providers serving the El Paso United States--Mexico border region. Methods: ?We will conduct a randomized, blinded, multiple posttest-only controlled behavioral trial using a parallel group design that will examine the effectiveness of a fully automated, web-based, culturally tailored HPV education and professional skills intervention containing unique reading material and video role-play, as compared to a standard Centers for Disease Control and Prevention fact sheet and video about general communication skills. Participants were recruited using a purposive sampling technique, both internet-based and in-person outreach events. Study data are being collected and managed using REDCap (Research Electronic Data Capture; Vanderbilt University) hosted at the University of Texas at El Paso. Chi-square analyses, ANOVA, and other statistical tests will be used with 2-tail $\alpha$ to reject null hypotheses at .05 to analyze the self-assessed outcome data. The Mauchly test of sphericity for each ANOVA and the Huynh-Feldt epsilon test or Greenhouse-Geisser correction to the degrees of freedom of the F-ratio will be reported for each significant effect. We may use multiple imputation procedures to handle the missing data (if applicable). This study is being conducted in the west Texas or southeast New Mexico region of the United States. Chi-square analyses will be used to assess associations between variables reported on the baseline provider knowledge, attitudes, and practice scales. We seek to examine self-assessed changes in provider attitudes and behaviors regarding HPV vaccine recommendation 1 month after receiving our unique multimedia and culturally tailored intervention. Results: ?Research and data collection for this clinical trial began in December 2023. Participant recruitment was closed by May 2024 (N=128), with final data collection expected to be completed by December 2024. Conclusions: ?This study team decided to report on the intervention protocol to help ensure transparency in the research process and facilitate the improvement of the research design. Tailored web-based educational programs for health care professionals, designed to address regional and patient population characteristics, may be a promising approach to enhancing the real-world implementation of clinical practice guidelines. Trial Registration: ClinicalTrials.gov NCT05120869; http://clinicaltrials.gov/ct2/show/NCT05120869 International Registered Report Identifier (IRRID): PRR1-10.2196/60790 ", doi="10.2196/60790", url="https://www.researchprotocols.org/2025/1/e60790" } @Article{info:doi/10.2196/55313, author="Wiet, Ryan and Casanova, P. Madeline and Moore, D. Jonathan and Deming, M. Sarah and Baker Jr, T. Russell", title="Creation of the ECHO Idaho Podcast: Tutorial and Pilot Assessment", journal="JMIR Med Educ", year="2025", month="Mar", day="21", volume="11", pages="e55313", keywords="Project ECHO", keywords="ECHO Idaho", keywords="medical education", keywords="medical training", keywords="medication teaching", keywords="medical knowledge", keywords="rural health care", keywords="rural medicine", keywords="underserved population", keywords="underserved people", keywords="substance use", keywords="substance use disorder", keywords="SUD", keywords="drug abuse", keywords="drug use", keywords="alcoholism", keywords="addiction", keywords="pain", keywords="behavioral health", keywords="podcast", keywords="webinar", abstract="Background: Project ECHO (Extension for Community Health Outcomes) is an innovative program that uses videoconferencing technology to connect health care providers with experts. The model has been successful in reaching health care providers in rural and underserved areas and positively impacting clinical practice. ECHO Idaho, a replication partner, has developed programming that has increased knowledge and confidence of health care professionals throughout the state of Idaho, United States. Although the ECHO model has a demonstrated ability to recruit, educate, and train health care providers, barriers to attending Project ECHO continuing education (CE) programs remain. The asynchronous nature of podcasts could be used as an innovative medium to help address barriers to CE access that health care professionals face. The ECHO Idaho ``Something for the Pain'' podcast was developed to increase CE accessibility to rural and frontier providers, while upscaling their knowledge of and competence to treat and assess substance use disorders, pain, and behavioral health conditions. Objective: This paper describes the creation and preliminary assessment of the ECHO Idaho ``Something for the Pain'' podcast. Methods: Podcast episodes consisted of interviews with individuals as well as didactic lectures. Audio from these recordings were edited for content and length and then professionally reviewed by subject matter experts (eg, featured episode speakers). Target audiences consisted of health care providers and community members interested in behavioral health and substance use disorders. Metrics on podcast listeners were assessed using SoundCloud's RSS feed, continuing education survey completion, and iECHO. Results: The ECHO Idaho ``Something for the Pain'' podcast's inaugural season comprised 14 episodes with 626 minutes of CE material. The podcast series received a total of 2441 listens from individuals in 14 different cities across Idaho, and 63 health care providers listened and claimed CE credits. The largest professional group was social workers (n=22; 35\%). Conclusions: We provide preliminary evidence that podcasts can be used to provide health care providers with opportunities to access CE material. Health care providers listened to and claimed CE credits from the ECHO Idaho ``Something for the Pain'' podcast. Project ECHO programs should consider creating podcasts as an additional platform for disseminating ECHO material. ", doi="10.2196/55313", url="https://mededu.jmir.org/2025/1/e55313" } @Article{info:doi/10.2196/67993, author="Katta, Sravya and Davoody, Nadia", title="Exploring Health Care Professionals' Perspectives on Education, Awareness, and Preferences for Digital Educational Resources to Support Transgender, Nonbinary, and Intersex Care: Interview Study", journal="JMIR Med Educ", year="2025", month="Mar", day="6", volume="11", pages="e67993", keywords="health care professionals", keywords="transgender, nonbinary, and intersex", keywords="communication challenges", keywords="systematic barriers", keywords="information and communication technology", abstract="Background: Health care professionals often face challenges in providing affirming and culturally competent care to transgender, nonbinary, and intersex (TNBI) patients due to a lack of understanding and training in TNBI health care. This gap highlights the opportunity for tailored educational resources to enhance health care professionals' interactions with TNBI individuals. Objective: This study aimed to explore health care professionals' perspectives on education and awareness of health issues related to TNBI individuals. Specifically, it aimed to identify their needs, challenges, and preferences in accessing and using digital educational resources to enhance their knowledge and competence in providing inclusive and effective care for this population. Methods: A qualitative research approach was used in this study. In total, 15 health care professionals were recruited via convenience sampling to participate in semistructured interviews. Thematic analysis was applied to identify recurring codes and themes. Results: The study identified several themes and subthemes related to gender diversity awareness, inclusive communication and understanding the needs of TNBI individuals, societal and structural challenges, regulatory gaps in training and support infrastructure, education and training needs for health care professionals on TNBI care, educational resources and training tools for TNBI care, challenges and design considerations for eHealth tools integrations, and evaluating eHealth impact. Participants identified communication barriers, the need for health care providers to use inclusive language, and gaps in both health care system infrastructure and specialized training for gender-affirming care. In addition, participants expressed a need for comprehensive education on transgender and nonbinary health issues, resources for mental health professionals, user-friendly design, and accessibility features in eHealth tools. Conclusions: The study revealed substantial deficiencies in health care professionals' knowledge of gender diversity, cultural competency, and the importance of inclusive communication. Addressing the identified barriers and challenges through targeted interventions, such as providing training and support for health care professionals, investing in user-friendly design and data security, and promoting cultural competence in TNBI health care, is essential. Despite integration challenges, eHealth tools have the potential to improve patient--health care professional relationships and access to care. ", doi="10.2196/67993", url="https://mededu.jmir.org/2025/1/e67993", url="http://www.ncbi.nlm.nih.gov/pubmed/40053815" } @Article{info:doi/10.2196/67921, author="Colwell, Rebecca and Gullickson, Mitchell and Cutlan, Jonathan and Stratman, Erik", title="Cutaneous Atrophy Following Corticosteroid Injections for Tendonitis: Report of Two Cases", journal="JMIR Dermatol", year="2025", month="Feb", day="13", volume="8", pages="e67921", keywords="lipoatrophy", keywords="cutaneous atrophy", keywords="corticosteroid", keywords="adverse effects", keywords="tendonitis", keywords="musculoskeletal", doi="10.2196/67921", url="https://derma.jmir.org/2025/1/e67921" } @Article{info:doi/10.2196/63480, author="Basheer N, Amitha and Jodalli, Praveen and Shetty, Shishir and Shenoy, Ramya and Rao, Ashwini and Pai, Mithun and Gowdar, Murugendrappa Inderjit and Almalki, Abdulrahman Sultan", title="Development and Validation of the ``Basic Oral Health Assessment Tool'' (BOHAT) for Nondental Health Care Professionals to Use With the Indian Adult Population: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2025", month="Feb", day="13", volume="14", pages="e63480", keywords="oral health assessment tool", keywords="oral health", keywords="screening", keywords="nondental health care professionals", keywords="primary health centers", keywords="India", keywords="tool validation", keywords="health care training", keywords="mixed methods research", abstract="Background: Oral health is a significant indicator of general health, well-being, and quality of life. The prevention of oral health problems requires periodic inspection of the oral cavity. Routine oral health examinations at the individual level appears to be one way to deliver quality oral health care but are too often missed as an opportunity for improved oral health in the nondental health care setting in India. This is because of limited training and inaccessible or lack of specialized oral health assessment tools. Objective: This study will focus on the development, validation, and implementation of the Basic Oral Health Assessment Tool (BOHAT) to improve the oral health assessment capabilities of nondental health care professionals and thus contribute to improved overall health outcomes of the Indian adult population. Methods: This study will be a mixed methods, multistage study conducted in 3 stages. The study will be conducted with 708 nondental health care professionals in 33 Primary Health Centers (PHCs) of Mangalore Taluk, Karnataka. Ethical approval was sought from the institutional ethics committee of Manipal College of Dental Sciences Mangalore. Informed consent will be obtained from every participant prior to the study. A literature review and qualitative interviews will be used for item and domain generation with respect to BOHAT, and an expert panel review and pilot testing will be used to refine the items and domains. Finally, statistical analyses will be conducted to validate the reliability and consistency. The second phase will involve capacity building and user experience exploration through comprehensive training for nondental health professionals using audio and visual aids, with hands-on learning methodologies including relevant feedback processes in the form of focus group discussions. The third stage will check the effectiveness of BOHAT regarding the changes in knowledge, attitudes, and practices through pre- and posttraining questionnaires, which will then be followed by a retention analysis 3 months later. Results: As of January 20, 2025, the study is in its preliminary phase: ``Substage A: Item and Domain\enspaceDevelopment.'' We have received institutional ethics committee and Institutional Protocol Approval Committee approval for the study. Data collection procedures have not started yet. The study is progressing as per the planned timeline. Conclusions: The BOHAT study holds considerable potential to promote oral health care through collaborative and interdisciplinary approaches. It will facilitate early diagnosis, timely referrals, and comprehensive care by integrating assessment actions for oral health into routine practices of nondental primary health care professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/63480 ", doi="10.2196/63480", url="https://www.researchprotocols.org/2025/1/e63480" } @Article{info:doi/10.2196/46257, author="Kraushaar, Judith and Bohnet-Joschko, Sabine", title="The Role of the Organization in Promoting Information Security--Related Behavior Among Resident Physicians in Hospitals in Germany: Cross-Sectional Questionnaire Study", journal="J Med Internet Res", year="2025", month="Jan", day="7", volume="27", pages="e46257", keywords="information security", keywords="compliance", keywords="work engagement", keywords="awareness", keywords="leadership", keywords="communication", keywords="education and training", keywords="security", keywords="privacy", keywords="structural equation modeling", keywords="resident", keywords="fellow", keywords="medical education", keywords="continuing education", keywords="professional development", abstract="Background: Nowadays, optimal patient care should be based on data-driven decisions. In the course of digitization, hospitals, in particular, are becoming complex organizations with an enormously high density of digital information. Ensuring information security is, therefore, essential and has become a major challenge. Researchers have shown that---in addition to technological and regulatory measures---it is also necessary for all employees to follow security policies and consciously use information technology (compliance), because noncompliance can lead to security breaches with far-reaching consequences for the organization. There is little empirical research on information security--related behavior in hospitals and its organizational antecedents. Objective: This study aimed to explore the impact of specific job demands and resources on resident physicians' information security--related compliance in hospitals through the mediating role of work engagement and information security--related awareness. Methods: We used a cross-sectional, survey-based study design to collect relevant data from our target population, namely resident physicians in hospitals. For data analysis, we applied structural equation modeling. Our research model consisted of a total of 7 job demands and resources as exogenous variables, 2 mediators, and information security--related compliance as the endogenous variable. Results: Overall, data from 281 participating physicians were included in the analyses. Both mediators---work engagement and awareness---had a significant positive effect on information security--related compliance ($\beta$=.208, P=.001 vs $\beta$=.552, P<.001). Quality of leadership was found to be the only resource with a significant indirect effect on physicians' compliance, mediated by work engagement ($\beta$=.086, P=.03). Furthermore, awareness mediated the relationships between information security--related communication and information security--related compliance ($\beta$=.192, P<.001), as well as between further education and training and the endogenous variable ($\beta$=.096, P=.02). Contrary to our hypothesis, IT resources had a negative effect on compliance, mediated by awareness ($\beta$=--.114, P=.02). Conclusions: This study provides new insights into how a high standard of information security compliance among resident physicians could be achieved through strengthening physicians' security work engagement and awareness. Hospital management is required to establish an information security culture that is informative and motivating and that raises awareness. Particular attention should be paid to the quality of leadership, further education and training, as well as clear communication. ", doi="10.2196/46257", url="https://www.jmir.org/2025/1/e46257" } @Article{info:doi/10.2196/59720, author="Nicolau, Abel and Jorge, In{\^e}s and Vieira-Marques, Pedro and Sa-Couto, Carla", title="Influence of Training With Corrective Feedback Devices on Cardiopulmonary Resuscitation Skills Acquisition and Retention: Systematic Review and Meta-Analysis", journal="JMIR Med Educ", year="2024", month="Dec", day="19", volume="10", pages="e59720", keywords="cardiopulmonary resuscitation", keywords="CPR quality", keywords="resuscitation training", keywords="corrective feedback devices", keywords="skills acquisition", keywords="skills retention", keywords="systematic review", keywords="evidence-based research", keywords="meta-analysis", keywords="feedback devices", keywords="PRISMA", abstract="Background: Several studies related to the use of corrective feedback devices in cardiopulmonary resuscitation training, with different populations, training methodologies, and equipment, present distinct results regarding the influence of this technology. Objective: This systematic review and meta-analysis aimed to examine the impact of corrective feedback devices in cardiopulmonary resuscitation skills acquisition and retention for laypeople and health care professionals. Training duration was also studied. Methods: The search was conducted in PubMed, Web of Science, and Scopus from January 2015 to December 2023. Eligible randomized controlled trials compared technology-based training incorporating corrective feedback with standard training. Outcomes of interest were the quality of chest compression--related components. The risk of bias was assessed using the Cochrane tool. A meta-analysis was used to explore the heterogeneity of the selected studies. Results: In total, 20 studies were included. Overall, it was reported that corrective feedback devices used during training had a positive impact on both skills acquisition and retention. Medium to high heterogeneity was observed. Conclusions: This systematic review and meta-analysis suggest that corrective feedback devices enhance skills acquisition and retention over time. Considering the medium to high heterogeneity observed, these findings should be interpreted with caution. More standardized, high-quality studies are needed. Trial Registration: PROSPERO CRD42021240953; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=240953 ", doi="10.2196/59720", url="https://mededu.jmir.org/2024/1/e59720", url="http://www.ncbi.nlm.nih.gov/pubmed/39699935" } @Article{info:doi/10.2196/54112, author="Mun, Michelle and Chanchlani, Sonia and Lyons, Kayley and Gray, Kathleen", title="Transforming the Future of Digital Health Education: Redesign of a Graduate Program Using Competency Mapping", journal="JMIR Med Educ", year="2024", month="Oct", day="31", volume="10", pages="e54112", keywords="digital health", keywords="digital transformation", keywords="health care", keywords="clinical informatics", keywords="competencies", keywords="graduate education", doi="10.2196/54112", url="https://mededu.jmir.org/2024/1/e54112" } @Article{info:doi/10.2196/48518, author="Devlin, M. Paulina and Akingbola, Oluwabukola and Stonehocker, Jody and Fitzgerald, T. James and Winkel, Ford Abigail and Hammoud, M. Maya and Morgan, K. Helen", title="Opportunities to Improve Communication With Residency Applicants: Cross-Sectional Study of Obstetrics and Gynecology Residency Program Websites", journal="JMIR Med Educ", year="2024", month="Oct", day="21", volume="10", pages="e48518", keywords="obstetrics and gynecology", keywords="residency program", keywords="residency application", keywords="website", keywords="program signals", keywords="communication best practices", abstract="Background: As part of the residency application process in the United States, many medical specialties now offer applicants the opportunity to send program signals that indicate high interest to a limited number of residency programs. To determine which residency programs to apply to, and which programs to send signals to, applicants need accurate information to determine which programs align with their future training goals. Most applicants use a program's website to review program characteristics and criteria, so describing the current state of residency program websites can inform programs of best practices. Objective: This study aims to characterize information available on obstetrics and gynecology residency program websites and to determine whether there are differences in information available between different types of residency programs. Methods: This was a cross-sectional observational study of all US obstetrics and gynecology residency program website content. The authorship group identified factors that would be useful for residency applicants around program demographics and learner trajectories; application criteria including standardized testing metrics, residency statistics, and benefits; and diversity, equity, and inclusion mission statements and values. Two authors examined all available websites from November 2011 through March 2022. Data analysis consisted of descriptive statistics and one-way ANOVA, with P<.05 considered significant. Results: Among 290 programs, 283 (97.6\%) had websites; 238 (82.1\%) listed medical schools of current residents; 158 (54.5\%) described residency alumni trajectories; 107 (36.9\%) included guidance related to the preferred United States Medical Licensing Examination Step 1 scores; 53 (18.3\%) included guidance related to the Comprehensive Osteopathic Medical Licensing Examination Level 1 scores; 185 (63.8\%) included international applicant guidance; 132 (45.5\%) included a program-specific mission statement; 84 (29\%) included a diversity, equity, and inclusion statement; and 167 (57.6\%) included program-specific media or links to program social media on their websites. University-based programs were more likely to include a variety of information compared to community-based university-affiliated and community-based programs, including medical schools of current residents (113/123, 91.9\%, university-based; 85/111, 76.6\%, community-based university-affiliated; 40/56, 71.4\%, community-based; P<.001); alumni trajectories (90/123, 73.2\%, university-based; 51/111, 45.9\%, community-based university-affiliated; 17/56, 30.4\%, community-based; P<.001); the United States Medical Licensing Examination Step 1 score guidance (58/123, 47.2\%, university-based; 36/111, 32.4\%, community-based university-affiliated; 13/56, 23.2\%, community-based; P=.004); and diversity, equity, and inclusion statements (57/123, 46.3\%, university-based; 19/111, 17.1\%, community-based university-affiliated; 8/56, 14.3\%, community-based; P<.001). Conclusions: There are opportunities to improve the quantity and quality of data on residency websites. From this work, we propose best practices for what information should be included on residency websites that will enable applicants to make informed decisions. ", doi="10.2196/48518", url="https://mededu.jmir.org/2024/1/e48518" } @Article{info:doi/10.2196/48594, author="Tong, Wenting and Zhang, Xiaowen and Zeng, Haiping and Pan, Jianping and Gong, Chao and Zhang, Hui", title="Reforming China's Secondary Vocational Medical Education: Adapting to the Challenges and Opportunities of the AI Era", journal="JMIR Med Educ", year="2024", month="Aug", day="15", volume="10", pages="e48594", keywords="secondary vocational medical education", keywords="artificial intelligence", keywords="practical skills", keywords="critical thinking", keywords="AI", doi="10.2196/48594", url="https://mededu.jmir.org/2024/1/e48594" } @Article{info:doi/10.2196/52906, author="Curran, Vernon and Glynn, Robert and Whitton, Cindy and Hollett, Ann", title="An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care", journal="JMIR Med Educ", year="2024", month="Aug", day="8", volume="10", pages="e52906", keywords="virtual care", keywords="continuing professional development", keywords="needs assessment", keywords="remote care", keywords="medical education", keywords="continuing medical education", keywords="CME", keywords="CPD", keywords="PD", keywords="professional development", keywords="integration", keywords="implementation", keywords="training", keywords="eHealth", keywords="e-health", keywords="telehealth", keywords="telemedicine", keywords="ICT", keywords="information and communication technology", keywords="provider", keywords="providers", keywords="healthcare professional", keywords="healthcare professionals", keywords="accreditation", keywords="instructional", keywords="teaching", keywords="module", keywords="modules", keywords="e-learning", keywords="eLearning", keywords="online learning", keywords="distance learning", doi="10.2196/52906", url="https://mededu.jmir.org/2024/1/e52906" } @Article{info:doi/10.2196/54071, author="Landis-Lewis, Zach and Andrews, A. Chris and Gross, A. Colin and Friedman, P. Charles and Shah, J. Nirav", title="Exploring Anesthesia Provider Preferences for Precision Feedback: Preference Elicitation Study", journal="JMIR Med Educ", year="2024", month="Jun", day="11", volume="10", pages="e54071", keywords="audit and feedback", keywords="dashboard", keywords="motivation", keywords="visualization", keywords="anesthesia care", keywords="anesthesia", keywords="feedback", keywords="engagement", keywords="effectiveness", keywords="precision feedback", keywords="experimental design", keywords="design", keywords="clinical practice", keywords="motivational", keywords="performance", keywords="performance data", abstract="Background: Health care professionals must learn continuously as a core part of their work. As the rate of knowledge production in biomedicine increases, better support for health care professionals' continuous learning is needed. In health systems, feedback is pervasive and is widely considered to be essential for learning that drives improvement. Clinical quality dashboards are one widely deployed approach to delivering feedback, but engagement with these systems is commonly low, reflecting a limited understanding of how to improve the effectiveness of feedback about health care. When coaches and facilitators deliver feedback for improving performance, they aim to be responsive to the recipient's motivations, information needs, and preferences. However, such functionality is largely missing from dashboards and feedback reports. Precision feedback is the delivery of high-value, motivating performance information that is prioritized based on its motivational potential for a specific recipient, including their needs and preferences. Anesthesia care offers a clinical domain with high-quality performance data and an abundance of evidence-based quality metrics. Objective: The objective of this study is to explore anesthesia provider preferences for precision feedback. Methods: We developed a test set of precision feedback messages with balanced characteristics across 4 performance scenarios. We created an experimental design to expose participants to contrasting message versions. We recruited anesthesia providers and elicited their preferences through analysis of the content of preferred messages. Participants additionally rated their perceived benefit of preferred messages to clinical practice on a 5-point Likert scale. Results: We elicited preferences and feedback message benefit ratings from 35 participants. Preferences were diverse across participants but largely consistent within participants. Participants' preferences were consistent for message temporality ($\alpha$=.85) and display format ($\alpha$=.80). Ratings of participants' perceived benefit to clinical practice of preferred messages were high (mean rating 4.27, SD 0.77). Conclusions: Health care professionals exhibited diverse yet internally consistent preferences for precision feedback across a set of performance scenarios, while also giving messages high ratings of perceived benefit. A ``one-size-fits-most approach'' to performance feedback delivery would not appear to satisfy these preferences. Precision feedback systems may hold potential to improve support for health care professionals' continuous learning by accommodating feedback preferences. ", doi="10.2196/54071", url="https://mededu.jmir.org/2024/1/e54071" } @Article{info:doi/10.2196/48135, author="Koester, MacKenzie and Motz, Rosemary and Porto, Ariel and Reyes Nieves, Nikita and Ashley, Karen", title="Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Apr", day="1", volume="10", pages="e48135", keywords="continuing medical education", keywords="telementoring", keywords="substance use disorder treatment", keywords="substance use disorder", keywords="SUD", keywords="primary care", keywords="Extension for Community Healthcare Outcomes", keywords="Project ECHO", abstract="Background: Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio's growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care. Objective: The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants' change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health. Methods: We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants' self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants' knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries. Results: The results of the content analysis indicated that 3 learning objective themes---team-based care, harm reduction, and social determinants of health---resulted in the highest frequencies and dose, appearing in 100\% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81\% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03). Conclusions: These findings indicate that the ECHO program's content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care. ", doi="10.2196/48135", url="https://mededu.jmir.org/2024/1/e48135", url="http://www.ncbi.nlm.nih.gov/pubmed/38557477" } @Article{info:doi/10.2196/50864, author="Kimber, Melissa and Baker-Sullivan, Elizabeth and Stewart, E. Donna and Vanstone, Meredith", title="Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials", journal="JMIR Res Protoc", year="2024", month="Mar", day="21", volume="13", pages="e50864", keywords="medical education", keywords="health professions education", keywords="child maltreatment", keywords="intimate partner violence", keywords="mixed methods", keywords="pilot trial", keywords="qualitative description", keywords="family violence", abstract="Background: The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence. Objective: Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters. Methods: The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct service capacity. Participants complete quantitative assessments at baseline, after intervention, and at 3-month follow-up. A subset of participants from each arm also undergoes a qualitative semistructured interview with the aim of describing participants' perceptions of the value and impact of each VEGA modality, as well as research burden. Scores on potential outcome measures will be mapped to excerpts of qualitative data via a mixed methods joint display to aid in the interpretation of findings. Results: We consented 71 individuals to participate in the RISE with Residents study. Data collection was completed on August 31, 2023, and data are currently being cleaned and prepared for analysis. As of January 15, 2024, we consented 34 individuals in the RISE with Veterans study; data collection will be completed in March 2024. For both studies, no data analysis had taken place at the time of manuscript submission. Results will be disseminated through peer-reviewed publications; academic conferences; and posting and sharing of study summaries and infographics on social media, the project website, and via professional network listserves. Conclusions: Reducing the impacts of family violence remains a pressing public health challenge. Both research studies will provide a valuable methodological contribution about the feasibility of trial methods in health professions education focused on family violence. They will also contribute to education science about the differences in the effectiveness of self-directed versus facilitator-led learning strategies. Trial Registration: ClinicalTrials.gov NCT05490121, https://clinicaltrials.gov/study/NCT05490121; ClinicalTrials.gov NCT05490004, https://clinicaltrials.gov/study/NCT05490004 International Registered Report Identifier (IRRID): DERR1-10.2196/50864 ", doi="10.2196/50864", url="https://www.researchprotocols.org/2024/1/e50864", url="http://www.ncbi.nlm.nih.gov/pubmed/38512307" } @Article{info:doi/10.2196/50156, author="Mareli{\'c}, Marko and Klasni{\'c}, Ksenija and Vuku{\vs}i{\'c} Rukavina, Tea", title="Measuring e-Professional Behavior of Doctors of Medicine and Dental Medicine on Social Networking Sites: Indexes Construction With Formative Indicators", journal="JMIR Med Educ", year="2024", month="Feb", day="27", volume="10", pages="e50156", keywords="e-professionalism", keywords="social media", keywords="formative index", keywords="social networking", keywords="doctors", keywords="medical", keywords="dental medicine", abstract="Background: Previous studies have predominantly measured e-professionalism through perceptions or attitudes, yet there exists no validated measure specifically targeting the actual behaviors of health care professionals (HCPs) in this realm. This study addresses this gap by constructing a normative framework, drawing from 3 primary sources to define e-professional behavior across 6 domains. Four domains pertain to the dangers of social networking sites (SNSs), encompassing confidentiality, privacy, patient interaction, and equitable resource allocation. Meanwhile, 2 domains focus on the opportunities of SNSs, namely, the proactive dissemination of public health information and maintaining scientific integrity. Objective: This study aims to develop and validate 2 new measures assessing the e-professional behavior of doctors of medicine (MDs) and doctors of dental medicine (DMDs), focusing on both the dangers and opportunities associated with SNSs. Methods: The study used a purposive sample of MDs and DMDs in Croatia who were users of at least one SNS. Data collection took place in 2021 through an online survey. Validation of both indexes used a formative approach, which involved a 5-step methodology: content specification, indicators definition with instructions for item coding and index construction, indicators collinearity check using the variance inflation factor (VIF), external validity test using multiple indicators multiple causes (MIMIC) model, and external validity test by checking the relationships of the indexes with the scale of attitude toward SNSs using Pearson correlation coefficients. Results: A total of 753 responses were included in the analysis. The first e-professionalism index, assessing the dangers associated with SNSs, comprises 14 items. During the indicators collinearity check, all indicators displayed acceptable VIF values below 2.5. The MIMIC model showed good fit ($\chi$213=9.4, P=.742; $\chi$2/df=0.723; root-mean-square error of approximation<.001; goodness-of-fit index=0.998; comparative fit index=1.000). The external validity of the index is supported by a statistically significant negative correlation with the scale measuring attitudes toward SNSs (r=--0.225, P<.001). Following the removal of 1 item, the second e-professionalism index, focusing on the opportunities associated with SNSs, comprises 5 items. During the indicators collinearity check, all indicators exhibited acceptable VIF values below 2.5. Additionally, the MIMIC model demonstrated a good fit ($\chi$24=2.5, P=.718; $\chi$2/df=0.637; root-mean-square error of approximation<0.001; goodness-of-fit index=0.999; comparative fit index=1.000). The external validity of the index is supported by a statistically significant positive correlation with the scale of attitude toward SNSs (r=0.338; P<.001). Conclusions: Following the validation process, the instrument designed for gauging the e-professional behavior of MDs and DMDs consists of 19 items, which contribute to the formation of 2 distinct indexes: the e-professionalism index, focusing on the dangers associated with SNSs, comprising 14 items, and the e-professionalism index, highlighting the opportunities offered by SNSs, consisting of 5 items. These indexes serve as valid measures of the e-professional behavior of MDs and DMDs, with the potential for further refinement to encompass emerging forms of unprofessional behavior that may arise over time. ", doi="10.2196/50156", url="https://mededu.jmir.org/2024/1/e50156", url="http://www.ncbi.nlm.nih.gov/pubmed/38412021" } @Article{info:doi/10.2196/53138, author="Abbiati, Milena and Nendaz, R. Mathieu and Cerutti, Bernard and Brodmann M{\"a}der, Monika and Spinas, A. Giatgen and Vicente Alvarez, David and Teodoro, Douglas and Savoldelli, L. Georges and Bajwa, M. Nadia", title="Exploring Medical Career Choice to Better Inform Swiss Physician Workforce Planning: Protocol for a National Cohort Study", journal="JMIR Res Protoc", year="2024", month="Jan", day="17", volume="13", pages="e53138", keywords="career choice", keywords="medical specialty", keywords="medically underserved area", keywords="motivation", keywords="professional practice", keywords="medical students", keywords="residents", keywords="prediction model", keywords="machine learning", keywords="physician workforce", abstract="Background: A medical student's career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland. Objective: The overall objective of this study is to better understand the process of Swiss medical students' career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students' career choice and their ultimate career path, including an international comparison with French medical students. Methods: The Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master's programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model. Results: This study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection. Conclusions: Our research will inform national stakeholders and medical schools on the prediction of students' future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions. International Registered Report Identifier (IRRID): DERR1-10.2196/53138 ", doi="10.2196/53138", url="https://www.researchprotocols.org/2024/1/e53138", url="http://www.ncbi.nlm.nih.gov/pubmed/38231561" } @Article{info:doi/10.2196/43705, author="Monahan, Ken and Gould, Edward and Rice, Todd and Wright, Patty and Vasilevskis, Eduard and Harrell, Frank and Drago, Monique and Mitchell, Sarah", title="Impact of the COVID-19 Pandemic on Medical Grand Rounds Attendance: Comparison of In-Person and Remote Conferences", journal="JMIR Med Educ", year="2024", month="Jan", day="3", volume="10", pages="e43705", keywords="continuing medical education", keywords="COVID-19", keywords="distance education", keywords="professional development", keywords="virtual learning", abstract="Background: Many academic medical centers transitioned from in-person to remote conferences due to the COVID-19 pandemic, but the impact on faculty attendance is unknown. Objective: This study aims to evaluate changes in attendance at medical grand rounds (MGR) following the transition from an in-person to remote format and as a function of the COVID-19 census at Vanderbilt Medical Center. Methods: We obtained the faculty attendee characteristics from Department of Medicine records. Attendance was recorded using a SMS text message--based system. The daily COVID-19 census was recorded independently by hospital administration. The main attendance metric was the proportion of eligible faculty that attended each MGR. Comparisons were made for the entire cohort and for individual faculty. Results: The observation period was from March 2019 to June 2021 and included 101 MGR conferences with more than 600 eligible faculty. Overall attendance was unchanged during the in-person and remote formats (12,536/25,808, 48.6\% vs 16,727/32,680, 51.2\%; P=.44) and did not change significantly during a surge in the COVID-19 census. Individual faculty members attendance rates varied widely. Absolute differences between formats were less than --20\% or greater than 20\% for one-third (160/476, 33.6\%) of faculty. Pulmonary or critical care faculty attendance increased during the remote format compared to in person (1450/2616, 55.4\% vs 1004/2045, 49.1\%; P<.001). A cloud-based digital archive of MGR lectures was accessed by <1\% of faculty per conference. Conclusions: Overall faculty attendance at MGR did not change following the transition to a remote format, regardless of the COVID-19 census, but individual attendance habits fluctuated in a bidirectional manner. Incentivizing the use of a digital archive may represent an opportunity to increase faculty consumption of MGR. ", doi="10.2196/43705", url="https://mededu.jmir.org/2024/1/e43705", url="http://www.ncbi.nlm.nih.gov/pubmed/38029287" } @Article{info:doi/10.2196/49013, author="Davoudi, Kaveh and Rakhecha, Tushar and Corriero, Chiara Anna and Ko, Natalie Kar Chang and Ismail, Roseanne and King, B. Esther R. and Holl{\'e}n, Linda", title="The Impact of UK Medical Students' Demographics and Socioeconomic Factors on Their Self-Reported Familiarity With the Postgraduate Training Pathways and Application Process: Cross-Sectional Study", journal="JMIR Med Educ", year="2023", month="Nov", day="24", volume="9", pages="e49013", keywords="age", keywords="career progression", keywords="clinicians", keywords="cross-sectional study", keywords="demographics", keywords="ethnicity", keywords="gender", keywords="leadership", keywords="medical students demographics", keywords="medical students", keywords="online survey", keywords="research", keywords="students", keywords="teaching", keywords="training", abstract="Background: UK medical graduates can apply for specialty training after completing a 2-year internship (foundation training). Postfoundation training application requirements vary depending on specialty but fundamentally require key skills such as teaching, research, and leadership. Objective: This study investigated whether medical student demographics impact their self-reported familiarity with the Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP). Methods: This was a cross-sectional study using a Bristol Online Survey. We invited all UK medical students to answer a range of questions about their demographics. Students were then asked to rank their familiarity with PFTPs and PFAP on a scale of 1 to 5 (1=least familiar and 5=most familiar). The responses were collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata (version 17.1; StataCorp) using chi-square tests. Results: A total of 850 students from 31 UK medical schools took part. There was a significant difference between gender and self-reported familiarity with PFTPs (P<.001) and PFAP (P<.001), with male students expressing higher familiarity. Similarly, there was a difference between ethnicity and self-reported familiarity with PFTPs (P=.02) and PFAP (P<.001), with White students more likely to express higher familiarity than their Black, Asian, or Mixed Ethnic counterparts. Lastly, there was an overall difference between medical background and age and self-reported familiarity with PFTPs and PFAP (all P<.001), with students from medical backgrounds and older students being more likely to express higher familiarity. Conclusions: The impact of gender, ethnicity, age, and medical background on students' self-reported familiarity with PFTPs and PFAP is significant. Further studies are required to evaluate the impact of these factors on tested knowledge of PFTPs and PFAP and whether this impacts the success rate of postfoundation applications. ", doi="10.2196/49013", url="https://mededu.jmir.org/2023/1/e49013", url="http://www.ncbi.nlm.nih.gov/pubmed/37999951" } @Article{info:doi/10.2196/49825, author="Blomberg, Debra and Stephenson, Christopher and Atkinson, Teresa and Blanshan, Anissa and Cabrera, Daniel and Ratelle, T. John and Mohabbat, B. Arya", title="Continuing Medical Education in the Post COVID-19 Pandemic Era", journal="JMIR Med Educ", year="2023", month="Nov", day="15", volume="9", pages="e49825", keywords="continuing medical education", keywords="post COVID-19 pandemic", keywords="content development", keywords="collaboration", keywords="audience", keywords="marketing", keywords="budgeting", keywords="accreditation", keywords="evaluation and outcomes", keywords="competitive assessment", keywords="education", keywords="development", keywords="assessment", keywords="continuing education", keywords="medical education", keywords="framework", doi="10.2196/49825", url="https://mededu.jmir.org/2023/1/e49825", url="http://www.ncbi.nlm.nih.gov/pubmed/37966881" } @Article{info:doi/10.2196/45311, author="Zhang, Yue Xi and Arata Found, Anelyse and Butler, Sheila", title="Effects of Distance-Learning Strategies in Dental Fixed Prosthodontics Amidst the COVID-19 Pandemic: Cross-Sectional Questionnaire Study on Preclinical Dental Students' Perspective", journal="JMIR Form Res", year="2023", month="Nov", day="8", volume="7", pages="e45311", keywords="dental education", keywords="dental", keywords="dentist", keywords="dentistry", keywords="technology-based learning", keywords="online learning", keywords="pre-clinical training", keywords="distance learning", keywords="transmissibility", keywords="dental school", keywords="mental health", keywords="COVID-19", keywords="student perception", keywords="online teaching", keywords="survey", keywords="teaching methods", keywords="training", keywords="isolation", keywords="teaching", keywords="module", keywords="education", abstract="Background: COVID-19's high transmissibility led to gathering restrictions where dental schools experienced disruptions due to restrictions on attending in-person lectures and limitations placed on applied preclinical and clinical activities. Students not only had to rapidly switch to digital technology-based learning (TB-learning) modules but also experienced high levels of social isolation and anxiety around virus transmission. Objective: This study aims to evaluate the preclinical students' perception of switching TB-learning modules amidst the COVID-19 pandemic, identifying which module parameters were associated with strong student outcomes. Methods: A web-based survey of 39 Likert scale questions was delivered to preclinical dental students (Western University) to evaluate students' perceptions concerning TB-learning, fear amidst the COVID-19 pandemic, and the impact on their preclinical training. A Spearman rank correlation coefficient was determined to estimate the relationship between 2 variables in isolation (P=.01). An ordinal regression analysis was performed on variables of interest to determine how module variables (typically within the instructor's control) influenced the student outcomes (P=.05). Results: The response rate was 30\% (n=39). TB-learning was considered vital (34/39, 87.2\%) as the students' education improved (18/39, 46.2\%). However, 53.8\% (n=21) of students showed increased difficulties in retaining, visualizing, or understanding the materials using TB-learning, and 64.1\% (n=25) found it more difficult to concentrate than in in-person classes. In total, 79.5\% (n=31) of students showed different levels of agreement about feeling fatigued from TB-learning. Through Spearman $\rho$ correlation analysis, the quality of questions in quizzes ($\rho$=0.514; P<.001), relevant handouts ($\rho$=0.729; P<.001), and high-quality audiovisuals ($\rho$=0.585; P<.001) were positively correlated with students responding that the modules were useful to preclinical training. Similarly, good organization ($\rho$=0.512; P<.001), high-quality questions in quizzes ($\rho$=0.431; P=.01), and relevant handouts ($\rho$=0.551; P<.001) were positively correlated with web-based classes as an effective way to learn. In total, 91.6\% (n=36) of the students agreed that COVID-19 was a dangerous disease, whereas 53.8\% (n=21) showed different levels of agreement that they were afraid to be infected personally, and 69.2\% (n=27) feared passing COVID-19 along to family and friends. A total of 82.1\% (n=32) of the students showed that COVID-19 impacted their overall learning process and had a negative impact on their practical preclinical training (31/39, 79.5\%). Conclusions: The students found a difference between TB-learning and face-to-face learning methods, where the students perceived fatigue toward the web-based method with difficulty concentrating and visualizing the subject. Moreover, there was a consensus that COVID-19 itself affected the students' overall learning process and preclinical training. As dental schools continue implementing TB-learning into their curriculum, this investigation identifies the students' struggles with the paradigm shift. In an effort to improve TB-learning, this work highlights 4 variables (organization, quizzes, quality handouts, and quality audiovisuals) within the control of instructors that can help improve content deliverance, improving the students' experience. ", doi="10.2196/45311", url="https://formative.jmir.org/2023/1/e45311", url="http://www.ncbi.nlm.nih.gov/pubmed/37938882" } @Article{info:doi/10.2196/48586, author="Lucero, Stringer Katie and Larkin, Amy and Zakharkin, Stanislav and Wysham, Carol and Anderson, John", title="The Impact of Web-Based Continuing Medical Education Using Patient Simulation on Real-World Treatment Selection in Type 2 Diabetes: Retrospective Case-Control Analysis", journal="JMIR Med Educ", year="2023", month="Aug", day="29", volume="9", pages="e48586", keywords="continuing medical education", keywords="virtual patient simulation", keywords="real-world evidence", keywords="evaluation", keywords="outcomes", keywords="diabetes education", keywords="medical education", keywords="type 2 diabetes", keywords="web-based learning", keywords="web-based education", abstract="Background: Despite guidelines recommending the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in certain patients with type 2 diabetes (T2D), they are not being prescribed for many of these patients. Web-based continuing medical education (CME) patient simulations have been used to identify clinicians' practice gaps and improve clinical decision-making as measured within a simulation, but the impact of this format on real-world treatment has not been researched. Objective: This study aimed to evaluate the effect of a simulation-based CME intervention on real-world use of GLP-1 RAs by endocrinologists and primary care physicians. Methods: Two evaluation phases of the CME simulation were conducted: phase I, the CME simulation phase, was a paired, pre-post study of 435 physician learners in the United States; and phase II, the real-world phase, was a retrospective, matched case-control study of 157 of the 435 physicians who had claims data available for the study period. Results: Phase I CME results showed a 29 percentage point increase in correct decisions from pre- to postfeedback (178/435, 40.9\% to 304/435, 69.9\%; P<.001) in selecting treatment that addresses both glycemic control and cardiovascular event protection. Phase II results showed that 39 of 157 (24.8\%) physicians in the intervention group increased use of GLP-1 RAs, compared to 20 of 157 (12.7\%) in the comparison group. Being in the intervention group predicted GLP-1 RA use after education (odds ratio 4.49; 95\% CI 1.45-13.97; P=.001). Conclusions: A web-based CME simulation focused on secondary prevention of cardiovascular events in a patient with T2D was associated with increased use of evidence-based treatment selection in the real world. ", doi="10.2196/48586", url="https://mededu.jmir.org/2023/1/e48586", url="http://www.ncbi.nlm.nih.gov/pubmed/37642994" } @Article{info:doi/10.2196/50109, author="Ozair, Ahmad and Bhat, Vivek and Detchou, E. Donald K.", title="Authors' Reply to: Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on ``The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators''", journal="JMIR Med Educ", year="2023", month="Aug", day="17", volume="9", pages="e50109", keywords="admission", keywords="assessment", keywords="postgraduate training", keywords="selection", keywords="standardized testing", keywords="graduate medical education", keywords="medical education", doi="10.2196/50109", url="https://mededu.jmir.org/2023/1/e50109", url="http://www.ncbi.nlm.nih.gov/pubmed/37590044" } @Article{info:doi/10.2196/47763, author="Sow, Yacine and Gangal, Ameya and Yeung, Howa and Blalock, Travis and Stoff, Benjamin", title="Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on ``The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators''", journal="JMIR Med Educ", year="2023", month="Aug", day="17", volume="9", pages="e47763", keywords="admission", keywords="assessment", keywords="postgraduate training", keywords="selection", keywords="standardized testing", keywords="USMLE", keywords="medical school", keywords="medical students", keywords="residency application", keywords="research training", doi="10.2196/47763", url="https://mededu.jmir.org/2023/1/e47763", url="http://www.ncbi.nlm.nih.gov/pubmed/37590047" } @Article{info:doi/10.2196/48978, author="Borchert, J. Robin and Hickman, R. Charlotte and Pepys, Jack and Sadler, J. Timothy", title="Performance of ChatGPT on the Situational Judgement Test---A Professional Dilemmas--Based Examination for Doctors in the United Kingdom", journal="JMIR Med Educ", year="2023", month="Aug", day="7", volume="9", pages="e48978", keywords="ChatGPT", keywords="language models", keywords="Situational Judgement Test", keywords="medical education", keywords="artificial intelligence", keywords="language model", keywords="exam", keywords="examination", keywords="SJT", keywords="judgement", keywords="reasoning", keywords="communication", keywords="chatbot", abstract="Background: ChatGPT is a large language model that has performed well on professional examinations in the fields of medicine, law, and business. However, it is unclear how ChatGPT would perform on an examination assessing professionalism and situational judgement for doctors. Objective: We evaluated the performance of ChatGPT on the Situational Judgement Test (SJT): a national examination taken by all final-year medical students in the United Kingdom. This examination is designed to assess attributes such as communication, teamwork, patient safety, prioritization skills, professionalism, and ethics. Methods: All questions from the UK Foundation Programme Office's (UKFPO's) 2023 SJT practice examination were inputted into ChatGPT. For each question, ChatGPT's answers and rationales were recorded and assessed on the basis of the official UK Foundation Programme Office scoring template. Questions were categorized into domains of Good Medical Practice on the basis of the domains referenced in the rationales provided in the scoring sheet. Questions without clear domain links were screened by reviewers and assigned one or multiple domains. ChatGPT's overall performance, as well as its performance across the domains of Good Medical Practice, was evaluated. Results: Overall, ChatGPT performed well, scoring 76\% on the SJT but scoring full marks on only a few questions (9\%), which may reflect possible flaws in ChatGPT's situational judgement or inconsistencies in the reasoning across questions (or both) in the examination itself. ChatGPT demonstrated consistent performance across the 4 outlined domains in Good Medical Practice for doctors. Conclusions: Further research is needed to understand the potential applications of large language models, such as ChatGPT, in medical education for standardizing questions and providing consistent rationales for examinations assessing professionalism and ethics. ", doi="10.2196/48978", url="https://mededu.jmir.org/2023/1/e48978", url="http://www.ncbi.nlm.nih.gov/pubmed/37548997" } @Article{info:doi/10.2196/45587, author="Raumer-Monteith, Lauren and Kennedy, Madonna and Ball, Lauren", title="Web-Based Learning for General Practitioners and Practice Nurses Regarding Behavior Change: Qualitative Descriptive Study", journal="JMIR Med Educ", year="2023", month="Jul", day="27", volume="9", pages="e45587", keywords="continuing professional development", keywords="continuing medical education", keywords="web-based", keywords="e-learning", keywords="behavior change", keywords="general practitioner", keywords="practice nurse", keywords="nurse", keywords="medical education", keywords="professional development", keywords="general practice", keywords="web-based learning", keywords="remote learning", keywords="adoption", keywords="perspective", keywords="health care professional", abstract="Background: Supporting patients to live well by optimizing behavior is a core tenet of primary health care. General practitioners and practice nurses experience barriers in providing behavior change interventions to patients for lifestyle behaviors, including low self-efficacy in their ability to enact change. Web-based learning technologies are readily available for general practitioners and practice nurses; however, opportunities to upskill in behavior change are still limited. Understanding what influences general practitioners' and practice nurses' adoption of web-based learning is crucial to enhancing the quality and impact of behavior change interventions in primary health care. Objective: This study aimed to explore general practitioners' and practice nurses' perceptions regarding web-based learning to support patients with behavior change. Methods: A qualitative, cross-sectional design was used involving web-based, semistructured interviews with general practitioners and practice nurses in Queensland, Australia. The interviews were recorded and transcribed using the built-in Microsoft Teams transcription software. Inductive coding was used to generate codes from the interview data for thematic analysis. Results: In total, there were 11 participants in this study, including general practitioners (n=4) and practice nurses (n=7). Three themes emerged from the data analysis: (1) reflecting on the provider of the Healthy Lifestyles suite; (2) valuing the web-based learning content and presentation; and (3) experiencing barriers and facilitators to using the Healthy Lifestyles suite. Conclusions: Provider reputation, awareness of availability, resources, content quality, usability, cost, and time influence adoption of web-based learning. Perceived quality is associated with culturally tailored information, resources, a balance of information and interactivity, plain language, user-friendly navigation, appealing visual presentation, communication examples, and simple models. Free web-based learning that features progress saving and module lengths of less than 2 hours alleviate perceived time and cost barriers. Learning providers may benefit by including these features in their future behavior change web-based learning for general practitioners and practice nurses. ", doi="10.2196/45587", url="https://mededu.jmir.org/2023/1/e45587", url="http://www.ncbi.nlm.nih.gov/pubmed/37498657" } @Article{info:doi/10.2196/50336, author="Gilson, Aidan and Safranek, W. Conrad and Huang, Thomas and Socrates, Vimig and Chi, Ling and Taylor, Andrew Richard and Chartash, David", title="Authors' Reply to: Variability in Large Language Models' Responses to Medical Licensing and Certification Examinations", journal="JMIR Med Educ", year="2023", month="Jul", day="13", volume="9", pages="e50336", keywords="natural language processing", keywords="NLP", keywords="MedQA", keywords="generative pre-trained transformer", keywords="GPT", keywords="medical education", keywords="chatbot", keywords="artificial intelligence", keywords="AI", keywords="education technology", keywords="ChatGPT", keywords="conversational agent", keywords="machine learning", keywords="large language models", keywords="knowledge assessment", doi="10.2196/50336", url="https://mededu.jmir.org/2023/1/e50336", url="http://www.ncbi.nlm.nih.gov/pubmed/37440299" } @Article{info:doi/10.2196/48305, author="Epstein, H. Richard and Dexter, Franklin", title="Variability in Large Language Models' Responses to Medical Licensing and Certification Examinations. Comment on ``How Does ChatGPT Perform on the United States Medical Licensing Examination? The Implications of Large Language Models for Medical Education and Knowledge Assessment''", journal="JMIR Med Educ", year="2023", month="Jul", day="13", volume="9", pages="e48305", keywords="natural language processing", keywords="NLP", keywords="MedQA", keywords="generative pre-trained transformer", keywords="GPT", keywords="medical education", keywords="chatbot", keywords="artificial intelligence", keywords="AI", keywords="education technology", keywords="ChatGPT", keywords="Google Bard", keywords="conversational agent", keywords="machine learning", keywords="large language models", keywords="knowledge assessment", doi="10.2196/48305", url="https://mededu.jmir.org/2023/1/e48305", url="http://www.ncbi.nlm.nih.gov/pubmed/37440293" } @Article{info:doi/10.2196/48392, author="Mesko, Bertalan", title="The ChatGPT (Generative Artificial Intelligence) Revolution Has Made Artificial Intelligence Approachable for Medical Professionals", journal="J Med Internet Res", year="2023", month="Jun", day="22", volume="25", pages="e48392", keywords="artificial intelligence", keywords="digital health", keywords="future", keywords="technology", keywords="ChatGPT", keywords="medical practice", keywords="large language model", keywords="language model", keywords="generative", keywords="conversational agent", keywords="conversation agents", keywords="chatbot", keywords="generated text", keywords="computer generated", keywords="medical education", keywords="continuing education", keywords="professional development", keywords="curriculum", keywords="curricula", doi="10.2196/48392", url="https://www.jmir.org/2023/1/e48392", url="http://www.ncbi.nlm.nih.gov/pubmed/37347508" } @Article{info:doi/10.2196/47801, author="Himstedt, S. Jessica D. and Bloomgarden, Eve and Shah, Purvi", title="Empowering the Invisible: Accelerating Leadership Development for Midcareer Women in Medicine", journal="J Med Internet Res", year="2023", month="Jun", day="16", volume="25", pages="e47801", keywords="leadership development", keywords="women in medicine", keywords="gender parity", keywords="leadership in medicine", keywords="women physicians", keywords="midcareer development", doi="10.2196/47801", url="https://www.jmir.org/2023/1/e47801", url="http://www.ncbi.nlm.nih.gov/pubmed/37327052" } @Article{info:doi/10.2196/40545, author="Babiker, Samar and Ogunmwonyi, Innocent and Georgi, W. Maria and Tan, Lawrence and Haque, Sharmi and Mullins, William and Singh, Prisca and Ang, Nadya and Fu, Howell and Patel, Krunal and Khera, Jevan and Fricker, Monty and Fleming, Simon and Giwa-Brown, Lolade and A Brennan, Peter and Irune, Ekpemi and Vig, Stella and Nathan, Arjun", title="Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="16", volume="12", pages="e40545", keywords="diversity in surgery", keywords="Black and Minority Ethnic", keywords="BME in surgery", keywords="differential attainment", keywords="diversity", keywords="surgery", keywords="health care system", keywords="surgical training", keywords="disparity", keywords="ethnic disparity", keywords="ethnicity", keywords="medical student", keywords="doctor", keywords="training experience", keywords="surgical placements", keywords="physician", keywords="health care provider", keywords="experience", keywords="perception", keywords="cross-sectional", keywords="doctor in training", keywords="resident", keywords="fellow", keywords="fellowship", keywords="questionnaire", keywords="survey", keywords="Everyday Discrimination Scale", keywords="Maslach Burnout Inventory", keywords="Higher Education", keywords="ethnicities", abstract="Background: The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom.BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10\% less likely to be considered suitable for core surgical training.Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors.The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. Objective: The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. Methods: This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. Results: Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. Conclusions: Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. International Registered Report Identifier (IRRID): DERR1-10.2196/40545 ", doi="10.2196/40545", url="https://www.researchprotocols.org/2023/1/e40545", url="http://www.ncbi.nlm.nih.gov/pubmed/37327055" } @Article{info:doi/10.2196/42060, author="Tewfik, George and Naftalovich, Rotem and Rodriguez-Aponte, Carlos and Ezzat, Bishoy", title="Intervention for Intraoperative Teaching in Anesthesiology Using Weekly Keyword Program: Development and Usability Study", journal="Interact J Med Res", year="2023", month="May", day="18", volume="12", pages="e42060", keywords="resident teaching", keywords="intraoperative teaching", keywords="educational strategies", keywords="teaching", keywords="anesthesiology", keywords="education", keywords="efficacy", keywords="survey", keywords="electronic", keywords="medical residents", keywords="operation", abstract="Background: Learning in the operating room (OR) for residents in anesthesiology is difficult but essential for successful resident education. Numerous approaches have been attempted in the past to varying degrees of success, with efficacy often judged afterward using surveys distributed to participants. The OR presents a particularly complex set of challenges for academic faculty due to the pressures required by concurrent patient care, production pressures, and a noisy environment. Often, educational reviews in ORs are personnel specific, and instruction may or may not take place in this setting, as it is left to the discretion of the parties without regular direction. Objective: This study aims to determine if a structured intraoperative keyword training program could be used to implement a curriculum to improve teaching in the OR and to facilitate impactful discussion between residents and faculty. A structured curriculum was chosen to allow for the standardization of the educational material to be studied and reviewed by faculty and trainees. Given the reality that educational reviews in the OR tend to be personnel specific and are often focused on the clinical cases of the day, this initiative sought to increase both the time and efficiency of learning interactions between learners and teachers in the stressful environment of the OR. Methods: The American Board of Anesthesiology keywords from the Open Anesthesia website were used to construct a weekly intraoperative didactic curriculum, which was distributed by email to all residents and faculty. A weekly worksheet from this curriculum included 5 keywords with associated questions for discussion. The residents and faculty were instructed to complete these questions on a weekly basis. After 2 years, an electronic survey was distributed to the residents to evaluate the efficacy of the keyword program. Results: A total of 19 teaching descriptors were polled for participants prior to and following the use of the intraoperative keyword program to assess the efficacy of the structured curriculum. The survey results showed no improvement in intraoperative teaching based on respondent perception, despite a slight improvement in teaching time, though this was statistically insignificant. The respondents reported some favorable aspects of the program, including the use of a set curriculum, suggesting that greater structure may be beneficial to facilitate more effective intraoperative teaching in anesthesiology. Conclusions: Although learning is difficult in the OR for residents, the use of a formalized didactic curriculum, centered on daily keywords, does not appear to be a useful solution for residents and faculty. Further efforts are required to improve intraoperative teaching, which is well known to be a difficult endeavor for both teachers and trainees. A structured curriculum may be used to augment other educational modalities to improve the overall intraoperative teaching for anesthesia residents. ", doi="10.2196/42060", url="https://www.i-jmr.org/2023/1/e42060", url="http://www.ncbi.nlm.nih.gov/pubmed/37200082" } @Article{info:doi/10.2196/40716, author="Chan, Yi Evelyn Hui and Chan, Yan Vernice Hui and Roed, Jannie and Chen, Yun Julie", title="Observed Interactions, Challenges, and Opportunities in Student-Led, Web-Based Near-Peer Teaching for Medical Students: Interview Study Among Peer Learners and Peer Teachers", journal="JMIR Med Educ", year="2023", month="May", day="15", volume="9", pages="e40716", keywords="peer teaching", keywords="peer-assisted learning", keywords="medical student", keywords="medical education", keywords="web-based education", keywords="distance learning", abstract="Background: Near-peer teaching (NPT) is becoming an increasingly popular pedagogical tool in health professions education. Despite the shift in formal medical education from face-to-face teaching toward encompassing web-based learning activities, NPT has not experienced a similar transition. Apart from the few reports on NPT programs hastily converted to web-based learning in light of the COVID-19 pandemic, no studies to date have explored web-based learning in the specific context of NPT. Objective: This qualitative study examined the nature of interactions among peer learners (PLs), peer teachers (PTs), and the learning content in a student-led, web-based NPT program for medical students. Methods: A 5-month-long voluntary NPT program to support first- and second-year medical students' biomedical science learning in the undergraduate medical curriculum was designed by 2 senior-year medical students and delivered by 25 PTs with 84 PLs participating. In total, 9 PLs and 3 PTs underwent individual semistructured interviews at the end of the program to explore general NPT experience, reasons for joining NPT, the effectiveness of NPT, the demand and importance of NPT, and the feasibility of incorporating NPT in the formal curriculum. Interview transcripts were analyzed using a thematic analysis approach. Results: The first general theme focused on the nature of student-student, student-teacher, and student-content interactions. Although PLs were engaged in web-based NPT, there was minimal interaction between students, as most PLs preferred to learn passively and remain anonymous. PLs believed the web-based NPT learning process to be a unidirectional transmission of knowledge from teacher to learner, with the teacher responsible for driving the interactions. This was in sharp contrast to PTs' expectation that both parties shared responsibility for learning in a collaborative effort. The second general theme identified the advantages and disadvantages of delivering NPT on a web platform, which were mainly convenience and teaching skills development and poor interactivity, respectively. Conclusions: Student-led, web-based NPT offers a flexible and comfortable means of delivering academic and nonacademic guidance to medical students. However, the web-based mode of delivery presents unique challenges in facilitating meaningful interactions among PLs, PTs, and subject content. A blended learning approach may be best suited for this form of student-led NPT program to optimize its efficacy. ", doi="10.2196/40716", url="https://mededu.jmir.org/2023/1/e40716", url="http://www.ncbi.nlm.nih.gov/pubmed/37184931" } @Article{info:doi/10.2196/41353, author="Bogarin, Roberto and Elizondo, Luis and Kalaitzoglou, Evangelia and Popovic, Jadranka and Rogol, Alan and Richmond, Erick and Chanoine, Jean-Pierre and Lopez-Pedrosa, M. Jose and Ruiz Salazar, Francis and Vuguin, Patricia", title="Bringing the Pediatric Endocrine Spanish Speaking Community Together: First Virtual Pediatric Endocrine Meeting in Low- and Middle-Income Countries in Central and South America", journal="Interact J Med Res", year="2023", month="May", day="8", volume="12", pages="e41353", keywords="continuing medical education", keywords="continuing education", keywords="medical education", keywords="professional development", keywords="pediatric", keywords="child", keywords="endocrinology", keywords="endocrine", keywords="pediatric endocrinology", keywords="diabetes", keywords="low- and middle-income countries", keywords="Latin America", keywords="Spanish", keywords="virtual", keywords="resources", keywords="digital", abstract="Background: Pediatric endocrinology is a specialty that is struggling worldwide to maintain adequately trained professionals. Pediatric endocrine care in Central America and Caribbean countries is often performed by pediatricians or adult endocrinologists due to the limited number of pediatric endocrinologists. These health care providers are seldom members of endocrine societies and frequently lack formal training in the field. Objective: In this study, we describe the scope of a virtual conference in pediatric endocrinology and diabetes targeted to low- and middle-income countries to provide equal opportunities for access to medical education for health care professionals. Methods: The virtual conference was sponsored by the Pediatric Endocrine Society (North America), Asociaci{\'o}n Costarricense de Endocrinolog{\'i}a (previously, Asociaci{\'o}n Nacional Pro Estudio de la Diabetes, Endocrinolog{\'i}a y Metabolismo), and Asociacion Centroamericana y del Caribe de Endocrinologia Pedi{\'a}trica. The conference was free to participants and comprised 23 sessions that were either synchronous with ability for real-time interactive sessions or asynchronous sessions, where content was available online to access at their convenience. Topics included idiopathic short stature, polycystic ovarian syndrome, diabetes mellitus, telemedicine, Turner syndrome, congenital adrenal hyperplasia, obesity, central precocious puberty, and subclinical hypothyroidism. The participants were asked to evaluate the conference after its completion with a questionnaire. Results: A total of 8 speakers from Spain, Canada, Costa Rica, and the United States delivered the virtual event to 668 health care professionals from Guatemala, Venezuela, Dominican Republic, Costa Rica, Ecuador, Peru, Uruguay, Mexico, Honduras, Argentina, the United States, Bolivia, Chile, Panama, El Salvador, Nicaragua, Paraguay, Belize, Spain, and Colombia. Name, profession, and country were fully disclosed by 410 (61.4\%) of the 668 health care professionals. The profession or level of training of participants were as follows: pediatric endocrinologists (n=129, 19.3\%), pediatricians (n=116, 17.4\%), general practitioners (n=77, 11.5\%), adult endocrinologists (n=34, 5.1\%), medical students (n=23, 3.4\%), residents in various specialties (n=14, 2.1\%), and others (n=17, 2.6\%). A total of 23 sessions were offered, most of which were bilingual (Spanish and English). Feedback from the evaluation questionnaire indicated that the content of the conference was very relevant to the participants' professional practice. Additionally, the participants reported that they were very satisfied with the organization, the web-based platform, and the sessions of the conference. Conclusions: Lack of accessibility to the latest and cutting-edge medical education in pediatric endocrinology and diabetes for medical professionals from low- and middle-income countries can be overcome with a virtual conference. Online availability, low cost, and easy-to-use technology were well received from the participants, who were overall very satisfied by the quality and the relevance of the sessions to their professional practice. ", doi="10.2196/41353", url="https://www.i-jmr.org/2023/1/e41353", url="http://www.ncbi.nlm.nih.gov/pubmed/37155229" } @Article{info:doi/10.2196/44989, author="Frank, Charis Ariadne and Jennrich, Linda and Kanzow, Philipp and Wiegand, Annette and Krantz-Sch{\"a}fers, Christiane", title="A Sex-Specific Evaluation of Dental Students' Ability to Perform Subgingival Debridement: Randomized Trial", journal="JMIR Med Educ", year="2023", month="Apr", day="28", volume="9", pages="e44989", keywords="dental", keywords="dental education", keywords="dentist", keywords="education", keywords="gender", keywords="periodontics", keywords="preclinical education", keywords="root debridement", keywords="sex", keywords="student", abstract="Background: A successful periodontitis treatment demands good manual skills. A correlation between biological sex and dental students' manual dexterity is currently unknown. Objective: This study examines performance differences between male and female students within subgingival debridement. Methods: A total of 75 third-year dental students were divided by biological sex (male/female) and randomly assigned to one of two work methods (manual curettes n=38; power-driven instruments n=37). Students were trained on periodontitis models for 25 minutes daily over 10 days using the assigned manual or power-driven instrument. Practical training included subgingival debridement of all tooth types on phantom heads. Practical exams were performed after the training session (T1) and after 6 months (T2), and comprised subgingival debridement of four teeth within 20 minutes. The percentage of debrided root surface was assessed and statistically analyzed using a linear mixed-effects regression model (P<.05). Results: The analysis is based on 68 students (both groups n=34). The percentage of cleaned surfaces was not significantly different (P=.40) between male (mean 81.6\%, SD 18.2\%) and female (mean 76.3\%, SD 21.1\%) students, irrespective of the instrument used. The use of power-driven instruments (mean 81.3\%, SD 20.5\%) led to significantly better results than the use of manual curettes (mean 75.4\%, SD 19.4\%; P=.02), and the overall performance decreased over time (T1: mean 84.5\%, SD 17.5\%; T2: mean 72.3\%, SD 20.8\%; P<.001). Conclusions: Female and male students performed equally well in subgingival debridement. Therefore, sex-differentiated teaching methods are not necessary. ", doi="10.2196/44989", url="https://mededu.jmir.org/2023/1/e44989", url="http://www.ncbi.nlm.nih.gov/pubmed/37002956" } @Article{info:doi/10.2196/42639, author="Blease, Charlotte and Kharko, Anna and Bernstein, Michael and Bradley, Colin and Houston, Muiris and Walsh, Ian and D Mandl, Kenneth", title="Computerization of the Work of General Practitioners: Mixed Methods Survey of Final-Year Medical Students in Ireland", journal="JMIR Med Educ", year="2023", month="Mar", day="20", volume="9", pages="e42639", keywords="medical students", keywords="medical education", keywords="general practitioners", keywords="artificial intelligence", keywords="machine learning", keywords="digital health", keywords="technology", keywords="tool", keywords="medical professional", keywords="biomedical", keywords="design", keywords="survey", keywords="COVID-19", abstract="Background: The potential for digital health technologies, including machine learning (ML)--enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics. Objective: We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks. Methods: Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses. Results: In total, 43.1\% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6\%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs. Conclusions: We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow's doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow's patients. ", doi="10.2196/42639", url="https://mededu.jmir.org/2023/1/e42639", url="http://www.ncbi.nlm.nih.gov/pubmed/36939809" } @Article{info:doi/10.2196/42340, author="Mart{\'i}n-Carbonell, Marta and Espejo, Bego{\~n}a and Castro-Melo, Patricia Greys and Sequeira-Daza, Doris and Checa, Irene", title="Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study", journal="J Med Internet Res", year="2023", month="Mar", day="9", volume="25", pages="e42340", keywords="psychometric properties", keywords="structural equation modeling", keywords="older adulthood", keywords="geriatric", keywords="gerontology", keywords="health care college students", keywords="health care professionals", keywords="questionnaire", keywords="stereotype", keywords="agism", abstract="Background: In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. Objective: The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. Methods: A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. Results: The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. Conclusions: The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism. ", doi="10.2196/42340", url="https://www.jmir.org/2023/1/e42340", url="http://www.ncbi.nlm.nih.gov/pubmed/36892936" } @Article{info:doi/10.2196/38870, author="Bieri, Julie and Tuor, Carlotta and Nendaz, Mathieu and L Savoldelli, Georges and Blondon, Katherine and Schiffer, Eduardo and Zamberg, Ido", title="Implementation of a Student-Teacher--Based Blended Curriculum for the Training of Medical Students for Nasopharyngeal Swab and Intramuscular Injection: Mixed Methods Pre-Post and Satisfaction Surveys", journal="JMIR Med Educ", year="2023", month="Mar", day="2", volume="9", pages="e38870", keywords="peer-learning", keywords="educator", keywords="education method", keywords="knowledge acquisition", keywords="training", keywords="student-teacher", keywords="COVID-19", keywords="nasal swab", keywords="vaccine", keywords="injection", keywords="skill assessment", keywords="skill development", keywords="vaccination", keywords="blended learning", keywords="blended education", keywords="hybrid education", keywords="medical education", keywords="pandemic", keywords="teaching", keywords="health care sector", keywords="medical student", keywords="hybrid learning", keywords="online learning", keywords="digital education", keywords="online education", keywords="online course", keywords="online class", keywords="simulation", abstract="Background: The COVID-19 pandemic caused a major disruption in the health care sector with increased workload and the need for new staff to assist with screening and vaccination tasks. Within this context, teaching medical students to perform intramuscular injections and nasal swabs could help address workforce needs. Although several recent studies discuss medical students' role and integration in clinical activities during the pandemic, knowledge gaps exist concerning their role and potential benefit in designing and leading teaching activities during this period. Objective: The aim of our study was to prospectively assess the impact in terms of confidence, cognitive knowledge, and perceived satisfaction of a student-teacher--designed educational activity consisting of nasopharyngeal swabs and intramuscular injections for the training of second-year medical students in the Faculty of Medicine, University of Geneva, Switzerland. Methods: This was a mixed methods pre-post surveys and satisfaction survey study. Activities were designed using evidence-based teaching methodologies based on the SMART (specific, measurable, achievable, realistic, and timely) criteria. All second-year medical students who did not participate in the activity's old format were recruited unless they explicitly stated that they wanted to opt out. Pre-post activity surveys were designed to assess perception of confidence and cognitive knowledge. An additional survey was designed to assess satisfaction in the mentioned activities. Instructional design was blended with a presession e-learning activity and a 2-hour practice session with simulators. Results: Between December 13, 2021, and January 25, 2022, a total of 108 second-year medical students were recruited; 82 (75.9\%) students participated in the preactivity survey and 73 (67.6\%) in the postactivity survey. Students' confidence in performing intramuscular injections and nasal swabs significantly increased on a 5-point Likert scale for both procedures---from 3.31 (SD 1.23) and 3.59 (SD 1.13) before the activity to 4.45 (SD 0.62) and 4.32 (SD 0.76) after the activity (P<.001), respectively. Perceptions of cognitive knowledge acquisition also significantly increased for both activities. For the nasopharyngeal swab, knowledge acquisition concerning indications increased from 2.7 (SD 1.24) to 4.15 (SD 0.83), and for the intramuscular injection, knowledge acquisition concerning indications increased from 2.64 (SD 1.1) to 4.34 (SD 0.65) (P<.001). Knowledge of contraindications for both activities increased from 2.43 (SD 1.1) to 3.71 (SD 1.12) and from 2.49 (SD 1.13) to 4.19 (SD 0.63), respectively (P<.001). High satisfaction rates were reported for both activities. Conclusions: Student-teacher--based blended activities for training novice medical students in commonly performed procedural skills seem effective for increasing their confidence and cognitive knowledge and should be further integrated within a medical school curriculum. Blended learning instructional design increases students' satisfaction about clinical competency activities. Future research should elucidate the impact of student-teacher--designed and student-teacher--led educational activities. ", doi="10.2196/38870", url="https://mededu.jmir.org/2023/1/e38870", url="http://www.ncbi.nlm.nih.gov/pubmed/36862500" } @Article{info:doi/10.2196/43916, author="Preiksaitis, Carl and Dayton, R. John and Kabeer, Rana and Bunney, Gabrielle and Boukhman, Milana", title="Teaching Principles of Medical Innovation and Entrepreneurship Through Hackathons: Case Study and Qualitative Analysis", journal="JMIR Med Educ", year="2023", month="Feb", day="24", volume="9", pages="e43916", keywords="hackathon", keywords="innovation", keywords="entrepreneurship", keywords="medical education", keywords="gamification", keywords="curriculum", keywords="biodesign", keywords="emergency medicine", keywords="health care innovation", keywords="medical innovation", keywords="training", keywords="design", keywords="implementation", keywords="development", keywords="physician", keywords="educational", abstract="Background: Innovation and entrepreneurship training are increasingly recognized as being important in medical education. However, the lack of faculty comfort with the instruction of these concepts as well as limited scholarly recognition for this work has limited the implementation of curricula focused on these skills. Furthermore, this lack of familiarity limits the inclusion of practicing physicians in health care innovation, where their experience is valuable. Hackathons are intense innovation competitions that use gamification principles to increase comfort with creative thinking, problem-solving, and interpersonal collaboration, but they require further exploration in medical innovation. Objective: To address this, we aimed to design, implement, and evaluate a health care hackathon with 2 main goals: to improve emergency physician familiarity with the principles of health care innovation and entrepreneurship and to develop innovative solutions to 3 discrete problems facing emergency medicine physicians and patients. Methods: We used previously described practices for conducting hackathons to develop and implement our hackathon (HackED!). We partnered with the American College of Emergency Physicians, the Stanford School of Biodesign, and the Institute of Design at Stanford (d.school) to lend institutional support and expertise in health care innovation to our event. We determined a location, time frame, and logistics for the competition and settled on 3 use cases for teams to work on. We planned to explore the learning experience of participants within a pragmatic paradigm and complete an abductive thematic analysis using data from a variety of sources. Results: HackED! took place from October 1-3, 2022. In all, 3 teams developed novel solutions to each of the use cases. Our investigation into the educational experience of participants suggested that the event was valuable and uncovered themes suggesting that the learning experience could be understood within a framework from entrepreneurship education not previously described in relation to hackathons. Conclusions: Health care hackathons appear to be a viable method of increasing physician experience with innovation and entrepreneurship principles and addressing complex problems in health care. Hackathons should be considered as part of educational programs that focus on these concepts. ", doi="10.2196/43916", url="https://mededu.jmir.org/2023/1/e43916", url="http://www.ncbi.nlm.nih.gov/pubmed/36826988" } @Article{info:doi/10.2196/45312, author="Gilson, Aidan and Safranek, W. Conrad and Huang, Thomas and Socrates, Vimig and Chi, Ling and Taylor, Andrew Richard and Chartash, David", title="How Does ChatGPT Perform on the United States Medical Licensing Examination (USMLE)? The Implications of Large Language Models for Medical Education and Knowledge Assessment", journal="JMIR Med Educ", year="2023", month="Feb", day="8", volume="9", pages="e45312", keywords="natural language processing", keywords="NLP", keywords="MedQA", keywords="generative pre-trained transformer", keywords="GPT", keywords="medical education", keywords="chatbot", keywords="artificial intelligence", keywords="education technology", keywords="ChatGPT", keywords="conversational agent", keywords="machine learning", keywords="USMLE", abstract="Background: Chat Generative Pre-trained Transformer (ChatGPT) is a 175-billion-parameter natural language processing model that can generate conversation-style responses to user input. Objective: This study aimed to evaluate the performance of ChatGPT on questions within the scope of the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 exams, as well as to analyze responses for user interpretability. Methods: We used 2 sets of multiple-choice questions to evaluate ChatGPT's performance, each with questions pertaining to Step 1 and Step 2. The first set was derived from AMBOSS, a commonly used question bank for medical students, which also provides statistics on question difficulty and the performance on an exam relative to the user base. The second set was the National Board of Medical Examiners (NBME) free 120 questions. ChatGPT's performance was compared to 2 other large language models, GPT-3 and InstructGPT. The text output of each ChatGPT response was evaluated across 3 qualitative metrics: logical justification of the answer selected, presence of information internal to the question, and presence of information external to the question. Results: Of the 4 data sets, AMBOSS-Step1, AMBOSS-Step2, NBME-Free-Step1, and NBME-Free-Step2, ChatGPT achieved accuracies of 44\% (44/100), 42\% (42/100), 64.4\% (56/87), and 57.8\% (59/102), respectively. ChatGPT outperformed InstructGPT by 8.15\% on average across all data sets, and GPT-3 performed similarly to random chance. The model demonstrated a significant decrease in performance as question difficulty increased (P=.01) within the AMBOSS-Step1 data set. We found that logical justification for ChatGPT's answer selection was present in 100\% of outputs of the NBME data sets. Internal information to the question was present in 96.8\% (183/189) of all questions. The presence of information external to the question was 44.5\% and 27\% lower for incorrect answers relative to correct answers on the NBME-Free-Step1 (P<.001) and NBME-Free-Step2 (P=.001) data sets, respectively. Conclusions: ChatGPT marks a significant improvement in natural language processing models on the tasks of medical question answering. By performing at a greater than 60\% threshold on the NBME-Free-Step-1 data set, we show that the model achieves the equivalent of a passing score for a third-year medical student. Additionally, we highlight ChatGPT's capacity to provide logic and informational context across the majority of answers. These facts taken together make a compelling case for the potential applications of ChatGPT as an interactive medical education tool to support learning. ", doi="10.2196/45312", url="https://mededu.jmir.org/2023/1/e45312", url="http://www.ncbi.nlm.nih.gov/pubmed/36753318" } @Article{info:doi/10.2196/43656, author="Martin-Sanchez, Fernando and L{\'a}zaro, Mart{\'i}n and L{\'o}pez-Ot{\'i}n, Carlos and Andreu, L. Antoni and Cigudosa, Cruz Juan and Garcia-Barbero, Milagros", title="Personalized Precision Medicine for Health Care Professionals: Development of a Competency Framework", journal="JMIR Med Educ", year="2023", month="Feb", day="7", volume="9", pages="e43656", keywords="personalized precision medicine", keywords="professional competence", keywords="domains", keywords="determinants of health", keywords="digitalization", keywords="communication", keywords="bioethics", keywords="digital health", abstract="Background: Personalized precision medicine represents a paradigm shift and a new reality for the health care system in Spain, with training being fundamental for its full implementation and application in clinical practice. In this sense, health care professionals face educational challenges related to the acquisition of competencies to perform their professional practice optimally and efficiently in this new environment. The definition of competencies for health care professionals provides a clear guide on the level of knowledge, skills, and attitudes required to adequately carry out their professional practice. In this context, this acquisition of competencies by health care professionals can be defined as a dynamic and longitudinal process by which they use knowledge, skills, attitudes, and good judgment associated with their profession to develop it effectively in all situations corresponding to their field of practice. Objective: This report aims to define a proposal of essential knowledge domains and common competencies for all health care professionals, which are necessary to optimally develop their professional practice within the field of personalized precision medicine as a fundamental part of the medicine of the future. Methods: Based on a benchmark analysis and the input and expertise provided by a multidisciplinary group of experts through interviews and workshops, a new competency framework that would guarantee the optimal performance of health care professionals was defined. As a basis for the development of this report, the most relevant national and international competency frameworks and training programs were analyzed to identify aspects that are having an impact on the application of personalized precision medicine and will be considered when developing professional competencies in the future. Results: This report defines a framework made up of 58 competencies structured into 5 essential domains: determinants of health, biomedical informatics, practical applications, participatory health, and bioethics, along with a cross-cutting domain that impacts the overall performance of the competencies linked to each of the above domains. Likewise, 6 professional profiles to which this proposal of a competency framework is addressed were identified according to the area where they carry out their professional activity: health care, laboratory, digital health, community health, research, and management and planning. In addition, a classification is proposed by progressive levels of training that would be advisable to acquire for each competency according to the professional profile. Conclusions: This competency framework characterizes the knowledge, skills, and attitudes required by health care professionals for the practice of personalized precision medicine. Additionally, a classification by progressive levels of training is proposed for the 6 professional profiles identified according to their professional roles. ", doi="10.2196/43656", url="https://mededu.jmir.org/2023/1/e43656", url="http://www.ncbi.nlm.nih.gov/pubmed/36749626" } @Article{info:doi/10.2196/42197, author="Grant, William and Adan, A. Matthew and Samurkas, A. Christina and Quigee, Daniela and Benitez, Jorge and Gray, Brett and Carnevale, Caroline and Gordon, J. Rachel and Castor, Delivette and Zucker, Jason and Sobieszczyk, E. Magdalena", title="Effect of Participative Web-Based Educational Modules on HIV and Sexually Transmitted Infection Prevention Competency Among Medical Students: Single-Arm Interventional Study", journal="JMIR Med Educ", year="2023", month="Jan", day="24", volume="9", pages="e42197", keywords="HIV prevention", keywords="medical education", keywords="sexual health education", keywords="pre-exposure prophylaxis", keywords="PrEP", abstract="Background: The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers' practice habits are established. Objective: The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers. Methods: Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire. Results: Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2\%) and postexposure prophylaxis (114/123, 92.7\%). Before the training, 30.9\% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91\% (81/89) after the intervention. Conclusions: Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts. ", doi="10.2196/42197", url="https://mededu.jmir.org/2023/1/e42197", url="http://www.ncbi.nlm.nih.gov/pubmed/36692921" } @Article{info:doi/10.2196/37069, author="Ozair, Ahmad and Bhat, Vivek and Detchou, E. Donald K.", title="The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators", journal="JMIR Med Educ", year="2023", month="Jan", day="6", volume="9", pages="e37069", keywords="admission", keywords="assessment", keywords="postgraduate training", keywords="selection", keywords="standardized testing", doi="10.2196/37069", url="https://mededu.jmir.org/2023/1/e37069", url="http://www.ncbi.nlm.nih.gov/pubmed/36607718" } @Article{info:doi/10.2196/38329, author="Kamat, Samir and Danias, George and Agarwal, Aneesh and Chennareddy, Sumanth and Han, Joseph and Lee, Samuel", title="Incorporating Paid Caregivers Into Medical Education to Enhance Medical Student Exposure to This Essential Workforce", journal="JMIR Med Educ", year="2022", month="Dec", day="9", volume="8", number="4", pages="e38329", keywords="medical education", keywords="education", keywords="student", keywords="communication", keywords="perspective", keywords="medical student", keywords="paid caregiver", keywords="caregiver", keywords="health care model", keywords="home-based health care", keywords="patient care", keywords="health care provider", keywords="student experience", keywords="training", keywords="care team", keywords="integration", keywords="clinical decision", doi="10.2196/38329", url="https://mededu.jmir.org/2022/4/e38329", url="http://www.ncbi.nlm.nih.gov/pubmed/36485028" } @Article{info:doi/10.2196/40082, author="Zeng, Minrui and Cai, Yiyuan and Cao, Jin and He, Qianyu and Wang, Xiaohui and Lu, Yun and Liang, Huijuan and Xu, Dong and Liao, Jing", title="The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China", journal="J Med Internet Res", year="2022", month="Dec", day="2", volume="24", number="12", pages="e40082", keywords="virtual patient", keywords="unannounced standardized patient", keywords="primary health care", keywords="primary care", keywords="quality assessment", keywords="quality improvement", keywords="scenario", keywords="simulation", keywords="simulate", keywords="medical education", keywords="cross-sectional", keywords="digital health", keywords="eHealth", abstract="Background: The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. Objective: This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Methods: Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted $\kappa$ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Results: Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95\% CI 0.24-0.49); for physical examination, 0.27 (95\% CI 0.12-0.42); for laboratory and imaging tests, --0.03 (95\% CI --0.20 to 0.14); and for treatment, 0.22 (95\% CI 0.07-0.37). The weighted $\kappa$ for diagnosis was 0.32 (95\% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. Conclusions: There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the ``know-do'' gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study. ", doi="10.2196/40082", url="https://www.jmir.org/2022/12/e40082", url="http://www.ncbi.nlm.nih.gov/pubmed/36459416" } @Article{info:doi/10.2196/37478, author="Garvey, V. Kim and Thomas Craig, Jean Kelly and Russell, Regina and Novak, L. Laurie and Moore, Don and Miller, M. Bonnie", title="Considering Clinician Competencies for the Implementation of Artificial Intelligence--Based Tools in Health Care: Findings From a Scoping Review", journal="JMIR Med Inform", year="2022", month="Nov", day="16", volume="10", number="11", pages="e37478", keywords="artificial intelligence", keywords="competency", keywords="clinical education", keywords="patient", keywords="digital health", keywords="digital tool", keywords="clinical tool", keywords="health technology", keywords="health care", keywords="educational framework", keywords="decision-making", keywords="clinical decision", keywords="health information", keywords="physician", abstract="Background: The use of artificial intelligence (AI)--based tools in the care of individual patients and patient populations is rapidly expanding. Objective: The aim of this paper is to systematically identify research on provider competencies needed for the use of AI in clinical settings. Methods: A scoping review was conducted to identify articles published between January 1, 2009, and May 1, 2020, from MEDLINE, CINAHL, and the Cochrane Library databases, using search queries for terms related to health care professionals (eg, medical, nursing, and pharmacy) and their professional development in all phases of clinical education, AI-based tools in all settings of clinical practice, and professional education domains of competencies and performance. Limits were provided for English language, studies on humans with abstracts, and settings in the United States. Results: The searches identified 3476 records, of which 4 met the inclusion criteria. These studies described the use of AI in clinical practice and measured at least one aspect of clinician competence. While many studies measured the performance of the AI-based tool, only 4 measured clinician performance in terms of the knowledge, skills, or attitudes needed to understand and effectively use the new tools being tested. These 4 articles primarily focused on the ability of AI to enhance patient care and clinical decision-making by improving information flow and display, specifically for physicians. Conclusions: While many research studies were identified that investigate the potential effectiveness of using AI technologies in health care, very few address specific competencies that are needed by clinicians to use them effectively. This highlights a critical gap. ", doi="10.2196/37478", url="https://medinform.jmir.org/2022/11/e37478", url="http://www.ncbi.nlm.nih.gov/pubmed/36318697" } @Article{info:doi/10.2196/38759, author="Seto, Noah and Beach, Jeffrey and Calvano, Joshua and Lu, Shu and He, Shuhan", title="American Anesthesiology Residency Programs: Website Usability Analysis", journal="Interact J Med Res", year="2022", month="Oct", day="20", volume="11", number="2", pages="e38759", keywords="medical student education", keywords="education in anesthesia", keywords="technology in education", keywords="quality improvement", keywords="communication", abstract="Background: The Association of American Medical Colleges has recently issued recommendations for the upcoming 2022-2023 application cycle that residency programs should conduct all interviews for this upcoming application cycle over the web. In light of these recommendations, many students will have limited exposure to anesthesiology programs and will rely on information gleaned digitally. This change means that the aspects of program websites used to provide information, such as size, structure, location, requirements, and contact information, will be crucial in helping prospective residents decide where and how to apply in the future. An evaluation of website usability, which includes initial appearance along with factors that influence its ease of navigation and convenience of use, can thus be applied to anesthesiology residency websites. Areas of need can be targeted to increase web presence and provide effective pathways to exhibit the different attributes of their programs to future applicants. Objective: This study aimed to compile a list of US anesthesiology residency programs and their websites while objectively analyzing the websites using a formally published usability scoring system, as well as to identify positive and negative trends to offer areas of improvement among anesthesiology residency websites. Methods: We included only 114 US anesthesiology residency program websites in our sample set, since some websites we analyzed showed errors or inconclusive. Website usability was separated into 4 distinct categories for analysis based on methodology outlined in previous literature on both health care website usability and residency website usability. The 4 categories were Accessibility, Marketing, Content Quality, and Technology. Each website was then analyzed and scored based on key components highlighted within the 4 categories. The multiple factors were then graded using a percentage system to create a comprehensive score for each program. Results: The highest scoring category was Content Quality (mean 4.7, SD 2.48, SE 0.23). The lowest scoring category was Technology (mean 0.9, SD 0.38, SE 0.04). Conclusions: Through the application of a health care website usability framework, multiple anesthesiology residency programs were analyzed and scored in the areas of Accessibility, Marketing, Content Quality, and Technology, which allowed us to determine the effectiveness of the usability of these websites to convey information to their end user. Websites must communicate vital information, with usability at the forefront, to continue to grow, especially as the United States faces challenges due to the COVID-19 pandemic. Our recommendation is that anesthesiology programs should strive to improve website usability to increase the ease by which applicants can collect vital information about anesthesiology programs. A few proposed solutions include making changes such as decreasing error pages on websites, migrating away from using in-line cascading style sheets, and improving web page loading speeds to improve the Technology category. ", doi="10.2196/38759", url="https://www.i-jmr.org/2022/2/e38759", url="http://www.ncbi.nlm.nih.gov/pubmed/36264625" } @Article{info:doi/10.2196/40520, author="Harris, B. Stewart and Idzik, Shannon and Boasso, Adriano and Neunie, Quasheba Sola and Noble, Daniel Alexander and Such, Elaine Helen and Van, Joanna", title="The Educational Impact of Web-Based, Faculty-Led Continuing Medical Education Programs in Type 2 Diabetes: A Survey Study to Analyze Changes in Knowledge, Competence, and Performance of Health Care Professionals", journal="JMIR Med Educ", year="2022", month="Oct", day="14", volume="8", number="4", pages="e40520", keywords="clinical case", keywords="competence", keywords="continuing medical education", keywords="knowledge", keywords="multidisciplinary team", keywords="web-based education", keywords="performance", keywords="type 2 diabetes", abstract="Background: The treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited. Objective: This study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence, and performance following short, case-based, multidisciplinary web-based CME activities; and identify the remaining educational gaps. Methods: Two faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5). Results: Each activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80\%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P<.001), with the proportion of learners answering at least six of 7 questions correctly, increasing from 22\% (11/50) to 60\% (30/50). A nonsignificant improvement in knowledge and competence was observed following participation in touch MultiDisciplinary Team (mean score, SD 4.36, 1.24 vs 4.58, 1.07; P=.35); however, baseline knowledge and competence were relatively high, where 80\% of the respondents (40/50) answered at least four of 6 questions correctly. A significant improvement in HCP self-reported performance was observed in a combined analysis of both activities (mean score, SD 2.65, 1.32 vs 3.15, 1.26; P=.03), with the proportion of learners selecting the answer representing the best clinical option for all 4 questions increasing from 32\% (11/34) to 59\% (20/34) after the activity. Several unmet educational needs were self-reported or identified from the analysis of incorrectly answered questions, including setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. Conclusions: Short, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. ", doi="10.2196/40520", url="https://mededu.jmir.org/2022/4/e40520", url="http://www.ncbi.nlm.nih.gov/pubmed/36102282" } @Article{info:doi/10.2196/37081, author="Balapal, Neha and Ankem, Amala and Shyamsundar, Saishravan and He, Shuhan", title="Opioid Use Disorder Education for Students and the Future of Opioid Overdose Treatment", journal="JMIR Med Educ", year="2022", month="Jul", day="18", volume="8", number="3", pages="e37081", keywords="opioid use disorder", keywords="students", keywords="buprenorphine", keywords="education", keywords="public health", keywords="opioid", keywords="health care providers", keywords="healthcare providers", keywords="medication-assisted treatment", keywords="youth", keywords="substance use", keywords="opioid agonist", keywords="overdose", doi="10.2196/37081", url="https://mededu.jmir.org/2022/3/e37081", url="http://www.ncbi.nlm.nih.gov/pubmed/35849432" } @Article{info:doi/10.2196/38050, author="Aggarwal, Anuj and Hess, Olivia and Lockman, L. Justin and Smith, Lauren and Stevens, Mitchell and Bruce, Janine and Caruso, Thomas", title="Anesthesiologists With Advanced Degrees in Education: Qualitative Study of a Changing Paradigm", journal="JMIR Med Educ", year="2022", month="Jun", day="30", volume="8", number="2", pages="e38050", keywords="academic medical centers", keywords="trends", keywords="medical education", keywords="medical", keywords="faculty", keywords="anesthesiologists", keywords="medical professionals", keywords="learning", keywords="institute", keywords="clinician", keywords="educator", keywords="experience", keywords="decision-making", keywords="training", abstract="Background: Anesthesiology education has undergone profound changes over the past century, from a pure clinical apprenticeship to novel comprehensive curricula based on andragogic learning theories. Combined with institutional and regulatory requirements, these new curricula have propagated professionalization of the clinician-educator role. A significant number of clinician-educator anesthesiologists, often with support from department chairs, pursue formal health professions education (HPE) training, yet there are no published data demonstrating the benefits or costs of these degrees to educational leaders. Objective: This study aims to collect the experiences of anesthesiologists who have pursued HPE degrees to understand the advantages and costs of HPE degrees to anesthesiologists. Methods: Investigators performed a qualitative study of anesthesiologists with HPE degrees working at academic medical centers. Interviews were thematically analyzed via an iterative process. They were coded using a team-based approach, and representative themes and exemplary quotations were identified. Results: Seven anesthesiologists were interviewed, representing diverse geographic regions, subspecialties, and medical institutions. Analyses of interview transcripts resulted in the following 6 core themes: outcomes, extrinsic motivators, intrinsic motivators, investment, experience, and recommendations. The interviewees noted the advantages of HPE training for those wishing to pursue leadership or scholarship in medical education; however, they also noted the costs and investment of time in addition to preexisting commitments. The interviewees also highlighted the issues faculty and chairs might consider for the optimal timing of HPE training. Conclusions: There are numerous professional and personal benefits to pursuing HPE degrees for faculty interested in education leadership or scholarship. Making an informed decision to pursue HPE training can be challenging when considering the competing pressures of clinical work and personal obligations. The experiences of the interviewed anesthesiologists offer direction to future anesthesiologists and chairs in their decision-making process of whether and when to pursue HPE training. ", doi="10.2196/38050", url="https://mededu.jmir.org/2022/2/e38050", url="http://www.ncbi.nlm.nih.gov/pubmed/35771619" } @Article{info:doi/10.2196/35074, author="Jensen, Katherine and Yan, Qi and Davies, G. Mark", title="Critical Comparison of the Quality and Content of Integrated Vascular Surgery, Thoracic Surgery, and Interventional Radiology Residency Training Program Websites: Qualitative Study", journal="JMIR Med Educ", year="2022", month="Jun", day="29", volume="8", number="2", pages="e35074", keywords="training", keywords="recruitment", keywords="website", keywords="content", keywords="quality", keywords="vascular surgery", keywords="thoracic surgery", keywords="interventional radiology", keywords="radiology", keywords="surgery", keywords="web-based", keywords="web resource", keywords="surgeon", keywords="comparison", keywords="residency", keywords="integrated program", abstract="Background: With the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery, and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program. Objective: The aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs. Methods: A list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) database. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software. Results: Of ACGME-accredited programs, 56 of 61 (92\%) vascular surgery, 27 of 27 (100\%) thoracic surgery, and 74 of 85 (87\%) interventional radiology programs had functional websites (P=.12). Vascular surgery websites contained a median of 26 (IQR 20-32) content items, thoracic surgery websites contained a median of 27 (IQR 21-32) content items, and interventional radiology websites contained a median of 23 (IQR 18-27) content items. Two content items considered highly influential to applicant program decisions are procedural experience and faculty mentorship, which were reported at 32\% (18/56) and 11\% (6/56) for vascular surgery, 19\% (5/27) and 11\% (3/27) for thoracic surgery, and 50\% (37/74) and 15\% (11/74) for interventional radiology (P=.008 and P=.75), respectively. Key deficits were work hours, debt management, and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; and operative experiences and the program director's contact and message for thoracic surgery. Interventional radiology deficits were work hours, and thoracic surgery deficits were procedural experience. Both interventional radiology and thoracic surgery websites lacked information on evaluation criteria and faculty mentorship. Conclusions: This study has uncovered key differences in the availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content to attract valuable candidates. ", doi="10.2196/35074", url="https://mededu.jmir.org/2022/2/e35074", url="http://www.ncbi.nlm.nih.gov/pubmed/35767342" } @Article{info:doi/10.2196/34791, author="James, K. Hannah and Fawdington, A. Ross", title="Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study", journal="JMIR Med Educ", year="2022", month="Jun", day="29", volume="8", number="2", pages="e34791", keywords="simulation", keywords="high fidelity simulation", keywords="orthopedic residency", keywords="surgical training", keywords="postgraduate education", keywords="medical education", keywords="medical student", keywords="surgeon", keywords="hand", keywords="hand surgery", keywords="surgery", keywords="orthopedic", keywords="cadaver", keywords="cadaveric simulation", keywords="cadaveric", keywords="training", keywords="cadaveric training", keywords="DP", keywords="deliberate practice", abstract="Background: Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact. Objective: The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training. Methods: This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study. Results: The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training. Conclusions: Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work. ", doi="10.2196/34791", url="https://mededu.jmir.org/2022/2/e34791", url="http://www.ncbi.nlm.nih.gov/pubmed/35767315" } @Article{info:doi/10.2196/34299, author="Bergeron, Lysa and D{\'e}cary, Simon and Djade, Djignefa Codjo and Daniel, J. Sam and Tremblay, Martin and Rivest, Louis-Paul and L{\'e}gar{\'e}, France", title="Factors Associated With Specialists' Intention to Adopt New Behaviors After Taking Web-Based Continuing Professional Development Courses: Cross-sectional Study", journal="JMIR Med Educ", year="2022", month="Jun", day="2", volume="8", number="2", pages="e34299", keywords="continuing professional development", keywords="CPD-Reaction", keywords="behavioral intention", keywords="medical specialists", keywords="web-based training", keywords="medical education", keywords="education", keywords="physician", keywords="psychosocial", keywords="online course", abstract="Background: Web-based continuing professional development (CPD) is a convenient and low-cost way for physicians to update their knowledge. However, little is known about the factors that influence their intention to put this new knowledge into practice. Objective: We aimed to identify sociocognitive factors associated with physicians' intention to adopt new behaviors as well as indications of Bloom's learning levels following their participation in 5 web-based CPD courses. Methods: We performed a cross-sectional study of specialist physicians who had completed 1 of 5 web-based CPD courses offered by the Federation of Medical Specialists of Quebec. The participants then completed CPD-Reaction, a questionnaire based on Godin's integrated model for health professional behavior change and with evidence of validity that measures behavioral intention (dependent variable) and psychosocial factors influencing intention (n=4). We also assessed variables related to sociodemographics (n=5), course content (n=9), and course format (eg, graphic features and duration) (n=8). Content variables were derived from CanMEDS competencies, Bloom's learning levels, and Godin's integrated model. We conducted ANOVA single-factor analysis, calculated the intraclass correlation coefficient (ICC), and performed bivariate and multivariate analyses. Results: A total of 400 physicians participated in the courses (range: 38-135 physicians per course). Average age was 50 (SD 12) years; 56\% (n=223) were female, and 44\% (n=177) were male. Among the 259 who completed CPD-Reaction, behavioral intention scores ranged from 5.37 (SD 1.17) to 6.60 (SD 0.88) out of 7 and differed significantly from one course to another (P<.001). The ICC indicated that 17\% of the total variation in the outcome of interest, the behavioral intention of physicians, could be explained at the level of the CPD course (ICC=0.17). In bivariate analyses, social influences (P<.001), beliefs about capabilities (P<.001), moral norm (P<.001), beliefs about consequences (P<.001), and psychomotor learning (P=.04) were significantly correlated with physicians' intention to adopt new behaviors. Multivariate analysis showed the same factors, except for social influences and psychomotor learning, as significantly correlated with intention. Conclusions: We observed average to high behavioral intention scores after all 5 web-based courses, with some variations by course taken. Factors affecting physicians' intention were beliefs about their capabilities and about the consequences of adopting new clinical behaviors, as well as doubts about whether the new behavior aligned with their moral values. Our results will inform design of future web-based CPD courses to ensure they contribute to clinical behavior change. ", doi="10.2196/34299", url="https://mededu.jmir.org/2022/2/e34299", url="http://www.ncbi.nlm.nih.gov/pubmed/35476039" } @Article{info:doi/10.2196/38126, author="Leung, I. Tiffany and Wang, H. Karen and Lin, L. Tammy and Gin, T. Geneen and Pendharkar, S. Sima and Chen, Angie Chwen-Yuen", title="Women Physicians in Transition Learning to Navigate the Pipeline from Early to Mid-Career: Protocol for a Qualitative Study", journal="JMIR Res Protoc", year="2022", month="Jun", day="2", volume="11", number="6", pages="e38126", keywords="gender equity", keywords="women physician", keywords="female physicians", keywords="career development", keywords="professional development", keywords="career pipeline", keywords="leaky pipeline", keywords="mid-career physicians", keywords="early-career physicians", keywords="physician", keywords="healthcare profession", keywords="peer support", keywords="physician perspective", keywords="physician experience", keywords="professional learning", keywords="healthcare", keywords="health care", keywords="healthcare education", keywords="career support", keywords="gender equality", keywords="gender bias", keywords="healthcare learning", abstract="Background: Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. Objective: The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. Methods: Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. Results: The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. Conclusions: Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section. ", doi="10.2196/38126", url="https://www.researchprotocols.org/2022/6/e38126", url="http://www.ncbi.nlm.nih.gov/pubmed/35653172" } @Article{info:doi/10.2196/34302, author="Dunn, Sheila and Munro, Sarah and Devane, Courtney and Guilbert, Edith and Jeong, Dahn and Stroulia, Eleni and Soon, A. Judith and Norman, V. Wendy", title="A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study", journal="J Med Internet Res", year="2022", month="May", day="5", volume="24", number="5", pages="e34302", keywords="mifepristone", keywords="abortion", keywords="community of practice", keywords="virtual community of practice", keywords="diffusion of innovation", keywords="learning community", abstract="Background: Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective: The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communaut{\'e} de pratique canadienne sur l'avortement (CAPS-CPCA) VCoP and explore physicians' experience with CAPS-CPCA and their views on its value in supporting implementation. Methods: This was a mixed methods intrinsic case study of Canadian health care providers' use and physicians' perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians' characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians' experiences and perceptions of the VCoP. Results: From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6\%) completed a baseline survey. Of these 222 respondents, 156 (70.3\%) were family physicians, 170 (80.2\%) were women, and 78 (35.1\%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9\% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9\% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project's knowledge translation activities with policy makers to mitigate these barriers. Conclusions: A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028443 ", doi="10.2196/34302", url="https://www.jmir.org/2022/5/e34302", url="http://www.ncbi.nlm.nih.gov/pubmed/35511226" } @Article{info:doi/10.2196/36948, author="Ayivi-Vinz, Gloria and Bakwa Kanyinga, Felly and Bergeron, Lysa and D{\'e}cary, Simon and Adisso, Lionel {\'E}v{\`e}hou{\'e}nou and Zomahoun, Vignon Herv{\'e} Tchala and Daniel, J. Sam and Tremblay, Martin and Plourde, V. Karine and Guay-B{\'e}langer, Sabrina and L{\'e}gar{\'e}, France", title="Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review", journal="JMIR Med Educ", year="2022", month="May", day="2", volume="8", number="2", pages="e36948", keywords="CPD-REACTION", keywords="behavior", keywords="intention", keywords="education medical", keywords="continuing", keywords="health care professionals", keywords="questionnaire", keywords="web-based", keywords="continuing professional development", abstract="Background: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory--informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory--informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions. Objective: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. Methods: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58\%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65\%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31\% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60\%). Conclusions: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. Trial Registration: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=116492 ", doi="10.2196/36948", url="https://mededu.jmir.org/2022/2/e36948", url="http://www.ncbi.nlm.nih.gov/pubmed/35318188" } @Article{info:doi/10.2196/35083, author="Ewais, Tatjana and Hunt, Georgia and Munro, Jonathan and Pun, Paul and Hogan, Christy and William, Leeroy and Teodorczuk, Andrew", title="Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial", journal="JMIR Res Protoc", year="2022", month="Apr", day="27", volume="11", number="4", pages="e35083", keywords="Schwartz Rounds", keywords="compassionate care", keywords="health care staff well-being", abstract="Background: Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective: Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods: This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory--Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results: The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions: The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/35083 ", doi="10.2196/35083", url="https://www.researchprotocols.org/2022/4/e35083", url="http://www.ncbi.nlm.nih.gov/pubmed/35475785" } @Article{info:doi/10.2196/28625, author="Main, Penelope and Anderson, Sarah", title="Evidence for Continuing Professional Development and Recency of Practice Standards for Regulated Health Professionals in Australia: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2022", month="Apr", day="13", volume="11", number="4", pages="e28625", keywords="protocol", keywords="systematic review", keywords="continuing professional development", keywords="continuing education", keywords="recency of practice", keywords="regulatory standards", keywords="health practitioners", abstract="Background: Continuing professional development (CPD) and recency of practice (ROP) standards are components of health practitioner regulation in Australia. The CPD and ROP standards are currently under review, and an evidence base to assist the development of consistent standards is required. Preliminary searching was unable to find a recent systematic review of the literature to provide an evidence base to underpin the standards review. Objective: This paper presents the protocol for a systematic review that aims to develop a current evidence base that will support the National Boards to develop more consistent, evidence-based, effective standards that are clear and easy to understand and operationalize. Methods: Research questions were developed to support the planned review of CPD and ROP registration standards. Major databases and relevant journals were searched for articles published in English between 2015 and 2021, using key search terms based on previous unpublished reviews of the CPD and ROP registration standards. The quality of the articles retrieved will be assessed using an instrument suitable for use in the development of public policy. The findings will be published in a peer-reviewed journal. Results: In September 2021, our search strategy identified 18,002 studies for the CPD-related research questions after removal of duplicates. Of these, 509 records were screened based on their title, and 66 full-text articles were assessed for eligibility based on their abstract, of which 31 met the inclusion criteria. A further 291 articles were identified as relevant to the ROP research questions. Of these, 87 records were screened based on their title, and 46 full-text articles were assessed for eligibility based on their abstract, of which 8 studies met our inclusion criteria. Conclusions: This protocol outlines the scope and methodology that will be used to conduct a systematic review of evidence for CPD and ROP and inform a review of the standards for regulated health professionals in Australia. Previous research has shown that while CPD improves practitioner knowledge, the link to public safety is unclear. While there has been a greater focus on maintenance of certification and other quality assurance activities over the past 10 years, there remains great variability in CPD requirements across both professions and jurisdictions. ROP was found to be a poorly researched area with most research concentrating on medical practitioners, nurses, and midwives and no clear consensus about the optimal time period after which retraining or an assessment of competence should be introduced. As the CPD and ROP standards are currently under review, it is timely that a review of current evidence be undertaken. International Registered Report Identifier (IRRID): DERR1-10.2196/28625 ", doi="10.2196/28625", url="https://www.researchprotocols.org/2022/4/e28625", url="http://www.ncbi.nlm.nih.gov/pubmed/35416788" } @Article{info:doi/10.2196/32242, author="Metcalf, Mary and Rossie, Karen and Stokes, Katie and Tanner, Bradley", title="Health Care Professionals' Clinical Skills to Address Vaping and e-Cigarette Use by Patients: Needs and Interest Questionnaire Study", journal="JMIR Form Res", year="2022", month="Apr", day="11", volume="6", number="4", pages="e32242", keywords="clinical skills", keywords="vaping", keywords="e-cigarettes", keywords="nicotine", keywords="brief interventions", keywords="addiction treatment", keywords="health care professionals", keywords="continuing education", abstract="Background: Widespread vaping and e-cigarette use is a relatively new phenomenon. Youth vaping peaked in 2019, with over 25\% of high school students currently vaping. e-Cigarettes are used where smoking is not permitted or as an alternative smoking cessation treatment instead of Food and Drug Administration--approved options. Vaping and e-cigarette use has the potential to harm health, including causing adverse respiratory effects and nicotine addiction. Health care professionals need skills training to help their patients with this relatively new and evolving health problem. Objective: The aim of this study is to understand health care professionals' training needs in this subject area to determine the focus for web-based continuing education training. Methods: We reviewed the literature on clinical aspects of vaping and e-cigarette use. Using the results and our experience in substance use continuing education, we created a list of key clinical skills and surveyed health care professionals about their training needs. We also asked about their interest in a list of related topics. We recruited individuals who completed our web-based courses on substance use, members of health care professional--related groups, and experts who had published an article on the subject. Half of the 31 health care professionals who completed the survey were physicians and the remainder were primarily nurses, social workers, and counselors. Participants self-identified as nonexperts (n=25) and experts (n=6) on vaping. Results: Participants who were nonexperts on average agreed or strongly agreed that they needed training in each of 8 clinical skills (n=25; range 3.7-4.4 agreement out of 5). The top two skills were recommending treatments for patients (4.4 out of 5, SD 0.49) and evaluating and treating the health effects of vaping and e-cigarette use (4.4 out of 5, SD 0.50). Experts agreed on the importance of training for health care professionals in all skills but rated the need for training higher than nonexperts for each topic. Over half of the participating health care professionals (44\%-80\%) were interested in nearly all (9/10, 90\%) vaping-related topics on a checklist. The topics participants were most interested in were the pros and cons of vaping versus smoking and the health effects of second- and third-hand vaping. Primary care physicians showed more interest in vaping-related topics than nonprimary care physicians (t13=2.17; P=.02). Conclusions: This study confirmed gaps in health care professionals' vaping-related clinical skills identified in the literature by identifying a perceived need for training in related skills and health care professionals' interest in key topics related to vaping prevention and cessation. This study provides specific guidance on which clinical skills training is most needed and which topics are most interesting to health care professionals. ", doi="10.2196/32242", url="https://formative.jmir.org/2022/4/e32242", url="http://www.ncbi.nlm.nih.gov/pubmed/35404264" } @Article{info:doi/10.2196/33592, author="Gibney, Ryan and Cantwell, Christina and Wray, Alisa and Boysen-Osborn, Megan and Wiechmann, Warren and Saadat, Soheil and Smart, Jonathan and Toohey, Shannon", title="Influence of Factors Relating to Sex and Gender on Rank List Decisions and Perceptions of Residency Training: Survey Study", journal="JMIR Med Educ", year="2022", month="Apr", day="5", volume="8", number="2", pages="e33592", keywords="residency", keywords="sex", keywords="gender", keywords="graduate medical education", keywords="emergency medicine", keywords="residents", keywords="program leadership", keywords="rank list", abstract="Background: Females make up more than half of medical school matriculants but only one-third of emergency medicine (EM) residents. Various factors may contribute to why fewer females choose the field of EM, such as the existing presence of females in the specialty. Objective: This study is a follow-up to previous work, and a survey is used to assess current residents' attitudes and perceptions on various factors, including those relating to sex and gender on creating rank lists as medical students and in perceived effects on residency education. Methods: A web-based survey consisting of Likert scale questions regarding a variety of factors influencing a student's decision to create a rank list and in perceived effects on residency education was sent to current EM residents in 2020. Results: Residents from 17 programs participated in the survey with an 18.2\% (138/758) response rate. The most important factors in creating a rank list were the personality of residents in the program, location, and facility type. For factors specifically related to gender, respondents who answered affirmatively to whether the gender composition of residents affected the selection of a program in making a rank list were more likely to also answer affirmatively to subsequent questions related to the gender of program leadership (P<.001) and gender composition of attending physicians (P<.001). The personality of residents was also the most important factor perceived to affect residency education. For factors influencing rank list and residency education, female respondents placed higher importance on subcategories related to gender (ie, gender composition of the residents, of the program leadership, and of the attending physicians) to a significant degree compared with their male counterparts. Conclusions: Although factors such as location and resident personality show the most importance in influencing residency selection, when stratifying based on respondent sex, females tend to indicate that factors relating to gender have more influence on rank list and residency education compared with males. ", doi="10.2196/33592", url="https://mededu.jmir.org/2022/2/e33592", url="http://www.ncbi.nlm.nih.gov/pubmed/35380547" } @Article{info:doi/10.2196/34369, author="Nguyen, Tuan Ba and Phung, Lam Toi and Khuc, Hanh Thi Hong and Nguyen, Thi Van Anh and Blizzard, Leigh Christopher and Palmer, Andrew and Nguyen, Tu Huu and Cong Quyet, Thang and Nelson, Mark", title="Trauma Care Training in Vietnam: Narrative Scoping Review", journal="JMIR Med Educ", year="2022", month="Jan", day="24", volume="8", number="1", pages="e34369", keywords="trauma training", keywords="Vietnamese medical education system", keywords="medical curricula", keywords="short course", abstract="Background: The model of trauma in Vietnam has changed significantly over the last decade and requires reforming medical education to deal with new circumstances. Our aim is to evaluate this transition regarding the new target by analyzing trauma and the medical training system as a whole. Objective: This study aimed to establish if medical training in the developing country of Vietnam has adapted to the new disease pattern of road trauma emerging in its economy. Methods: A review was performed of Vietnamese medical school, Ministry of Health, and Ministry of Education and Training literature on trauma education. The review process and final review paper were prepared following the guidelines on scoping reviews and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. Results: The current trauma training at the undergraduate level is minimal and involves less than 5\% of the total credit. At the postgraduate level, only the specialties of surgery and anesthesia have a significant and increasing trauma training component ranging from 8\% to 22\% in the content. Trauma training, which focuses on practical skills, accounts for 31\% and 32\% of the training time of orientation courses for young doctors in ``basic surgery'' and ``basic anesthesia,'' respectively. Other relevant short course trainings, such as continuing medical education, in trauma are available, but they vary in topics, facilitators, participants, and formats. Conclusions: Medical training in Vietnam has not adapted to the new emerging disease pattern of road trauma. In the interim, the implementation of short courses, such as basic trauma life support and primary trauma care, can be considered as an appropriate method to compensate for the insufficient competency-related trauma care among health care workers while waiting for the effectiveness of medical training reformation. ", doi="10.2196/34369", url="https://mededu.jmir.org/2022/1/e34369", url="http://www.ncbi.nlm.nih.gov/pubmed/34967756" } @Article{info:doi/10.2196/31042, author="Burgon, Trever and Casebeer, Linda and Aasen, Holly and Valdenor, Czarlota and Tamondong-Lachica, Diana and de Belen, Enrico and Paculdo, David and Peabody, John", title="Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Dec", day="23", volume="23", number="12", pages="e31042", keywords="quality improvement", keywords="physician engagement", keywords="MIPS", keywords="case simulation", keywords="feedback", keywords="value-based care", keywords="care standardization", keywords="simulation", keywords="gamification", keywords="medical education", keywords="continuing education", keywords="outcome", keywords="serious game", keywords="decision-support", abstract="Background: Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. Objective: In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). Methods: We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians ``cared'' for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. Results: We found strong, scalable engagement with the tool, with 75\% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3\%, P<.001) and osteoarthritis (+7.6\%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22\%, P<.001), depression screening (+11\%, P<.001), and asthma medications (+33\%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. Conclusions: Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. Trial Registration: ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901 ", doi="10.2196/31042", url="https://www.jmir.org/2021/12/e31042", url="http://www.ncbi.nlm.nih.gov/pubmed/34941547" } @Article{info:doi/10.2196/27984, author="Janssen, Anna and Talic, Stella and Gasevic, Dragan and Kay, Judy and Shaw, Tim", title="Exploring the Intersection Between Health Professionals' Learning and eHealth Data: Protocol for a Comprehensive Research Program in Practice Analytics in Health Care", journal="JMIR Res Protoc", year="2021", month="Dec", day="9", volume="10", number="12", pages="e27984", keywords="digital health", keywords="health informatics", keywords="practice analytics in health care", keywords="health professions education", keywords="continuing professional development", abstract="Background: There is an increasing amount of electronic data sitting within the health system. These data have untapped potential to improve clinical practice if extracted efficiently and harnessed to change the behavior of health professionals. Furthermore, there is an increasing expectation from the government and peak bodies that both individual health professionals and health care organizations will use electronic data for a range of applications, including improving health service delivery and informing clinical practice and professional accreditation. Objective: The aim of this research program is to make eHealth data captured within tertiary health care organizations more actionable to health professionals for use in practice reflection, professional development, and other quality improvement activities. Methods: A multidisciplinary approach was used to connect academic experts from core disciplines of health and medicine, education and learning sciences, and engineering and information communication technology with government and health service partners to identify key problems preventing the health care industry from using electronic data to support health professional learning. This multidisciplinary approach was used to design a large-scale research program to solve the problem of making eHealth data more accessible to health professionals for practice reflection. The program will be delivered over 5 years by doctoral candidates undertaking research projects with discrete aims that run in parallel to achieving this program's objectives. Results: The process used to develop the research program identified 7 doctoral research projects to answer the program objectives, split across 3 streams. Conclusions: This research program has the potential to successfully unpack electronic data siloed within clinical sites and enable health professionals to use them to reflect on their practice and deliver informed and improved care. The program will contribute to current practices by fostering stronger connections between industry and academia, interlinking doctoral research projects to solve complex problems, and creating new knowledge for clinical sites on how data can be used to understand and improve performance. Furthermore, the program aims to affect policy by developing insights on how professional development programs may be strengthened to enhance their alignment with clinical practice. The key contributions of this paper include the introduction of a new conceptualized research program, Practice Analytics in Health care, by describing the foundational academic disciplines that the program is formed of and presenting scientific methods for its design and development. International Registered Report Identifier (IRRID): PRR1-10.2196/27984 ", doi="10.2196/27984", url="https://www.researchprotocols.org/2021/12/e27984", url="http://www.ncbi.nlm.nih.gov/pubmed/34889768" } @Article{info:doi/10.2196/24182, author="Hicks, Paul Joseph and Allsop, John Matthew and Akaba, O. Godwin and Yalma, M. Ramsey and Dirisu, Osasuyi and Okusanya, Babasola and Tukur, Jamilu and Okunade, Kehinde and Akeju, David and Ajepe, Adegbenga and Okuzu, Okey and Mirzoev, Tolib and Ebenso, Bassey", title="Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="16", volume="9", number="9", pages="e24182", keywords="primary health worker training", keywords="digital health technology", keywords="eHealth", keywords="video-based training", keywords="maternal and child health", keywords="Nigeria", keywords="mobile phone", abstract="Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers' knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders' experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention's acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51\% (95\% CI 48\%-54\%) and mean posttest score of 69\% (95\% CI 66\%-72\%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95\% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs' workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372 ", doi="10.2196/24182", url="https://mhealth.jmir.org/2021/9/e24182", url="http://www.ncbi.nlm.nih.gov/pubmed/34528891" } @Article{info:doi/10.2196/29168, author="Newman, Julliana and Liew, Andrew and Bowles, Jon and Soady, Kelly and Inglis, Steven", title="Podcasts for the Delivery of Medical Education and Remote Learning", journal="J Med Internet Res", year="2021", month="Aug", day="27", volume="23", number="8", pages="e29168", keywords="digital", keywords="hepatitis C virus", keywords="health care professionals", keywords="hepatology", keywords="HIV", keywords="continuous professional development", keywords="podcasts", keywords="remote learning", keywords="virology", doi="10.2196/29168", url="https://www.jmir.org/2021/8/e29168", url="http://www.ncbi.nlm.nih.gov/pubmed/34448719" } @Article{info:doi/10.2196/28739, author="Emwodew, Delelegn and Melese, Tesfahun and Takele, Adamu and Mesfin, Nebiyu and Tariku, Binyam", title="Knowledge and Attitude Toward Evidence-Based Medicine and Associated Factors Among Medical Interns in Amhara Regional State Teaching Hospitals, Northwest Ethiopia: Cross-sectional Study", journal="JMIR Med Educ", year="2021", month="Jun", day="24", volume="7", number="2", pages="e28739", keywords="knowledge", keywords="attitude", keywords="evidence-based medicine", keywords="teaching hospitals", abstract="Background: Evidence-based medicine (EBM) is widely accepted in medicine. It is necessary to improve the knowledge and attitudes of medical students in the use of evidence. In Ethiopia, little is known about medical students' knowledge and attitudes toward EBM. Objective: This study aimed to assess the knowledge and attitudes toward EBM and its associated factors among medical interns in teaching hospitals. Methods: A cross-sectional survey was conducted using a random sample of medical interns in teaching hospitals in Ethiopia. Multivariable logistic regression analyses were used to identify the factors associated with the knowledge and attitudes toward EBM. Adjusted odds ratio (AOR) with 95\% confidence interval and P?.05 was used to quantify strength of association between variables. Results: Out of a sample of 423 medical interns, 403 completed the questionnaire (95.3\% response rate). Overall, 68.0\% (274/403 of respondents had a favorable attitude toward EBM and 57.1\% (230/403) had good knowledge of EBM. The majority (355/403, 88.1\%) of participants had internet access. Only 19.6\% (79/403) of respondents had received EBM-related training. Respondents' knowledge of EBM was associated with previous EBM training (AOR 2.947, 95\% CI 1.648-5.268, P<.001), understanding of sensitivity (AOR 2.836, 95\% CI 1.824-4.408, P=.003), and internet access (AOR 2.914, 95\% CI 1.494-5.685, P=.002). The use of an electronic database as a source of information (AOR 1.808, 95\% CI 1.143-2.861, P=.01) and understanding of absolute risk reduction (AOR 2.750, 95\% CI 1.105-6.841, P=.03) were predictors of positive attitudes. Conclusions: This study demonstrates a lack of formal EBM training and awareness of basic concepts of EBM among medical interns. Medical intern attitudes toward EBM are relatively good. To enhance EBM knowledge and skills, formal teaching of EBM should be integrated into medical education. ", doi="10.2196/28739", url="https://mededu.jmir.org/2021/2/e28739/", url="http://www.ncbi.nlm.nih.gov/pubmed/34185012" } @Article{info:doi/10.2196/23980, author="Ko, Po-Jen and Yu, Sheng-Yueh and Chang, Chien-Hwa John and Hsieh, Ming-Ju and Chu, Sung-Yu and Tan, Wei-Hwa Jimmy and Cheng, Wan-Ling and Ho, Pei", title="Using a Web-Based Platform as an Alternative for Conducting International, Multidisciplinary Medical Conferences During the Novel COVID-19 Pandemic: Analysis of a Conference", journal="JMIR Med Educ", year="2021", month="Jun", day="9", volume="7", number="2", pages="e23980", keywords="web-based conference", keywords="live broadcast", keywords="medical education", keywords="dialysis access", keywords="coronavirus", keywords="COVID-19", keywords="conference", keywords="social media", keywords="web-based platform", keywords="internet", keywords="interaction", keywords="teleconference", abstract="Background: The COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative. Objective: The unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic. Methods: The program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference. Results: We used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90\%) were retained in the web-based conference via live broadcasting. The conference was attended by 71\% (37/52) of the original international faculties and 71\% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92\%) were delivered. A special session---``Dialysis access management under the impact of viral epidemics''---was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively. Conclusions: Switching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic. ", doi="10.2196/23980", url="https://mededu.jmir.org/2021/2/e23980", url="http://www.ncbi.nlm.nih.gov/pubmed/33970866" } @Article{info:doi/10.2196/20704, author="Elkhadragy, Nervana and Aviado, Jeremie and Huang, Henry and Corelli, L. Robin and Hudmon, Suchanek Karen", title="Shared Tobacco Cessation Curriculum Website for Health Professionals: Longitudinal Analysis of User and Utilization Data Over a Period of 15 Years", journal="JMIR Med Educ", year="2021", month="May", day="25", volume="7", number="2", pages="e20704", keywords="health professional education", keywords="interprofessional education", keywords="shared curricula", keywords="website", keywords="end-user data", keywords="tobacco cessation", abstract="Background: Because tobacco use is a major cause of morbidity and mortality worldwide, it is essential to prepare health care providers to assist patients with quitting smoking. Created in 1999, the ``Rx for Change'' tobacco cessation curriculum was designed to fill an educational gap in cessation training of health professional students. In 2004, a website was launched to host teaching materials and tools to support the efforts of educators and clinicians. Objective: The objective of this study was to characterize users and utilization of a website hosting shared teaching materials over a period of 15 years. Methods: Data from the Rx for Change website have been collected prospectively since its inception. In this study, end-user data were analyzed to determine user characteristics, how they heard about the website, intended use of the materials, and numbers of logins and file downloads over time. Results: Total number of website registrants was 15,576, representing all 50 states in the United States and 94 countries. The most represented discipline was pharmacy (6393/15,505, 41.2\%), and nearly half of users were students or residents. The most common source of referral to the website was a faculty member or colleague (33.4\%, 2591/7758), and the purpose of enhancing personal knowledge and skills was the most commonly cited intended use of the curricular materials. A total of 259,835 file downloads occurred during the 15-year period, and the most commonly downloaded file type was ancillary handouts. Conclusions: The Rx for Change website demonstrated sustained use, providing immediate access to tobacco cessation teaching and practice tools for educators and clinicians over the first 15 years of its existence. The website has a broad interprofessional reach, and the consistent utilization over time and large number of downloads provide evidence for the feasibility and utility of a public-access website hosting teaching materials. The shared curriculum approach averts the need for educators to create their own materials for teaching tobacco cessation to students in the health professions. ", doi="10.2196/20704", url="https://mededu.jmir.org/2021/2/e20704", url="http://www.ncbi.nlm.nih.gov/pubmed/34032582" } @Article{info:doi/10.2196/25213, author="Rivera, Ronald and Smart, Jonathan and Sakaria, Sangeeta and Wray, Alisa and Wiechmann, Warren and Boysen-Osborn, Megan and Toohey, Shannon", title="Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era", journal="JMIR Med Educ", year="2021", month="May", day="11", volume="7", number="2", pages="e25213", keywords="distance education", keywords="videoconferencing", keywords="emergency medicine", keywords="teaching", keywords="learning", keywords="web-based lecture", keywords="medical education", keywords="technology", keywords="SARS-CoV-2", keywords="COVID-19", doi="10.2196/25213", url="https://mededu.jmir.org/2021/2/e25213", url="http://www.ncbi.nlm.nih.gov/pubmed/33872191" } @Article{info:doi/10.2196/27124, author="Said, Sadiq and Roche, Raoul Tadzio and Braun, Julia and Ganter, Thomas Micheal and Meybohm, Patrick and Herrmann, Johannes and Zacharowski, Kai and Raimann, J{\"u}rgen Florian and Piekarski, Florian and Rivas, Eva and L{\'o}pez-Baamonde, Manuel and Spahn, R. Donat and N{\"o}thiger, Beat Christoph and Tscholl, Werner David", title="Effects of an Animated Blood Clot Technology (Visual Clot) on the Decision-Making of Users Inexperienced in Viscoelastic Testing: Multicenter Trial", journal="J Med Internet Res", year="2021", month="May", day="3", volume="23", number="5", pages="e27124", keywords="avatar technology", keywords="coagulation management", keywords="hemostasis", keywords="intuitive design", keywords="rotational thromboelastometry", keywords="user-centered design", keywords="Visual Clot", keywords="testing", abstract="Background: Viscoelastic test--guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3D blood clot that illustrates raw rotational thromboelastometry (ROTEM) parameters in a user-centered and situation awareness--oriented method. Objective: This study aimed to evaluate the applicability of Visual Clot by examining its effects on users that are novices in viscoelastic-guided resuscitation. Methods: We conducted an investigator-initiated, international, multicenter study between September 16, 2020, and October 6, 2020, in 5 tertiary care hospitals in central Europe. We randomly recruited medical students and inexperienced resident physicians without significant prior exposure to viscoelastic testing. The 7 participants per center managed 9 different ROTEM outputs twice, once as standard ROTEM tracings and once as the corresponding Visual Clot. We randomly presented the 18 viscoelastic cases and asked the participants for their therapeutic decisions. We assessed the performance, diagnostic confidence, and perceived workload in managing the tasks using mixed statistical models and adjusted for possible confounding factors. Results: Analyzing a total of 630 results, we found that the participants solved more cases correctly (odds ratio [OR] 33.66, 95\% CI 21.13-53.64; P<.001), exhibited more diagnostic confidence (OR 206.2, 95\% CI 93.5-454.75; P<.001), and perceived less workload (coefficient --41.63; 95\% CI --43.91 to --39.36; P<.001) using Visual Clot compared to using standard ROTEM tracings. Conclusions: This study emphasizes the practical benefit of presenting viscoelastic test results in a user-centered way. Visual Clot may allow inexperienced users to be involved in the decision-making process to treat bleeding-associated coagulopathy. The increased diagnostic confidence, diagnostic certainty, reduced workload, and positive user feedback associated with this visualization may promote the further adoption of viscoelastic methods in diverse health care settings. ", doi="10.2196/27124", url="https://www.jmir.org/2021/5/e27124", url="http://www.ncbi.nlm.nih.gov/pubmed/33843602" } @Article{info:doi/10.2196/29099, author="Alcocer Alkureishi, Maria and Lenti, Gena and Choo, Zi-Yi and Castaneda, Jason and Weyer, George and Oyler, Julie and Lee, Wei Wei", title="Teaching Telemedicine: The Next Frontier for Medical Educators", journal="JMIR Med Educ", year="2021", month="Apr", day="29", volume="7", number="2", pages="e29099", keywords="telemedicine", keywords="virtual visits", keywords="patient-centered care", keywords="graduate medical education", keywords="medical education", keywords="telehealth", keywords="virtual health", keywords="graduate students", keywords="education", keywords="COVID-19", keywords="pandemic", doi="10.2196/29099", url="https://mededu.jmir.org/2021/2/e29099", url="http://www.ncbi.nlm.nih.gov/pubmed/33878011" } @Article{info:doi/10.2196/28945, author="Utunen, Heini and Van Kerkhove, D. Maria and Tokar, Anna and O'Connell, Gillian and Gamhewage, M. Gaya and Fall, Soc{\'e} Ibrahima", title="One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization's Technical Guidance", journal="JMIR Public Health Surveill", year="2021", month="Apr", day="21", volume="7", number="4", pages="e28945", keywords="COVID-19", keywords="e-learning", keywords="massive open web-based courses", keywords="OpenWHO", keywords="pandemic", keywords="public health", keywords="web-based learning", keywords="World Health Organization", doi="10.2196/28945", url="https://publichealth.jmir.org/2021/4/e28945", url="http://www.ncbi.nlm.nih.gov/pubmed/33881404" } @Article{info:doi/10.2196/24369, author="Wang, Menghua and Liao, Banghua and Jian, Zhongyu and Jin, Xi and Xiang, Liyuan and Yuan, Chi and Li, Hong and Wang, Kunjie", title="Participation in Virtual Urology Conferences During the COVID-19 Pandemic: Cross-sectional Survey Study", journal="J Med Internet Res", year="2021", month="Apr", day="21", volume="23", number="4", pages="e24369", keywords="virtual conference", keywords="COVID-19", keywords="survey", abstract="Background: Due to the influence of the COVID-19 pandemic, conventional face-to-face academic conferences have been restricted, and many of these conferences have moved onto the internet. Objective: The aim of this study was to investigate the virtual conferences in the field of urology during the COVID-19 pandemic and provide suggestions for better organization of such conferences. Methods: A cross-sectional survey was conducted from May 30 to June 15, 2020, in China. Our team designed a 23-item questionnaire to investigate the conferences attended by urologists during the COVID-19 pandemic. SPSS 22.0 (IBM Corporation) was applied to analyze the data collected. Results: A total of 330 Chinese urologists participated in our survey, and the response rate was 89.7\% (330/368). Among the participants, 40.9\% (135/330) were associate chief physicians. The proportion of participants who took part in conventional face-to-face academic conferences decreased from 92.7\% (306/330) before the COVID-19 pandemic to 22.1\% (73/330) during the pandemic (P<.001). In contrast, the proportion of urologists who took part in virtual conferences increased from 69.4\% (229/330) to 90\% (297/330) (P<.001). Most urologists (70.7\%, 210/297) chose to participate in the virtual conferences at home and thought that a meeting length of 1-2 hours was most appropriate. Among the urologists, 73.7\% (219/297) reported that their participation in the virtual conferences went smoothly, while the remaining respondents reported that they had experienced lags in video and audio streaming during the virtual conferences. When comparing conventional face-to-face conferences with virtual conferences, 70.7\% (210/297) of the respondents thought that both conference formats were acceptable, while 17.9\% (53/297) preferred virtual conferences and 11.5\% (34/297) preferred conventional face-to-face meetings. Conclusions: Virtual conferences are increasing in popularity during the COVID-19 pandemic; however, many aspects of these conferences could be improved for better organization. ", doi="10.2196/24369", url="https://www.jmir.org/2021/4/e24369", url="http://www.ncbi.nlm.nih.gov/pubmed/33844635" } @Article{info:doi/10.2196/23708, author="Beverly, Ann Elizabeth and Love, Carrie and Love, Matthew and Williams, Eric and Bowditch, John", title="Using Virtual Reality to Improve Health Care Providers' Cultural Self-Efficacy and Diabetes Attitudes: Pilot Questionnaire Study", journal="JMIR Diabetes", year="2021", month="Jan", day="27", volume="6", number="1", pages="e23708", keywords="virtual reality", keywords="diabetes attitudes", keywords="cultural self-efficacy", keywords="health care providers", keywords="VR", keywords="diabetes", keywords="training", abstract="Background: In southeastern Appalachian Ohio, the prevalence of diabetes is 19.9\%, nearly double that of the national average of 10.5\%. Here, people with diabetes are more likely to have a delayed diagnosis, limited access to health care, and lower health literacy. Despite the high rates of diabetes in the region, the availability of endocrinologists and certified diabetes care and education specialists is limited. Therefore, innovative strategies to address the growing diabetes care demands are needed. One approach is to train the primary care workforce in new and emerging therapies for type 2 diabetes to meet the increasing demands and complexity of diabetes care. Objective: The aim of this study was to assess the effectiveness of a virtual reality training program designed to improve cultural self-efficacy and diabetes attitudes. Methods: Health care providers and administrators were recruited from large health care systems, private practices, university-owned hospitals or clinics, Federally Qualified Health Centers, local health departments, and AmeriCorps. Providers and administrators participated in a 3-hour virtual reality training program consisting of 360-degree videos produced in a professional, cinematic manner; this technique is called virtual reality cinema (cine-VR). Questionnaires measuring cultural self-efficacy, diabetes attitudes, and presence in cine-VR were administered to providers and administrators before and after the program. Results: A total of 69 participants completed the study. The mean age of the sample was 42.2 years (SD 13.7), 86\% (59/69) identified as female, 83\% (57/69) identified as White, 86\% (59/69) identified as providers, and 25\% (17/69) identified as nurses. Following the training program, we observed positive improvements in all three of the cultural self-efficacy subscales: Cognitive (mean change --1.29; t65=--9.309; P<.001), Practical (mean change --1.85; t65=--9.319; P<.001), and Affective (mean change --0.75; t65=--7.067; P<.001). We observed the largest magnitude of change with the subscale, with a Cohen d of 1.16 indicating a very large effect. In addition, we observed positive improvements in all five of the diabetes attitude subscales: Need for special training (mean change --0.21; t67=--6.154; P<.001), Seriousness of type 2 diabetes (mean change --0.34; t67=--8.114; P<.001), Value of tight glucose control (mean change --0.13; t67=--3.029; P=.001), Psychosocial impact of diabetes (mean change --0.33; t67=--6.610; P<.001), and Attitude toward patient autonomy (mean change --0.17; t67=--3.889; P<.001). We observed the largest magnitude of change with the Psychosocial impact of diabetes subscale, with a Cohen d of 0.87 indicating a large effect. We observed only one significant correlation between presence in cine-VR (ie, Interface Quality) and a positive change score (ie, Affective self-efficacy) (r=.285; P=.03). Conclusions: Our findings support the notion that cine-VR education is an innovative approach to improve cultural self-efficacy and diabetes attitudes among health care providers and administrators. The long-term impact of cine-VR education on cultural self-efficacy and diabetes attitudes needs to be determined. ", doi="10.2196/23708", url="http://diabetes.jmir.org/2021/1/e23708/", url="http://www.ncbi.nlm.nih.gov/pubmed/33502335" } @Article{info:doi/10.2196/21855, author="Cutumisu, Maria and Ghoman, K. Simran and Lu, Chang and Patel, D. Siddhi and Garcia-Hidalgo, Catalina and Fray, Caroline and Brown, G. Matthew R. and Greiner, Russell and Schm{\"o}lzer, M. Georg", title="Health Care Providers' Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study", journal="JMIR Serious Games", year="2020", month="Dec", day="21", volume="8", number="4", pages="e21855", keywords="infant", keywords="newborn", keywords="delivery room", keywords="neonatal resuscitation", keywords="performance", keywords="neonatal resuscitation program", keywords="serious games", keywords="computer-based game simulation", keywords="mindset", abstract="Background: Neonatal resuscitation involves a complex sequence of actions to establish an infant's cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners' attitudes toward computer-based learning and assessment environments influence their performance. Objective: This study explores the relation between HCPs' attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation. Methods: Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants' survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN. Results: The results revealed that mindset moderated the relation between participants' perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=--1.19, SE=0.38, t44=--3.12, 95\% CI --1.96 to --0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=--1.21, SE=0.38, t44=?3.16, 95\% CI --1.99 to --0.44; P=.003). Conclusions: Mindset moderates the strength of the relationship between HCPs' perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks. ", doi="10.2196/21855", url="http://games.jmir.org/2020/4/e21855/", url="http://www.ncbi.nlm.nih.gov/pubmed/33346741" } @Article{info:doi/10.2196/19871, author="French, Blandine and Hall, Charlotte and Perez Vallejos, Elvira and Sayal, Kapil and Daley, David", title="Evaluation of a Web-Based ADHD Awareness Training in Primary Care: Pilot Randomized Controlled Trial With Nested Interviews", journal="JMIR Med Educ", year="2020", month="Dec", day="11", volume="6", number="2", pages="e19871", keywords="ADHD", keywords="primary care", keywords="general practice", keywords="randomized controlled trial", keywords="online intervention", keywords="interviews", abstract="Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting up to 5\% of children and adults. Undiagnosed and untreated ADHD can result in adverse long-term health, educational, and social impacts for affected individuals. Therefore, it is important to identify this disorder as early as possible. General practitioners (GPs) frequently play a gatekeeper role in access to specialist services in charge of diagnosis and treatment. Studies have shown that their lack of knowledge and understanding about ADHD can create barriers to care. Objective: This pilot randomized controlled trial assesses the efficacy of a web-based psychoeducation program on ADHD tailored for GPs. Methods: A total of 221 participants were randomized to either a sham intervention control or an awareness training intervention and they completed questionnaires on ADHD knowledge, confidence, and attitude at 3 time points (preintervention, postintervention, and 2-week follow-up). Participants in the intervention arm were invited to participate in a survey and follow-up interview between 3 and 6 months after the intervention. Results: The responses of 109 GPs were included in the analysis. The knowledge (P<.001) and confidence (P<.001) of the GPs increased after the intervention, whereas misconceptions decreased (P=.04); this was maintained at the 2-week follow-up (knowledge, P<.001; confidence, P<.001; misconceptions, P=.03). Interviews and surveys also confirmed a change in practice over time. Conclusions: These findings demonstrate that a short web-based intervention can increase GPs' understanding, attitude, and practice toward ADHD, potentially improving patients' access to care. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN45400501; http://www.isrctn.com/ISRCTN45400501. ", doi="10.2196/19871", url="http://mededu.jmir.org/2020/2/e19871/", url="http://www.ncbi.nlm.nih.gov/pubmed/33306027" } @Article{info:doi/10.2196/23299, author="Yin, Lukas Andrew and Gheissari, Pargol and Lin, Wanyin Inna and Sobolev, Michael and Pollak, P. John and Cole, Curtis and Estrin, Deborah", title="Role of Technology in Self-Assessment and Feedback Among Hospitalist Physicians: Semistructured Interviews and Thematic Analysis", journal="J Med Internet Res", year="2020", month="Nov", day="3", volume="22", number="11", pages="e23299", keywords="feedback", keywords="self-assessment", keywords="self-learning", keywords="hospitalist", keywords="electronic medical record", keywords="digital health", keywords="assessment", keywords="learning", abstract="Background: Lifelong learning is embedded in the culture of medicine, but there are limited tools currently available for many clinicians, including hospitalists, to help improve their own practice. Although there are requirements for continuing medical education, resources for learning new clinical guidelines, and developing fields aimed at facilitating peer-to-peer feedback, there is a gap in the availability of tools that enable clinicians to learn based on their own patients and clinical decisions. Objective: The aim of this study was to explore the technologies or modifications to existing systems that could be used to benefit hospitalist physicians in pursuing self-assessment and improvement by understanding physicians' current practices and their reactions to proposed possibilities. Methods: Semistructured interviews were conducted in two separate stages with analysis performed after each stage. In the first stage, interviews (N=12) were conducted to understand the ways in which hospitalist physicians are currently gathering feedback and assessing their practice. A thematic analysis of these interviews informed the prototype used to elicit responses in the second stage. Results: Clinicians actively look for feedback that they can apply to their practice, with the majority of the feedback obtained through self-assessment. The following three themes surrounding this aspect were identified in the first round of semistructured interviews: collaboration, self-reliance, and uncertainty, each with three related subthemes. Using a wireframe, the second round of interviews led to identifying the features that are currently challenging to use or could be made available with technology. Conclusions: Based on each theme and subtheme, we provide targeted recommendations for use by relevant stakeholders such as institutions, clinicians, and technologists. Most hospitalist self-assessments occur on a rolling basis, specifically using data in electronic medical records as their primary source. Specific objective data points or subjective patient relationships lead clinicians to review their patient cases and to assess their own performance. However, current systems are not built for these analyses or for clinicians to perform self-assessment, making this a burdensome and incomplete process. Building a platform that focuses on providing and curating the information used for self-assessment could help physicians make more accurately informed changes to their own clinical practice and decision-making. ", doi="10.2196/23299", url="http://www.jmir.org/2020/11/e23299/", url="http://www.ncbi.nlm.nih.gov/pubmed/33141098" } @Article{info:doi/10.2196/18648, author="L{\"o}ffler, Christin and Kr{\"u}ger, Antje and Daubmann, Anne and Iwen, Julia and Biedermann, Marc and Schulz, Maike and Wegscheider, Karl and Altiner, Attila and Feldmeier, Gregor and Wollny, Anja", title="Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program", journal="JMIR Res Protoc", year="2020", month="Sep", day="30", volume="9", number="9", pages="e18648", keywords="antibacterial agents", keywords="respiratory tract infection", keywords="upper respiratory tract infection", keywords="lower respiratory tract infection", keywords="primary care", keywords="primary health care", keywords="physician-patient relation", keywords="shared decision making", keywords="antibiotic resistance", abstract="Background: The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. Objective: The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. Methods: RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. Results: RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. Conclusions: With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. Trial Registration: ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 International Registered Report Identifier (IRRID): RR1-10.2196/18648 ", doi="10.2196/18648", url="http://www.researchprotocols.org/2020/9/e18648/", url="http://www.ncbi.nlm.nih.gov/pubmed/32996888" } @Article{info:doi/10.2196/16772, author="Chan, SY Windy and Leung, YM Angela", title="Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Jun", day="2", volume="22", number="6", pages="e16772", keywords="dementia", keywords="Facebook", keywords="social network sites", keywords="continuous professional education", abstract="Background: Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes. Objective: This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia. Methods: Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs. Results: Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75\% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95\% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6). Conclusions: The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants' knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings. ", doi="10.2196/16772", url="https://www.jmir.org/2020/6/e16772", url="http://www.ncbi.nlm.nih.gov/pubmed/32484441" } @Article{info:doi/10.2196/17729, author="Zamberg, Ido and Windisch, Olivier and Agoritsas, Thomas and Nendaz, Mathieu and Savoldelli, Georges and Schiffer, Eduardo", title="A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study", journal="JMIR Med Educ", year="2020", month="May", day="27", volume="6", number="1", pages="e17729", keywords="clinical skills", keywords="clinical competence", keywords="clinical practice guidelines", keywords="medical education", keywords="smartphone", keywords="innovation", keywords="medical guidance", keywords="mobile phone", abstract="Background: Finding readily accessible, high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores, and other formats for the day-to-day access and use by medical students and physicians during their pre- and postgraduate education. Objective: The aim of this paper is to describe the architecture, user interface, and potential strengths and limitations of an innovative knowledge dissemination platform developed at the University of Geneva, Switzerland. We also report preliminary results from a user-experience survey and usage statistics over a selected period. Methods: The dissemination platform consists of a smartphone app. Through an administration interface, content is managed by senior university and hospital staff. The app includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; and (4) favorites section. Each content item is programmed to be available for a given duration as defined by the content's author. Automatic notifications signal the author when the content is about to expire, hence, promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results: We launched the final version of the platform in March 2019, both at the Faculty of Medicine at the University of Geneva and at the University Hospital of Geneva in Switzerland. A total of 622 students at the university and 613 health professionals at the hospital downloaded the app. Two-thirds of users at both institutions had an iOS device. During the practical examination period (ie, May 2019) there was a significant increase in the number of active users (P=.003), user activity (P<.001), and daily usage time (P<.001) among medical students. In addition, there were 1086 clinical skills video views during this period compared to a total of 484 in the preceding months (ie, a 108\% increase). On a 10-point Likert scale, students and physicians rated the app with mean scores of 8.2 (SD 1.9) for user experience, 8.1 (SD 2.0) for usefulness, and 8.5 (SD 1.8) for relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology at our institution. Conclusions: HeadToToe is an educator-driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given high ratings for user experience, usefulness, and content quality and was used more often during the exam period. This suggests that the platform could be used as tool for exam preparation. ", doi="10.2196/17729", url="http://mededu.jmir.org/2020/1/e17729/", url="http://www.ncbi.nlm.nih.gov/pubmed/32249758" } @Article{info:doi/10.2196/15762, author="Hejjaji, Vittal and Malik, O. Ali and Peri-Okonny, A. Poghni and Thomas, Merrill and Tang, Yuanyuan and Wooldridge, David and Spertus, A. John and Chan, S. Paul", title="Mobile App to Improve House Officers' Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="19", volume="8", number="5", pages="e15762", keywords="cardiac arrest", keywords="advanced cardiac life support", keywords="mHealth", keywords="quality improvement", keywords="medical education", abstract="Background: Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective: The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers' adherence to ACLS guidelines. Methods: As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results: Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95\% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference --0.7 [95\% CI --0.3 to --1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9\% vs 89.0\%; absolute difference 1.9\% [95\% CI 0.6\% to 3.4\%]; P=.007). Conclusions: This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown. ", doi="10.2196/15762", url="https://mhealth.jmir.org/2020/5/e15762", url="http://www.ncbi.nlm.nih.gov/pubmed/32427115" } @Article{info:doi/10.2196/19076, author="Utunen, Heini and Ndiaye, Ngouille and Piroux, Corentin and George, Richelle and Attias, Melissa and Gamhewage, Gaya", title="Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data", journal="J Med Internet Res", year="2020", month="Apr", day="27", volume="22", number="4", pages="e19076", keywords="online learning", keywords="OpenWHO", keywords="novel coronavirus", keywords="COVID-19", keywords="coronavirus", keywords="pandemic", keywords="WHO", keywords="e-learning", keywords="MOOC", keywords="public health", abstract="Background: At the onset of the coronavirus outbreak, the World Health Organization's (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO's health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID?19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users' professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses' statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform's own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43\% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99\%) of all course enrollments, and the English language course was comprised of 38.21\% (n=88,988) of enrollments. The WHO's Region of the Americas accounted for most of the course enrollments, with more than 72.47\% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10\% enrollment for each. A total of 32.43\% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as ``Other.'' With the COVID-19 introductory course, the largest number of users selected ``Other'' (16,527/52,214, 31.65\%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO's technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform's aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. ", doi="10.2196/19076", url="https://www.jmir.org/2020/4/e19076", url="http://www.ncbi.nlm.nih.gov/pubmed/32293580" } @Article{info:doi/10.2196/17425, author="Katz, Daniel and Shah, Ronak and Kim, Elizabeth and Park, Chang and Shah, Anjan and Levine, Adam and Burnett, Garrett", title="Utilization of a Voice-Based Virtual Reality Advanced Cardiac Life Support Team Leader Refresher: Prospective Observational Study", journal="J Med Internet Res", year="2020", month="Mar", day="12", volume="22", number="3", pages="e17425", keywords="video game", keywords="experimental game", keywords="virtual reality", keywords="advanced cardiac life support", abstract="Background: The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of training are expensive, time consuming, and difficult to scale, which necessitates improvements in advanced cardiac life support (ACLS) training. Virtual reality (VR) has been proposed as an alternative or adjunct to high-fidelity simulation (HFS) in several environments. No evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills and demonstrate a cost comparison. Objective: This study aimed to explore the utility of a voice-based VR ACLS team leader refresher as compared with HFS. Methods: This prospective observational study performed at an academic institution consisted of 25 postgraduate year 2 residents. Participants were randomized to HFS or VR training and then crossed groups after a 2-week washout. Participants were graded on technical and nontechnical skills. Participants also completed self-assessments about the modules. Proctors were assessed for fatigue and task saturation, and cost analysis based on local economic data was performed. Results: A total of 23 of 25 participants were included in the scoring analysis. Fewer participants were familiar with VR compared with HFS (9/25, 36\% vs 25/25, 100\%; P<.001). Self-reported satisfaction and utilization scores were similar; however, significantly more participants felt HFS provided better feedback: 99 (IQR 89-100) vs 79 (IQR 71-88); P<.001. Technical scores were higher in the HFS group; however, nontechnical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 (IQR 19-24) min shorter than HFS sessions, the National Aeronautics and Space Administration task load index scores for proctors were lower in each category, and VR sessions were estimated to be US \$103.68 less expensive in a single-learner, single-session model. Conclusions: Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction. The VR module was more cost-effective and was easier to proctor; however, HFS was better at delivering feedback to participants. Optimal education strategies likely contain elements of both modalities. Further studies are needed to examine the utility of VR-based environments at scale. ", doi="10.2196/17425", url="http://www.jmir.org/2020/3/e17425/", url="http://www.ncbi.nlm.nih.gov/pubmed/32163038" } @Article{info:doi/10.2196/16808, author="Moehead, Anne and DeSouza, Kathryn and Walsh, Karen and Pit, W. Sabrina", title="A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review", journal="J Med Internet Res", year="2020", month="Jan", day="22", volume="22", number="1", pages="e16808", keywords="education", keywords="workforce", keywords="online learning", keywords="Web-based learning", keywords="distance education", keywords="dementia", keywords="nursing", keywords="facilitated learning", keywords="competency", keywords="training", keywords="network", keywords="capability", keywords="skills", keywords="person-centered", abstract="Background: Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC\&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia. Objective: This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program---an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice---and (2) determine how these features correlate with the DCC\&TN. Methods: Six electronic databases---Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar---were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick's model for the evaluation of training were used to ensure quality and rigor of the analysis. Results: A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick's four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick's model. Features were then correlated against the DCC\&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC\&TN. Conclusions: A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick's salient elements of the model---reaction, learning, behavior, and results---in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick's levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC\&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC\&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training. ", doi="10.2196/16808", url="http://www.jmir.org/2020/1/e16808/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012077" } @Article{info:doi/10.2196/14545, author="Murad, Abdulaziz and Hyde, Natalie and Chang, Shanton and Lederman, Reeva and Bosua, Rachelle and Pirotta, Marie and Audehm, Ralph and Yates, J. Christopher and Briggs, M. Andrew and Gorelik, Alexandra and Chiang, Cherie and Wark, D. John", title="Quantifying Use of a Health Virtual Community of Practice for General Practitioners' Continuing Professional Development: A Novel Methodology and Pilot Evaluation", journal="J Med Internet Res", year="2019", month="Nov", day="27", volume="21", number="11", pages="e14545", keywords="online systems", keywords="online social networking", keywords="general practitioners", keywords="online learning", keywords="continuing education", keywords="professional education", keywords="evaluation methodology", keywords="use-effectiveness", keywords="quantitative evaluation", keywords="knowledgebases", keywords="information sharing", abstract="Background: Health care practitioners (HPs), in particular general practitioners (GPs), are increasingly adopting Web-based social media platforms for continuing professional development (CPD). As GPs are restricted by time, distance, and demanding workloads, a health virtual community of practice (HVCoP) is an ideal solution to replace face-to-face CPD with Web-based CPD. However, barriers such as time and work schedules may limit participation in an HVCoP. Furthermore, it is difficult to gauge whether GPs engage actively or passively in HVCoP knowledge-acquisition for Web-based CPD, as GPs' competencies are usually measured with pre- and posttests. Objective: This study investigated a method for measuring the engagement features needed for an HVCoP (the Community Fracture Capture [CFC] Learning Hub) for learning and knowledge sharing among GPs for their CPD activity. Methods: A prototype CFC Learning Hub was developed using an Igloo Web-based social media software platform and involved a convenience sample of GPs interested in bone health topics. This Hub, a secure Web-based community site, included 2 key components: an online discussion forum and a knowledge repository (the Knowledge Hub). The discussion forum contained anonymized case studies (contributed by GP participants) and topical discussions (topics that were not case studies). Using 2 complementary tools (Google Analytics and Igloo Statistical Tool), we characterized individual participating GPs' engagement with the Hub. We measured the GP participants' behavior by quantifying the number of online sessions of the participants, activities undertaken within these online sessions, written posts made per learning topic, and their time spent per topic. We calculated time spent in both active and passive engagement for each topic. Results: Seven GPs participated in the CFC Learning Hub HVCoP from September to November 2017. The complementary tools successfully captured the GP participants' engagement in the Hub. GPs were more active in topics in the discussion forum that had direct clinical application as opposed to didactic, evidence-based discussion topics (ie, topical discussions). From our knowledge hub, About Osteoporosis and Prevention were the most engaging topics, whereas shared decision making was the least active topic. Conclusions: We showcased a novel complementary analysis method that allowed us to quantify the CFC Learning Hub's usage data into (1) sessions, (2) activities, (3) active or passive time spent, and (4) posts made to evaluate the potential engagement features needed for an HVCoP focused on GP participants' CPD process. Our design and evaluation methods for ongoing use and engagement in this Hub may be useful to evaluate future learning and knowledge-sharing projects for GPs and may allow for extension to other HPs' environments. However, owing to the limited number of GP participants in this study, we suggest that further research with a larger cohort should be performed to validate and extend these findings. ", doi="10.2196/14545", url="http://www.jmir.org/2019/11/e14545/", url="http://www.ncbi.nlm.nih.gov/pubmed/31774401" } @Article{info:doi/10.2196/12669, author="Jaunay, Louis-Baptiste and Zerr, Philippe and Peguin, Lino and Renouard, L{\'e}andre and Ivanoff, Anne-Sophie and Picard, Herv{\'e} and Griffith, James and Chassany, Olivier and Duracinsky, Martin", title="Development and Evaluation of a New Serious Game for Continuing Medical Education of General Practitioners (Hygie): Double-Blinded Randomized Controlled Trial", journal="J Med Internet Res", year="2019", month="Nov", day="20", volume="21", number="11", pages="e12669", keywords="general practice", keywords="continuing medical education", keywords="evidence-based medicine", keywords="video games", keywords="randomized controlled trial", keywords="pedagogy", abstract="Background: Continuing medical education is important but time-consuming for general practitioners (GPs). Current learning approaches are limited and lack the ability to engage some practitioners. Serious games are new learning approaches that use video games as engaging teaching material. They have significant advantages in terms of efficiency and dissemination. Objective: The aim of this study was to create a serious game and to evaluate it in terms of effectiveness and satisfaction, comparing it with a traditional method of continuing education---article reading. Methods: We produced a prototype video game called Hygie on the 5 most common reasons of consultation in general practice using 9 articles from independent evidence-based medicine journals (reviews from Prescrire and Minerva). We created 51 clinical cases. We then conducted a double-blinded randomized trial comparing the learning provided by a week of access to the game versus source articles. Participants were GPs involved as resident supervisors in 14 French university departments of family practice, recruited by email. Primary outcomes were (1) mean final knowledge score completed 3 to 5 weeks after the end of the intervention and (2) mean difference between knowledge pretest (before intervention) and posttest (3 to 5 weeks after intervention) scores, both scaled on 10 points. Secondary outcomes were transfer of knowledge learned to practice, satisfaction, and time spent playing. Results: A total of 269 GPs agreed to participate in the study. Characteristics of participants were similar between learning groups. There was no difference between groups on the mean score of the final knowledge test, with scores of 4.9 (95\% CI 4.6-5.2) in the Hygie group and 4.6 (95\% CI 4.2-4.9) in the reading group (P=.21). There was a mean difference score between knowledge pre- and posttests, with significantly superior performance for Hygie (mean gain of 1.6 in the Hygie group and 0.9 in the reading group; P=.02), demonstrating a more efficient and persistent learning with Hygie. The rate of participants that reported to have used the knowledge they learned through the teaching material was significantly superior in the Hygie group: 77\% (47/61) in the Hygie group and 53\% (25/47) in the reading group; odds ratio 2.9, 95\% CI 1.2-7.4. Moreover, 87\% of the opinions were favorable, indicating that Hygie is of interest for updating medical knowledge. Qualitative data showed that learners enjoyed Hygie especially for its playful, interactive, and stimulating aspects. Conclusions: We conclude that Hygie can diversify the offering for continuing education for GPs in an effective, pleasant, and evidence-based way. Trial Registration: ClinicalTrials.gov NCT03486275; https://clinicaltrials.gov/ct2/show/NCT03486275 ", doi="10.2196/12669", url="http://www.jmir.org/2019/11/e12669/", url="http://www.ncbi.nlm.nih.gov/pubmed/31746775" } @Article{info:doi/10.2196/15358, author="Kaufmann, Thomas and Castela Forte, Jos{\'e} and Hiemstra, Bart and Wiering, A. Marco and Grzegorczyk, Marco and Epema, H. Anne and van der Horst, C. Iwan C. and ", title="A Bayesian Network Analysis of the Diagnostic Process and its Accuracy to Determine How Clinicians Estimate Cardiac Function in Critically Ill Patients: Prospective Observational Cohort Study", journal="JMIR Med Inform", year="2019", month="Oct", day="30", volume="7", number="4", pages="e15358", keywords="cardiac function", keywords="physical examination", keywords="Bayesian network", keywords="critical care", keywords="ICU", keywords="medical education", keywords="educated guess", keywords="cognition", keywords="clinical decision-support", keywords="cardiology", abstract="Background: Hemodynamic assessment of critically ill patients is a challenging endeavor, and advanced monitoring techniques are often required to guide treatment choices. Given the technical complexity and occasional unavailability of these techniques, estimation of cardiac function based on clinical examination is valuable for critical care physicians to diagnose circulatory shock. Yet, the lack of knowledge on how to best conduct and teach the clinical examination to estimate cardiac function has reduced its accuracy to almost that of ``flipping a coin.'' Objective: The aim of this study was to investigate the decision-making process underlying estimates of cardiac function of patients acutely admitted to the intensive care unit (ICU) based on current standardized clinical examination using Bayesian methods. Methods: Patient data were collected as part of the Simple Intensive Care Studies-I (SICS-I) prospective cohort study. All adult patients consecutively admitted to the ICU with an expected stay longer than 24 hours were included, for whom clinical examination was conducted and cardiac function was estimated. Using these data, first, the probabilistic dependencies between the examiners' estimates and the set of clinically measured variables upon which these rely were analyzed using a Bayesian network. Second, the accuracy of cardiac function estimates was assessed by comparison to the cardiac index values measured by critical care ultrasonography. Results: A total of 1075 patients were included, of which 783 patients had validated cardiac index measurements. A Bayesian network analysis identified two clinical variables upon which cardiac function estimate is conditionally dependent, namely, noradrenaline administration and presence of delayed capillary refill time or mottling. When the patient received noradrenaline, the probability of cardiac function being estimated as reasonable or good P(ER,G) was lower, irrespective of whether the patient was mechanically ventilated (P[ER,G|ventilation, noradrenaline]=0.63, P[ER,G|ventilation, no noradrenaline]=0.91, P[ER,G|no ventilation, noradrenaline]=0.67, P[ER,G|no ventilation, no noradrenaline]=0.93). The same trend was found for capillary refill time or mottling. Sensitivity of estimating a low cardiac index was 26\% and 39\% and specificity was 83\% and 74\% for students and physicians, respectively. Positive and negative likelihood ratios were 1.53 (95\% CI 1.19-1.97) and 0.87 (95\% CI 0.80-0.95), respectively, overall. Conclusions: The conditional dependencies between clinical variables and the cardiac function estimates resulted in a network consistent with known physiological relations. Conditional probability queries allow for multiple clinical scenarios to be recreated, which provide insight into the possible thought process underlying the examiners' cardiac function estimates. This information can help develop interactive digital training tools for students and physicians and contribute toward the goal of further improving the diagnostic accuracy of clinical examination in ICU patients. Trial Registration: ClinicalTrials.gov NCT02912624; https://clinicaltrials.gov/ct2/show/NCT02912624 ", doi="10.2196/15358", url="http://medinform.jmir.org/2019/4/e15358/", url="http://www.ncbi.nlm.nih.gov/pubmed/31670697" } @Article{info:doi/10.2196/14984, author="Kyaw, Myint Bhone and Tudor Car, Lorainne and van Galen, Sandra Louise and van Agtmael, A. Michiel and Costelloe, E. C{\'e}ire and Ajuebor, Onyema and Campbell, James and Car, Josip", title="Health Professions Digital Education on Antibiotic Management: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Sep", day="12", volume="21", number="9", pages="e14984", keywords="digital education", keywords="antibiotic management", keywords="systematic review", keywords="meta-analysis", keywords="randomized controlled trial", abstract="Background: Inappropriate antibiotic prescription is one of the key contributors to antibiotic resistance, which is managed with a range of interventions including education. Objective: We aimed to summarize evidence on the effectiveness of digital education of antibiotic management compared to traditional education for improving health care professionals' knowledge, skills, attitudes, and clinical practice. Methods: Seven electronic databases and two trial registries were searched for randomized controlled trials (RCTs) and cluster RCTs published between January 1, 1990, and September 20, 2018. There were no language restrictions. We also searched the International Clinical Trials Registry Platform Search Portal and metaRegister of Controlled Trials to identify unpublished trials and checked the reference lists of included studies and relevant systematic reviews for study eligibility. We followed Cochrane methods to select studies, extract data, and appraise and synthesize eligible studies. We used random-effect models for the pooled analysis and assessed statistical heterogeneity by visual inspection of a forest plot and calculation of the I2 statistic. Results: Six cluster RCTs and two RCTs with 655 primary care practices, 1392 primary care physicians, and 485,632 patients were included. The interventions included personal digital assistants; short text messages; online digital education including emails and websites; and online blended education, which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed postintervention change in clinical practice. The majority of the studies (4/6) reported greater reduction in antibiotic prescription or dispensing rate with digital education than with traditional education. Two studies showed significant differences in postintervention knowledge scores in favor of mobile education over traditional education (standardized mean difference=1.09, 95\% CI 0.90-1.28; I2=0\%; large effect size; 491 participants [2 studies]). The findings for health care professionals' attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction, or potential adverse effects. Conclusions: Findings from studies deploying mobile or online modalities of digital education on antibiotic management were complementary and found to be more cost-effective than traditional education in improving clinical practice and postintervention knowledge, particularly in postregistration settings. There is a lack of evidence on the effectiveness of other digital education modalities such as virtual reality or serious games. Future studies should also include health care professionals working in settings other than primary care and low- and middle-income countries. Clinical Trial: PROSPERO CRD42018109742; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=109742 ", doi="10.2196/14984", url="http://www.jmir.org/2019/9/e14984/", url="http://www.ncbi.nlm.nih.gov/pubmed/31516125" } @Article{info:doi/10.2196/13993, author="Houze-Cerfon, Charles-Henri and Vaissi{\'e}, Christine and Gout, Laurent and Bastiani, Bruno and Charpentier, Sandrine and Lauque, Dominique", title="Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study", journal="JMIR Serious Games", year="2019", month="Aug", day="08", volume="7", number="3", pages="e13993", keywords="virtual reality", keywords="interprofessional relations", keywords="emergency medicine", abstract="Background: Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians' cognitive processes coping with overcrowding is limited. Objective: This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians' strategies and behaviors on quality of care in the context of ED overcrowding. Methods: A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants' mastering of the environment was expected for 90\% (12/13) of the participants. Results: The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100\% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions: The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding. ", doi="10.2196/13993", url="http://games.jmir.org/2019/3/e13993/", url="http://www.ncbi.nlm.nih.gov/pubmed/31397292" } @Article{info:doi/10.2196/14587, author="Jewer, Jennifer and Parsons, H. Michael and Dunne, Cody and Smith, Andrew and Dubrowski, Adam", title="Evaluation of a Mobile Telesimulation Unit to Train Rural and Remote Practitioners on High-Acuity Low-Occurrence Procedures: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2019", month="Aug", day="6", volume="21", number="8", pages="e14587", keywords="medical education", keywords="distributed medical education", keywords="simulation training", keywords="emergency medicine", keywords="rural health", keywords="remote-facilitation", keywords="assessment", keywords="chest tubes", abstract="Background: The provision of acute medical care in rural and remote areas presents unique challenges for practitioners. Therefore, a tailored approach to training providers would prove beneficial. Although simulation-based medical education (SBME) has been shown to be effective, access to such training can be difficult and costly in rural and remote areas. Objective: The aim of this study was to evaluate the educational efficacy of simulation-based training of an acute care procedure delivered remotely, using a portable, self-contained unit outfitted with off-the-shelf and low-cost telecommunications equipment (mobile telesimulation unit, MTU), versus the traditional face-to-face approach. A conceptual framework based on a combination of Kirkpatrick's Learning Evaluation Model and Miller's Clinical Assessment Framework was used. Methods: A written procedural skills test was used to assess Miller's learning level--- knows ---at 3 points in time: preinstruction, immediately postinstruction, and 1 week later. To assess procedural performance (shows how), participants were video recorded performing chest tube insertion before and after hands-on supervised training. A modified Objective Structured Assessment of Technical Skills (OSATS) checklist and a Global Rating Scale (GRS) of operative performance were used by a blinded rater to assess participants' performance. Kirkpatrick's reaction was measured through subject completion of a survey on satisfaction with the learning experiences and an evaluation of training. Results: A total of 69 medical students participated in the study. Students were randomly assigned to 1 of the following 3 groups: comparison (25/69, 36\%), intervention (23/69, 33\%), or control (21/69, 31\%). For knows, as expected, no significant differences were found between the groups on written knowledge (posttest, P=.13). For shows how, no significant differences were found between the comparison and intervention groups on the procedural skills learning outcomes immediately after the training (OSATS checklist and GRS, P=1.00). However, significant differences were found for the control versus comparison groups (OSATS checklist, P<.001; GRS, P=.02) and the control versus intervention groups (OSATS checklist, P<.001; GRS, P=.01) on the pre- and postprocedural performance. For reaction, there were no statistically significant differences between the intervention and comparison groups on the satisfaction with learning items (P=.65 and P=.79) or the evaluation of the training (P=.79, P=.45, and P=.31). Conclusions: Our results demonstrate that simulation-based training delivered remotely, applying our MTU concept, can be an effective way to teach procedural skills. Participants trained remotely in the MTU had comparable learning outcomes (shows how) to those trained face-to-face. Both groups received statistically significant higher procedural performance scores than those in the control group. Participants in both instruction groups were equally satisfied with their learning and training (reaction). We believe that mobile telesimulation could be an effective way of providing expert mentorship and overcoming a number of barriers to delivering SBME in rural and remote locations. ", doi="10.2196/14587", url="http://www.jmir.org/2019/8/e14587/" } @Article{info:doi/10.2196/14676, author="Kononowicz, A. Andrzej and Woodham, A. Luke and Edelbring, Samuel and Stathakarou, Natalia and Davies, David and Saxena, Nakul and Tudor Car, Lorainne and Carlstedt-Duke, Jan and Car, Josip and Zary, Nabil", title="Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Jul", day="02", volume="21", number="7", pages="e14676", keywords="computer simulation", keywords="professional education", keywords="computer-assisted instruction", keywords="systematic review", keywords="meta-analysis", abstract="Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95\% CI ?0.17 to 0.39, I2=74\%, n=927) and favored virtual patients for skills (SMD=0.90, 95\% CI 0.49 to 1.32, I2=88\%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients. ", doi="10.2196/14676", url="https://www.jmir.org/2019/7/e14676/", url="http://www.ncbi.nlm.nih.gov/pubmed/31267981" } @Article{info:doi/10.2196/10955, author="Nadir, Nur-Ain and Cook, J. Courtney and Bertino, E. Raymond and Squillante, D. Marc and Taylor, Cameron and Dragoo, David and Podolej, S. Gregory and Svendsen, D. Jessica and Fish, L. Jessica and McGarvey, S. Jeremy and Bond, F. William", title="Impact of an Electronic App on Resident Responses to Simulated In-Flight Medical Emergencies: Randomized Controlled Trial", journal="JMIR Med Educ", year="2019", month="Jun", day="7", volume="5", number="1", pages="e10955", keywords="in-flight medical emergencies", keywords="ground medical control", keywords="commercial aviation", keywords="simulation", 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. ", doi="10.2196/10955", url="http://mededu.jmir.org/2019/1/e10955/", url="http://www.ncbi.nlm.nih.gov/pubmed/31199299" } @Article{info:doi/10.2196/12474, author="Gorfinkel, Renee Lauren and Giesler, Amanda and Dong, Huiru and Wood, Evan and Fairbairn, Nadia and Klimas, Jan", title="Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting", journal="JMIR Med Educ", year="2019", month="May", day="24", volume="5", number="1", pages="e12474", keywords="medical education", keywords="substance-related disorders", keywords="education, distance", abstract="Background: Despite the enormous bur?den of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evi?dence-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. ", doi="10.2196/12474", url="http://mededu.jmir.org/2019/1/e12474/", url="http://www.ncbi.nlm.nih.gov/pubmed/31127722" } @Article{info:doi/10.2196/13868, author="Divakar, Ushashree and Nazeha, Nuraini and Posadzki, Pawel and Jarbrink, Krister and Bajpai, Ram and Ho, Yan Andy Hau and Campbell, James and Feder, Gene and Car, Josip", title="Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="May", day="23", volume="21", number="5", pages="e13868", keywords="systematic reviews", keywords="evidence-based", keywords="health workforce", keywords="domestic violence", abstract="Background: The World Health Organization states that 35\% of women experience domestic violence at least once during their lifetimes. However, approximately 80\% of health professionals have never received any training on management of this major public health concern. Objective: The objective of this study was to evaluate the effectiveness of health professions digital education on domestic violence compared to that of traditional ways or no intervention. Methods: Seven electronic databases were searched for randomized controlled trials from January 1990 to August 2017. The Cochrane Handbook guideline was followed, and studies reporting the use of digital education interventions to educate health professionals on domestic violence management were included. Results: Six studies with 631 participants met our inclusion criteria. Meta-analysis of 5 studies showed that as compared to control conditions, digital education may improve knowledge (510 participants and 5 studies; standardized mean difference [SMD] 0.67, 95\% CI 0.38-0.95; I2=59\%; low certainty evidence), attitudes (339 participants and 3 studies; SMD 0.67, 95\% CI 0.25-1.09; I2=68\%; low certainty evidence), and self-efficacy (174 participants and 3 studies; SMD 0.47, 95\% CI 0.16-0.77; I2=0\%; moderate certainty evidence). Conclusions: Evidence of the effectiveness of digital education on health professionals' understanding of domestic violence is promising. However, the certainty of the evidence is predominantly low and merits further research. Given the opportunity of scaled transformative digital education, both further research and implementation within an evaluative context should be prioritized. ", doi="10.2196/13868", url="http://www.jmir.org/2019/5/e13868/", url="http://www.ncbi.nlm.nih.gov/pubmed/31124462" } @Article{info:doi/10.2196/12540, author="Lukaschek, Karoline and Schneider, Nico and Schelle, Mercedes and Kirk, Bak Ulrik and Eriksson, Tina and Kunnamo, Ilkka and Rochfort, Andr{\'e}e and Collins, Claire and Gensichen, Jochen", title="Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study", journal="JMIR Ment Health", year="2019", month="Apr", day="29", volume="6", number="4", pages="e12540", keywords="motivational interviewing", keywords="e-learning", keywords="web-based learning", keywords="primary care", keywords="health behavior change", keywords="disease management", abstract="Background: Motivational interviewing (MI) is an established communication method for enhancing intrinsic motivation for changing health behavior. E-learning can reduce the cost and time involved in providing continuing education and can be easily integrated into individual working arrangements and the daily routines of medical professionals. Thus, a Web-based course was devised to familiarize health professionals with different levels of education and expertise with MI techniques for patients with chronic conditions. Objective: The aim of this study was to report participants' opinion on the practicality of MI (as learned in the course) in daily practice, stratified by the level of education. Methods: Participants (N=607) of the MI Web-based training course evaluated the course over 18 months, using a self-administered questionnaire. The evaluation was analyzed descriptively and stratified for the level of education (medical students, physicians in specialist training [PSTs], and general practitioners [GPs]). Results: Participants rated the applicability of the skills and knowledge gained by the course as positive (medical students: 94\% [79/84] good; PSTs: 88.6\% [109/123] excellent; and GPs: 51.3\% [182/355] excellent). When asked whether they envisage the use of MI in the future, 79\% (67/84) of the students stated to a certain extent, 88.6\% (109/123) of the PSTs stated to a great extent, and 38.6\% (137/355) of GPs stated to a great extent. Participants acknowledged an improvement of communication skills such as inviting (medical students: 85\% [72/84]; PSTs: 90.2\% [111/123]; GPs: 37.2\% [132/355]) and encouraging (medical students: 81\% [68/84]; PSTs: 45.5\% [56/123]; GPs: 36.3\% [129/355]) patients to talk about behavior change and conveying respect for patient's choices (medical students: 72\% [61/84]; PSTs: 50.0\% [61/123]; GPs: 23.4\% [83/355]). Conclusions: Participants confirmed the practicality of MI. However, the extent to which the practicality of MI was acknowledged as well as its expected benefits depended on the individual's level of education/expertise. ", doi="10.2196/12540", url="http://mental.jmir.org/2019/4/e12540/", url="http://www.ncbi.nlm.nih.gov/pubmed/31033446" } @Article{info:doi/10.2196/10982, author="Alturkistani, Abrar and Majeed, Azeem and Car, Josip and Brindley, David and Wells, Glenn and Meinert, Edward", title="Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study", journal="JMIR Med Educ", year="2019", month="Apr", day="02", volume="5", number="1", pages="e10982", keywords="education, distance", keywords="education", keywords="teaching", keywords="online learning", keywords="online education", keywords="MOOC", keywords="massive open online course", 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. ", doi="10.2196/10982", url="http://mededu.jmir.org/2019/1/e10982/", url="http://www.ncbi.nlm.nih.gov/pubmed/30938683" } @Article{info:doi/10.2196/10722, author="Wang, Dongwen and Abrams, Meredith", title="Health Care Providers' Profiles and Evaluations of a Statewide Online Education Program for Dissemination of Clinical Evidence on HIV, Hepatitis C Virus, and Sexually Transmitted Disease: Cross-Sectional Study", journal="JMIR Med Educ", year="2019", month="Mar", day="28", volume="5", number="1", pages="e10722", keywords="information dissemination", keywords="online systems", keywords="continuing education", keywords="HIV", keywords="hepatitis C", keywords="sexually transmitted diseases", keywords="multimedia", 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. ", doi="10.2196/10722", url="http://mededu.jmir.org/2019/1/e10722/", url="http://www.ncbi.nlm.nih.gov/pubmed/30920374" } @Article{info:doi/10.2196/12769, author="Albishi, Wahbi and Albeshri, Ahmad Marwan and Mortada, Hisham Hatan and Alzahrani, Khaled and Alharbi, Rakan and Aljuhani, Farrah and Aldaqal, Saleh", title="Awareness and Level of Knowledge About Surgical Site Infections and Risks of Wound Infection Among Medical Physicians in King Abdulaziz University Hospital: Cross-Sectional Study", journal="Interact J Med Res", year="2019", month="Mar", day="06", volume="8", number="1", pages="e12769", keywords="surgical site infections", keywords="knowledge", keywords="attitude", keywords="infection", abstract="Background: Surgical site infections (SSIs) are one of the leading causes of death, and its prevention is a key element of applying the concept of patient safety and quality care. Objective: This study aimed to assess the level of knowledge about SSIs and risks of wound infection among medical physicians in King Abdulaziz University Hospital. Methods: All surgical and medical consultants, specialists, residents, and medical interns were invited to participate in the study. A 20-Item multiple-choice questionnaire was developed by reviewing the previous literature and with the help of a group of certified surgeons to assess the level of knowledge in all participants. Results: A total of 119 doctors were included in this study. Among all respondents, 92 (77.3\%) were intern doctors, 16 (13.4\%) were resident doctors, and 11 (9.2\%) were specialist doctors. Moreover, 66 (55.5\%) doctors knew the definition of SSI. Only one-quarter, that is, 30 (25.2\%) doctors knew about the incidence of SSI. In addition, 8 doctors (6.7\%) had good knowledge, 75 (63.0\%) had fair knowledge, and 36 (30.2\%) had poor knowledge regarding SSI according to this study. Conclusions: Level of knowledge about SSIs and risks of wound infections among medical physicians should be improved to ensure better wound care and quality care for the patients. ", doi="10.2196/12769", url="http://www.i-jmr.org/2019/1/e12769/", url="http://www.ncbi.nlm.nih.gov/pubmed/30839280" } @Article{info:doi/10.2196/13000, author="Semwal, Monika and Whiting, Penny and Bajpai, Ram and Bajpai, Shweta and Kyaw, Myint Bhone and Tudor Car, Lorainne", title="Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Mar", day="04", volume="21", number="3", pages="e13000", keywords="evidence-based practice", keywords="health personnel", keywords="learning", keywords="systematic review", keywords="smoking cessation", abstract="Background: Tobacco smoking, one of the leading causes of preventable death and disease, is associated with 7 million deaths every year. This is estimated to rise to more than 8 million deaths per year by 2030, with 80\% occurring in low- and middle-income countries. Digital education, teaching, and learning using digital technologies have the potential to increase educational opportunities, supplement teaching activities, and decrease distance barriers in health professions education. Objective: The primary objective of this systematic review was to evaluate the effectiveness of digital education compared with various controls in improving learners' knowledge, skills, attitudes, and satisfaction to deliver smoking cessation therapy. The secondary objectives were to assess patient-related outcomes, change in health professionals' practice or behavior, self-efficacy or self-rated competence of health professionals in delivering smoking cessation therapy, and cost-effectiveness of the interventions. Methods: We searched 7 electronic databases and 2 trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and appraise eligible studies. Results: A total of 11 studies (number of participants, n=2684) were included in the review. All studies found that digital education was at least as effective as traditional or usual learning. There was some suggestion that blended education results in similar or greater improvements in knowledge (standardized mean difference, SMD=0.19, 95\% CI ?0.35 to 0.72), skill (SMD=0.58, 95\% CI 0.08-1.08), and satisfaction (SMD=0.62, 95\% CI 0.12-1.12) compared with digital education or usual learning alone. There was also some evidence for improved attitude (SMD=0.45, 95\% CI 0.18-0.72) following digital education compared with usual learning. Only 1 study reported patient outcomes and the setup cost of blended education but did not compare outcomes among groups. There were insufficient data to investigate what components of the digital education interventions were associated with the greatest improvements in learning outcomes. Conclusions: The evidence suggests that digital education is at least as effective as usual learning in improving health professionals' knowledge and skill for delivering smoking cessation therapy. However, limitations in the evidence base mean that these conclusions should be interpreted with some caution. Trial Registration: PROSPERO CRD42016046815; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=46815 ", doi="10.2196/13000", url="http://www.jmir.org/2019/3/e13000/", url="http://www.ncbi.nlm.nih.gov/pubmed/30829576" } @Article{info:doi/10.2196/11198, author="Laine, Anna and V{\"a}lim{\"a}ki, Maritta and L{\"o}yttyniemi, Eliisa and Pekurinen, Virve and Marttunen, Mauri and Anttila, Minna", title="The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study", journal="J Med Internet Res", year="2019", month="Mar", day="01", volume="21", number="3", pages="e11198", keywords="internet", keywords="online education", keywords="mental health", keywords="continuing education", abstract="Background: Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments. Objective: We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described. Methods: The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course. Results: Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages. Conclusions: Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed. ", doi="10.2196/11198", url="https://www.jmir.org/2019/3/e11198/", url="http://www.ncbi.nlm.nih.gov/pubmed/30821697" } @Article{info:doi/10.2196/13269, author="George, Paul Pradeep and Zhabenko, Olena and Kyaw, Myint Bhone and Antoniou, Panagiotis and Posadzki, Pawel and Saxena, Nakul and Semwal, Monika and Tudor Car, Lorainne and Zary, Nabil and Lockwood, Craig and Car, Josip", title="Online Digital Education for Postregistration Training of Medical Doctors: Systematic Review by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Feb", day="25", volume="21", number="2", pages="e13269", keywords="randomized controlled trials", keywords="effectiveness", keywords="systematic review", keywords="medical education", keywords="internet", abstract="Background: Globally, online and local area network--based (LAN) digital education (ODE) has grown in popularity. Blended learning is used by ODE along with traditional learning. Studies have shown the increasing potential of these technologies in training medical doctors; however, the evidence for its effectiveness and cost-effectiveness is unclear. Objective: This systematic review evaluated the effectiveness of online and LAN-based ODE in improving practicing medical doctors' knowledge, skills, attitude, satisfaction (primary outcomes), practice or behavior change, patient outcomes, and cost-effectiveness (secondary outcomes). Methods: We searched seven electronic databased for randomized controlled trials, cluster-randomized trials, and quasi-randomized trials from January 1990 to March 2017. Two review authors independently extracted data and assessed the risk of bias. We have presented the findings narratively. We mainly compared ODE with self-directed/face-to-face learning and blended learning with self-directed/face-to-face learning. Results: A total of 93 studies (N=16,895) were included, of which 76 compared ODE (including blended) and self-directed/face-to-face learning. Overall, the effect of ODE (including blended) on postintervention knowledge, skills, attitude, satisfaction, practice or behavior change, and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher postintervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge scores (small to large effect size and very low quality) for the intervention, while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size and low quality), while 13 studies reported no difference in the skill scores between the groups. One study reported a higher attitude score for the intervention (very low quality), while four studies reported no difference in the attitude score between the groups. Four studies reported higher postintervention physician satisfaction with the intervention (large effect size and low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher postintervention practice or behavior change for the ODE group (small to moderate effect size and low quality), while five studies reported no difference in practice or behavior change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects or cost-effectiveness of the interventions. Conclusions: Empiric evidence showed that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training practicing physicians. Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning. The quality of the evidence in these studies was found to be very low for knowledge. Further high-quality randomized controlled trials are required to confirm these findings. ", doi="10.2196/13269", url="http://www.jmir.org/2019/2/e13269/", url="http://www.ncbi.nlm.nih.gov/pubmed/30801252" } @Article{info:doi/10.2196/12997, author="Huang, Zhilian and Semwal, Monika and Lee, Yee Shuen and Tee, Mervin and Ong, William and Tan, Shin Woan and Bajpai, Ram and Tudor Car, Lorainne", title="Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Feb", day="21", volume="21", number="2", pages="e12997", keywords="evidence-based practice", keywords="health personnel", keywords="learning", keywords="systematic review", keywords="diabetes mellitus", abstract="Background: There is a shortage of health care professionals competent in diabetes management worldwide. Digital education is increasingly used in educating health professionals on diabetes. Digital diabetes self-management education for patients has been shown to improve patients' knowledge and outcomes. However, the effectiveness of digital education on diabetes management for health care professionals is still unknown. Objective: The objective of this study was to assess the effectiveness and economic impact of digital education in improving health care professionals' knowledge, skills, attitudes, satisfaction, and competencies. We also assessed its impact on patient outcomes and health care professionals' behavior. Methods: We included randomized controlled trials evaluating the impact of digitalized diabetes management education for health care professionals pre- and postregistration. Publications from 1990 to 2017 were searched in MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, ERIC, and Web of Science. Screening, data extraction and risk of bias assessment were conducted independently by 2 authors. Results: A total of 12 studies met the inclusion criteria. Studies were heterogeneous in terms of digital education modality, comparators, outcome measures, and intervention duration. Most studies comparing digital or blended education to traditional education reported significantly higher knowledge and skills scores in the intervention group. There was little or no between-group difference in patient outcomes or economic impact. Most studies were judged at a high or unclear risk of bias. Conclusions: Digital education seems to be more effective than traditional education in improving diabetes management--related knowledge and skills. The paucity and low quality of the available evidence call for urgent and well-designed studies focusing on important outcomes such as health care professionals' behavior, patient outcomes, and cost-effectiveness as well as its impact in diverse settings, including developing countries. ", doi="10.2196/12997", url="http://www.jmir.org/2019/2/e12997/", url="http://www.ncbi.nlm.nih.gov/pubmed/30789348" } @Article{info:doi/10.2196/10396, author="Choi, Sunhea and Yuen, Ming Ho and Annan, Reginald and Pickup, Trevor and Pulman, Andy and Monroy-Valle, Michele and Aduku, Linda Nana Esi and Kyei-Boateng, Samuel and Vel{\'a}squez Monz{\'o}n, Isabel Carmen and Portillo Serme{\~n}o, Elisa Carmen and Penn, Andrew and Ashworth, Ann and Jackson, A. Alan", title="Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study", journal="J Med Internet Res", year="2018", month="Oct", day="03", volume="20", number="10", pages="e10396", keywords="eLearning", keywords="severe acute malnutrition", keywords="WHO guidelines for malnutrition", keywords="capacity building", keywords="staff development", keywords="quality improvement", keywords="nutrition training and education", abstract="Background: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. Objective: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. Methods: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. Results: Before the course, awareness of the World Health Organization guidelines was 36.73\% (389/1059) overall, and 26.3\% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95\% CI 10.8-12.9; P<.001)---a relative increase of 41.5\%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7\% (356/606), compared with 18.2\% (110/606) in pretraining. Of the in-service professionals, 85.9\% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8\% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. Conclusions: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course. ", doi="10.2196/10396", url="http://www.jmir.org/2018/10/e10396/" } @Article{info:doi/10.2196/10277, author="Abraham, H. Traci and Marchant-Miros, Kathy and McCarther, B. Michael and Craske, G. Michelle and Curran, M. Geoffrey and Kearney, K. Lisa and Greene, Carolyn and Lindsay, A. Jan and Cucciare, A. Michael", title="Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach", journal="JMIR Ment Health", year="2018", month="Aug", day="22", volume="5", number="3", pages="e10277", keywords="therapy", keywords="veterans", keywords="depression", keywords="anxiety disorders", keywords="posttraumatic stress disorder", keywords="PTSD", abstract="Background: A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. Objective: The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program's acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. Methods: An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results: Key stakeholders suggested modifications to the original CALM program that altered its modules' appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. Conclusions: The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP. ", doi="10.2196/10277", url="http://mental.jmir.org/2018/3/e10277/", url="http://www.ncbi.nlm.nih.gov/pubmed/30135051" } @Article{info:doi/10.2196/mededu.9551, author="Rat, Anne-Christine and Ricci, Laetitia and Guillemin, Francis and Ricatte, Camille and Pongy, Manon and Vieux, Rachel and Spitz, Elisabeth and Muller, Laurent", title="Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET)", journal="JMIR Med Educ", year="2018", month="Jul", day="19", volume="4", number="2", pages="e17", keywords="bad news disclosure", keywords="health communication", keywords="physician-patient relationship", keywords="distance e-learning", abstract="Background: Although most physicians in medical settings have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and nonverbal skills, the ability to recognize and respond to patients' emotions and the importance of considering the patient's environment such as culture and social status. How bad news is delivered can have consequences that may affect patients, sometimes over the long term. Objective: This project aimed to develop a Web-based formative self-assessment tool for physicians to practice delivering bad news to minimize the deleterious effects of poor way of breaking bad news about a disease, whatever the disease. Methods: BReaking bAD NEws Tool (BRADNET) items were developed by reviewing existing protocols and recommendations for delivering bad news. We also examined instruments for assessing patient-physician communications and conducted semistructured interviews with patients and physicians. From this step, we selected specific themes and then pooled these themes before consensus was achieved on a good practices communication framework list. Items were then created from this list. To ensure that physicians found BRADNET acceptable, understandable, and relevant to their patients' condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was used to explore the impact of the items and messages and why and how these messages could change physicians' relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). Results: The good practices communication framework list comprised 70 specific issues related to breaking bad news pooled into 8 main domains: opening, preparing for the delivery of bad news, communication techniques, consultation content, attention, physician emotional management, shared decision making, and the relationship between the physician and the medical team. After constructing the items from this list, the items were extensively refined to make them more useful to the target audience, and one item was added. BRADNET contains 71 items, each including a question, response options, and a corresponding message, which were divided into 8 domains and assessed with 12 self-assessment sessions. The BRADNET Web-based platform was developed according to the cognitive load theory and the cognitive theory of multimedia learning. Conclusions: The objective of this Web-based assessment tool was to create a ``space'' for reflection. It contained items leading to self-reflection and messages that introduced recommended communication behaviors. Our approach was innovative as it provided an inexpensive distance-learning self-assessment tool that was manageable and less time-consuming for physicians with often overwhelming schedules. ", doi="10.2196/mededu.9551", url="http://mededu.jmir.org/2018/2/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/30026180" } @Article{info:doi/10.2196/mededu.7719, author="Bond, Evan Stuart and Crowther, P. Shelley and Adhikari, Suman and Chubaty, J. Adriana and Yu, Ping and Borchard, P. Jay and Boutlis, Steven Craig and Yeo, Winston Wilfred and Miyakis, Spiros", title="Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study", journal="JMIR Med Educ", year="2018", month="Feb", day="26", volume="4", number="1", pages="e5", keywords="nursing education", keywords="pharmacy education", keywords="medical education", keywords="continuing education", keywords="survey methods", keywords="antibacterial agents", 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. ", doi="10.2196/mededu.7719", url="http://mededu.jmir.org/2018/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/29483071" } @Article{info:doi/10.2196/cancer.9114, author="Rosen, L. Brittany and Bishop, M. James and McDonald, L. Skye and Kahn, A. Jessica and Kreps, L. Gary", title="Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment", journal="JMIR Cancer", year="2018", month="Feb", day="16", volume="4", number="1", pages="e3", keywords="papillomavirus vaccines", keywords="internet", keywords="program evaluation", keywords="health personnel", abstract="Background: Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. Objective: The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. Methods: Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions' content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. Results: A total of 21 interventions were identified, out of which 7 (33\%) were webinars, 7 (33\%) were videos or lectures, and 7 (33\%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81\%) identified the purpose of the intervention, 12 (57\%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67\%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24\%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. Conclusions: This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians. ", doi="10.2196/cancer.9114", url="http://cancer.jmir.org/2018/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/29453187" } @Article{info:doi/10.2196/resprot.7551, author="Govender, Pragashnie and Chetty, Verusia and Naidoo, Deshini and Pefile, Ntsikelelo", title="Integrated Decentralized Training for Health Professions Education at the University of KwaZulu-Natal, South Africa: Protocol for the I-DecT Project", journal="JMIR Res Protoc", year="2018", month="Jan", day="25", volume="7", number="1", pages="e19", keywords="decentralized clinical training, health science, South Africa, health care", abstract="Background: The Integrated Decentralized Training (i-DecT) project was created to address the current need for health care in South Africa among resource poor climates in rural and periurban settings. The University of KwaZulu-Natal (UKZN) in South Africa has embarked on a program within the School of Health Sciences (SHS) to decentralize the clinical learning platform in order to address this disparity. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of decentralized clinical training (DCT) within the province of KwaZulu-Natal. There currently remains uncertainty as to how the implementation of this program will unfold, especially for the diverse SHS, which includes specialities like audiology, dentistry, occupational therapy, optometry, pharmacy, physiotherapy, speech-language pathology, and sport science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the participating students have a positive learning experience and achieve expected academic outcomes, and that the needs of the communities are addressed adequately. Objective: The study aims to explore the factors that will influence the roll-out of the DCT by developing an inclusive and context-specific model that will adhere to the standards set by the SHS for the DCT program at UKZN. Methods: Key role players, including but not limited to, the South African Ministry of Health policy makers, clinicians, policy makers at UKZN, clinical educators, academicians, and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralized training, a context-specific model for DCTl will be proposed based on initial pilot data that will be tested within iterative cycles in an Action Learning Action Research (ALAR) process. Results: The study was designed to fit within the existing structures, and emerging framework and memorandum of understanding between the partners of this initiative, namely, the Ministry of Health and UKZN in order to develop health care professionals that are competent and prepared for the changing dynamics of healthcare in a developing world. Conclusions: It is envisioned that this study, the first to include a combination of health professionals in a DCT platform at UKZN, will not only contribute to effective service delivery, but may also serve to promote an interprofessional cooperation within the SHS and tertiary institutions in similar settings. ", doi="10.2196/resprot.7551", url="http://www.researchprotocols.org/2018/1/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/29371175" } @Article{info:doi/10.2196/mededu.7173, author="Douma, Lea Kirsten Freya and Aalfs, M. Cora and Dekker, Evelien and Tanis, J. Pieter and Smets, M. Ellen", title="An E-Learning Module to Improve Nongenetic Health Professionals' Assessment of Colorectal Cancer Genetic Risk: Feasibility Study", journal="JMIR Med Educ", year="2017", month="Dec", day="18", volume="3", number="2", pages="e24", keywords="colorectal neoplasms", keywords="colorectal, neoplasms, hereditary nonpolyposis", keywords="adenomatous polyposis coli", keywords="genetic testing", keywords="gastroenterology", keywords="health communication", keywords="feasibility studies", keywords="education", keywords="professional", abstract="Background: Nongenetic health providers may lack the relevant knowledge, experience, and communication skills to adequately detect familial colorectal cancer (CRC), despite a positive attitude toward the assessment of history of cancer in a family. Specific training may enable them to more optimally refer patients to genetic counseling. Objective: The aim of this study was to develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge, and comprehension of communication skills, and to assess the feasibility of the e-learning module for continued medical education of these specialists. Methods: A focus group helped to inform the development of a training framework. The e-learning module was then developed, followed by a feasibility test among a group of surgeons-in-training (3rd- and 4th-year residents) and then among gastroenterologists, using pre- and posttest questionnaires. Results: A total of 124 surgeons-in-training and 14 gastroenterologists participated. The e-learning was positively received (7.5 on a scale of 1 to 10). Between pre- and posttest, attitude increased significantly on 6 out of the 10 items. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49\% to 72\% correct at pretest to 67\% to 87\% correct at posttest. Conclusions: This study shows the feasibility of a problem-based e-learning module to help surgeons-in-training and gastroenterologists in recognizing a hereditary predisposition in patients with CRC. The e-learning led to improvements in attitude toward the assessment of cancer family history, knowledge on criteria for referral to genetic counseling for CRC, and comprehension of communication skills. ", doi="10.2196/mededu.7173", url="http://mededu.jmir.org/2017/2/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/29254907" } @Article{info:doi/10.2196/mededu.7480, author="Ebn Ahmady, Arezoo and Barker, Megan and Fahim, Myra and Dragonetti, Rosa and Selby, Peter", title="Evaluation of Web-Based Continuing Professional Development Courses: Aggregate Mixed-Methods Model", journal="JMIR Med Educ", year="2017", month="Oct", day="20", volume="3", number="2", pages="e19", keywords="learning", keywords="Internet", keywords="evaluation studies", keywords="tobacco use", abstract="Background: Many continuing professional development (CPD) Web-based programs are not explicit about underlying theory and fail to demonstrate impact. Objective: The aim of this study was to develop and apply an aggregate mixed-methods evaluation model to describe the paradigm, theoretical framework, and methodological approaches used to evaluate a CPD course in tobacco dependence treatment, the Training Enhancement in Applied Cessation Counseling and Health (TEACH) project. Methods: We evaluated the effectiveness of the 5-week TEACH Web-based Core Course in October 2015. The model of evaluation was derived using a critical realist lens to incorporate a dimension of utilitarian to intuitionist approaches. In addition, we mapped our findings to models described by Fitzpatrick et al, Moore et al, and Kirkpatrick. We used inductive and deductive approaches for thematic analysis of qualitative feedback and dependent samples t tests for quantitative analysis. Results: A total of 59 participants registered for the course, and 48/59 participants (81\%) completed all course requirements. Quantitative analysis indicated that TEACH participants reported (1) high ratings (4.55/5, where 5=best/excellent) for instructional content and overall satisfaction of the course (expertise and consumer-oriented approach), (2) a significant increase (P ?.001) in knowledge and skills (objective-oriented approach), and (3) high motivation (78.90\% of participants) to change and sustain practice change (management-oriented approach). Through the intuitionist lens, inductive and deductive qualitative thematic analysis highlighted three central themes focused on (1) knowledge acquisition, (2) recommendations to enhance learning for future participants, and (3) plans for practice change in the formative assessment, and five major themes emerged from the summative assessment: (1) learning objectives, (2) interprofessional collaboration, (3) future topics of relevance, (4) overall modification, and (5) overall satisfaction. Conclusions: In the current aggregate model to evaluate CPD Web-based training, evaluators have been influenced by different paradigms, theoretical lenses, methodological approaches, and data collection methods to address and respond to different needs of stakeholders impacted by the training outcomes. ", doi="10.2196/mededu.7480", url="http://mededu.jmir.org/2017/2/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/29054834" } @Article{info:doi/10.2196/jmir.7966, author="Kobak, A. Kenneth and Lipsitz, D. Joshua and Markowitz, C. John and Bleiberg, L. Kathryn", title="Web-Based Therapist Training in Interpersonal Psychotherapy for Depression: Pilot Study", journal="J Med Internet Res", year="2017", month="Jul", day="17", volume="19", number="7", pages="e257", keywords="psychotherapy", keywords="Internet", keywords="depression", keywords="education", keywords="humans", keywords="computer-assisted instruction", abstract="Background: Training mental health professionals to deliver evidence-based therapy (EBT) is now required by most academic accreditation bodies, and evaluating the effectiveness of such training is imperative. However, shortages of time, money, and trained EBT clinician teachers make these challenges daunting. New technologies may help. The authors have developed the first empirically evaluated comprehensive Internet therapist training program for interpersonal psychotherapy (IPT). Objective: The aim of this study was to examine whether (1) the training protocol would increase clinicians' knowledge of IPT concepts and skills and (2) clinicians would deem the training feasible as measured by satisfaction and utility ratings. Methods: A total of 26 clinicians enrolled in the training, consisting of (1) a Web-based tutorial on IPT concepts and techniques; (2) live remote training via videoconference, with trainees practicing IPT techniques in a role-play using a case vignette; and (3) a Web-based portal for therapists posttraining use to help facilitate implementation of IPT and maintain adherence over time. Results: Trainees' knowledge of IPT concepts and skills improved significantly (P<.001). The standardized effect size for the change was large: d=2.53, 95\% CI 2.23-2.92. Users found the technical features easy to use, the content useful for helping them treat depressed clients, and felt the applied training component enhanced their professional expertise. Mean rating of applied learning was 3.9 (scale range from 1=very little to 5=a great deal). Overall satisfaction rating was 3.5 (range from 1=very dissatisfied to 4=very satisfied). Conclusions: Results support the efficacy and feasibility of this technology in training clinicians in EBTs and warrant further empirical evaluation. ", doi="10.2196/jmir.7966", url="http://www.jmir.org/2017/7/e257/", url="http://www.ncbi.nlm.nih.gov/pubmed/28716769" } @Article{info:doi/10.2196/jmir.7072, author="Roland, Damian and Spurr, Jesse and Cabrera, Daniel", title="Preliminary Evidence for the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics", journal="J Med Internet Res", year="2017", month="Jul", day="14", volume="19", number="7", pages="e252", keywords="social media", keywords="network", keywords="community networks", keywords="community of practice", keywords="\#FOAMed", keywords="Twitter", abstract="Background: Online communities of practice (oCoPs) may emerge from interactions on social media. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, there is only a small body of evidence in medicine or health care to verify the existence of an oCoP. Objective: We aimed to examine the emergence of an oCoP through the study of social media interactions of the free open access medical education (FOAM) movement. Methods: We examined social media activity in Twitter by analyzing the network centrality metrics of tweets with the \#FOAMed hashtag and compared them with previously validated criteria of a community of practice (CoP). Results: The centrality analytics of the FOAM community showed concordance with aspects of a general CoP (in terms of community, domain, and practice), as well as some specific traits of a health care community, including social control, common purpose, flat hierarchy, and network-based and concrete achievement. Conclusions: This study demonstrated preliminary evidence of an oCoP focused on education and based on social media interactions. Further examination of the topology of the network is needed to definitely prove the existence of an oCoP. Given that these communities result in significant knowledge translation and practice change, further research in this area appears warranted. ", doi="10.2196/jmir.7072", url="http://www.jmir.org/2017/7/e252/", url="http://www.ncbi.nlm.nih.gov/pubmed/28710054" } @Article{info:doi/10.2196/mededu.7825, author="Damarell, A. Raechel and Tieman, J. Jennifer", title="How Do Clinicians Learn About Knowledge Translation? An Investigation of Current Web-Based Learning Opportunities", journal="JMIR Med Educ", year="2017", month="Jul", day="13", volume="3", number="2", pages="e12", keywords="knowledge", keywords="translational medical research", keywords="diffusion of innovation", keywords="health personnel", keywords="education, medical, continuing", keywords="quality assurance, health care", abstract="Background: Clinicians are important stakeholders in the translation of well-designed research evidence into clinical practice for optimal patient care. However, the application of knowledge translation (KT) theories and processes may present conceptual and practical challenges for clinicians. Online learning platforms are an effective means of delivering KT education, providing an interactive, time-efficient, and affordable alternative to face-to-face education programs. Objective: This study investigates the availability and accessibility of online KT learning opportunities for health professionals. It also provides an analysis of the types of resources and associated disciplines retrieved by a range of KT synonyms. Methods: We searched a range of bibliographic databases and the Internet (Google advanced option) using 9 KT terms to identify online KT learning resources. To be eligible, resources had to be free, aimed at clinicians, educational in intent, and interactive in design. Each term was searched using two different search engines. The details of the first 100 websites captured per browser (ie, n=200 results per term) were entered into EndNote. Each site was subsequently visited to determine its status as a learning resource. Eligible websites were appraised for quality using the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) tool. Results: We identified 971 unique websites via our multiple search strategies. Of these, 43 were health-related and educational in intent. Once these sites were evaluated for interactivity, a single website matched our inclusion criteria (Dementia Knowledge Translation Learning Centre). Conclusions: KT is an important but complex system of processes. These processes overlap with knowledge, practice, and improvement processes that go by a range of different names. For clinicians to be informed and competent in KT, they require better access to free learning opportunities. These resources should be designed from the viewpoint of the clinician, presenting KT's multifaceted theories and processes in an engaging, interactive way. This learning should empower clinicians to contextualize and apply KT strategies within their own care settings. ", doi="10.2196/mededu.7825", url="http://mededu.jmir.org/2017/2/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/28705788" } @Article{info:doi/10.2196/jmir.8014, author="Liang, Jun and Wei, Kunyan and Meng, Qun and Chen, Zhenying and Zhang, Jiajie and Lei, Jianbo", title="The Gap in Medical Informatics and Continuing Education Between the United States and China: A Comparison of Conferences in 2016", journal="J Med Internet Res", year="2017", month="Jun", day="21", volume="19", number="6", pages="e224", keywords="medical informatics", keywords="conferences", keywords="continuing education", keywords="Sino-American comparison", abstract="Background: China launched its second health reform in 2010 with considerable investments in medical informatics (MI). However, to the best of our knowledge, research on the outcomes of this ambitious undertaking has been limited. Objective: Our aim was to understand the development of MI and the state of continuing education in China and the United States from the perspective of conferences. Methods: We conducted a quantitative and qualitative analysis of four MI conferences in China and two in the United States: China Medical Information Association Annual Symposium (CMIAAS), China Hospital Information Network Annual Conference (CHINC), China Health Information Technology Exchange Annual Conference (CHITEC), China Annual Proceeding of Medical Informatics (CPMI) versus the American Medical Informatics Association (AMIA) and Healthcare Information and Management Systems Society (HIMSS). The scale, composition, and regional distribution of attendees, topics, and research fields for each conference were summarized and compared. Results: CMIAAS and CPMI are mainstream academic conferences, while CHINC and CHITEC are industry conferences in China. Compared to HIMSS 2016, the meeting duration of CHITEC was 3 versus 5 days, the number of conference sessions was 132 versus 950+, the number of attendees was 5000 versus 40,000+, the number of vendors was 152 versus 1400+, the number of subforums was 12 versus 230, the number of preconference education symposiums and workshops was 0 versus 12, and the duration of preconference educational symposiums and workshops was 0 versus 1 day. Compared to AMIA, the meeting duration of Chinese CMIAAS was 2 versus 5 days, the number of conference sessions was 42 versus 110, the number of attendees was 200 versus 2500+, the number of vendors was 5 versus 75+, and the number of subforums was 4 versus 10. The number of preconference tutorials and working groups was 0 versus 29, and the duration of tutorials and working group was 0 versus 1.5 days. Conclusions: Given the size of the Chinese economy and the substantial investment in MI, the output in terms of conferences remains low. The impact of conferences on continuing education to professionals is not significant. Chinese researchers and professionals should approach MI with greater rigor, including validated research methods, formal training, and effective continuing education, in order to utilize knowledge gained by other countries and to expand collaboration. ", doi="10.2196/jmir.8014", url="http://www.jmir.org/2017/6/e224/", url="http://www.ncbi.nlm.nih.gov/pubmed/28637638" } @Article{info:doi/10.2196/jmir.7840, author="Mira, Joaqu{\'i}n Jos{\'e} and Carrillo, Irene and Guilabert, Mercedes and Lorenzo, Susana and P{\'e}rez-P{\'e}rez, Pastora and Silvestre, Carmen and Ferr{\'u}s, Lena and ", title="The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers' Emotional Responses After a Clinical Error", journal="J Med Internet Res", year="2017", month="Jun", day="08", volume="19", number="6", pages="e203", keywords="patient safety", keywords="professionals", keywords="hospital", keywords="primary care", keywords="second victims", keywords="clinical error", keywords="e-learning", abstract="Background: Adverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening. Objective: The aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon. Methods: The design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design). Results: The website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88\% (23/26) and 92\% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse event (P<.001). Conclusions: The MISE program differs from existing intervention initiatives by its preventive nature in relation to the second victim phenomenon. Its online nature makes it an easily accessible tool for the professional community. This program has shown to increase user's knowledge on this issue and it helps them correct their approach. Furthermore, it is one of the first initiatives to attempt to bring the second victim phenomenon closer to primary care. ", doi="10.2196/jmir.7840", url="http://www.jmir.org/2017/6/e203/", url="http://www.ncbi.nlm.nih.gov/pubmed/28596148" } @Article{info:doi/10.2196/mededu.5434, author="Oliveira, Cristina Ana and Mattos, Sandra and Coimbra, Miguel", title="Development and Assessment of an E-learning Course on Pediatric Cardiology Basics", journal="JMIR Med Educ", year="2017", month="May", day="10", volume="3", number="1", pages="e10", keywords="distance learning", keywords="continuing medical education", keywords="pediatrics", keywords="cardiology", keywords="congenital heart defects", abstract="Background: Early detection of congenital heart disease is a worldwide problem. This is more critical in developing countries, where shortage of professional specialists and structural health care problems are a constant. E-learning has the potential to improve capacity, by overcoming distance barriers and by its ability to adapt to the reduced time of health professionals. Objective: The study aimed to develop an e-learning pediatric cardiology basics course and evaluate its pedagogical impact and user satisfaction. Methods: The sample consisted of 62 health professionals, including doctors, nurses, and medical students, from 20 hospitals linked via a telemedicine network in Northeast Brazil. The course was developed using Moodle (Modular Object Oriented Dynamic Learning Environment; Moodle Pty Ltd, Perth, Australia) and contents adapted from a book on this topic. Pedagogical impact evaluation used a pre and posttest approach. User satisfaction was evaluated using Wang's questionnaire. Results: Pedagogical impact results revealed differences in knowledge assessment before and after the course (Z=?4.788; P<.001). Questionnaire results indicated high satisfaction values (Mean=87\%; SD=12\%; minimum=67\%; maximum=100\%). Course adherence was high (79\%); however, the withdrawal exhibited a value of 39\%, with the highest rate in the early chapters. Knowledge gain revealed significant differences according to the profession (X22=8.6; P=.01) and specialty (X22=8.4; P=.04). Time dedication to the course was significantly different between specialties (X22=8.2; P=.04). Conclusions: The main contributions of this study are the creation of an asynchronous e-learning course on Moodle and the evaluation of its impact, confirming that e-learning is a viable tool to improve training in neonatal congenital heart diseases. ", doi="10.2196/mededu.5434", url="http://mededu.jmir.org/2017/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/28490416" } @Article{info:doi/10.2196/jmir.6453, author="Zhan, Xingxin and Zhang, Zhixia and Sun, Fang and Liu, Qian and Peng, Weijun and Zhang, Heng and Yan, Weirong", title="Effects of Improving Primary Health Care Workers' Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning", journal="J Med Internet Res", year="2017", month="May", day="01", volume="19", number="5", pages="e116", keywords="blended learning", keywords="e-learning", keywords="primary health care workers", keywords="public health services", abstract="Background: Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs' competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers' education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning. Objective: The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach. Methods: The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs---the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs---the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses' knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]). Results: The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95\% CI 92.49-93.93) in experimental group versus 88.29 (95\% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95\% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95\% CI 93.37-94.73) in the experimental group vs 90.22 (95\% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95\% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95\% CI 93.08-94.68) in the experimental group versus 89.09 (95\% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95\% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95\% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95\% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95\% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95\% CI 1.08-2.48; P=.02). Conclusions: Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings. ", doi="10.2196/jmir.6453", url="http://www.jmir.org/2017/5/e116/", url="http://www.ncbi.nlm.nih.gov/pubmed/28461286" } @Article{info:doi/10.2196/mededu.6312, author="Katz, Aric and Tepper, Ronnie and Shtub, Avraham", title="Simulation Training: Evaluating the Instructor's Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training", journal="JMIR Med Educ", year="2017", month="Apr", day="21", volume="3", number="1", pages="e8", keywords="distance learning", keywords="feedback", keywords="simulation training", keywords="evaluation research", abstract="Background: Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow's graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse. Objectives: This quantitative study assessed the effectiveness of a computerized interactive simulator coupled with an instructor who monitored students' progress and provided Web-based immediate feedback. Methods: A low-cost, globally accessible, telemedicine simulator, developed at the Technion---Israel Institute of Technology, Haifa, Israel---was used. A previous study in the field of interventional cardiology, evaluating the efficacy of the simulator to enhanced learning via knowledge exams, presented promising results of average scores varying from 94\% after training and 54\% before training (n=20) with P<.001. Two independent experiments involving obstetrics and gynecology (Ob-Gyn) physicians and senior ultrasound sonographers, with 32 subjects, were conducted using a new interactive concept of the WOZ (Wizard of OZ) simulator platform. The contribution of an instructor to learning outcomes was evaluated by comparing students' knowledge before and after each interactive instructor-led session as well as after fully automated e-learning in the field of Ob-Gyn. Results from objective knowledge tests were analyzed using hypothesis testing and model fitting. Results: A significant advantage (P=.01) was found in favor of the WOZ training approach. Content type and training audience were not significant. Conclusions: This study evaluated the contribution of an integrated teaching environment using a computerized interactive simulator, with an instructor providing immediate Web-based immediate feedback to trainees. Involvement of an instructor in the simulation-based training process provided better learning outcomes that varied training content and trainee populations did not affect the overall learning gains. ", doi="10.2196/mededu.6312", url="http://mededu.jmir.org/2017/1/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28432039" } @Article{info:doi/10.2196/mededu.6305, author="Schoenthaler, Antoinette and Albright, Glenn and Hibbard, Judith and Goldman, Ron", title="Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study", journal="JMIR Med Educ", year="2017", month="Apr", day="19", volume="3", number="1", pages="e7", keywords="simulation training", keywords="health communication", keywords="patient activation", keywords="motivational interviewing", keywords="decision making", abstract="Background: Despite clear evidence that antibiotics do not cure viral infections, the problem of unnecessary prescribing of antibiotics in ambulatory care persists, and in some cases, prescribing patterns have increased. The overuse of antibiotics for treating viral infections has created numerous economic and clinical consequences including increased medical costs due to unnecessary hospitalizations, antibiotic resistance, disruption of gut bacteria, and obesity. Recent research has underscored the importance of collaborative patient-provider communication as a means to reduce the high rates of unnecessary prescriptions for antibiotics. However, most patients and providers do not feel prepared to engage in such challenging conversations. Objectives: The aim of this pilot study was to assess the ability of a brief 15-min simulated role-play conversation with virtual humans to serve as a preliminary step to help health care providers and patients practice, and learn how to engage in effective conversations about antibiotics overuse. Methods: A total of 69 participants (35 providers and 34 patients) completed the simulation once in one sitting. A pre-post repeated measures design was used to assess changes in patients' and providers' self-reported communication behaviors, activation, and preparedness, intention, and confidence to effectively communicate in the patient-provider encounter. Changes in patients' knowledge and beliefs regarding antibiotic use were also evaluated. Results: Patients experienced a short-term positive improvement in beliefs about appropriate antibiotic use for infection (F1,30=14.10, P=.001). Knowledge scores regarding the correct uses of antibiotics improved immediately postsimulation, but decreased at the 1-month follow-up (F1,30=31.16, P<.001). There was no change in patient activation and shared decision-making (SDM) scores in the total sample of patients (P>.10) Patients with lower levels of activation exhibited positive, short-term benefits in increased intent and confidence to discuss their needs and ask questions in the clinic visit, positive attitudes regarding participation in SDM with their provider, and accurate beliefs about the use of antibiotics (P<.10). The results also suggest small immediate gains in providers' attitudes about SDM (mean change 0.20; F1,33= 8.03, P=.01). Conclusions: This pilot study provided preliminary evidence on the efficacy of the use of simulated conversations with virtual humans as a tool to improve patient-provider communication (ie, through increasing patient confidence to actively participate in the visit and physician attitudes about SDM) for engaging in conversations about antibiotic use. Future research should explore if repeated opportunities to use the 15-min simulation as well as providing users with several different conversations to practice with would result in sustained improvements in antibiotics beliefs and knowledge and communication behaviors over time. The results of this pilot study offered several opportunities to improve on the simulation in order to bolster communication skills and knowledge retention. ", doi="10.2196/mededu.6305", url="http://mededu.jmir.org/2017/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28428160" } @Article{info:doi/10.2196/mededu.6858, author="Kessler, Craig and Peerschke, I. Ellinor and Chitlur, B. Meera and Kulkarni, Roshni and Holot, Natalia and Cooper, L. David", title="The Coags Uncomplicated App: Fulfilling Educational Gaps Around Diagnosis and Laboratory Testing of Coagulation Disorders", journal="JMIR Med Educ", year="2017", month="Apr", day="18", volume="3", number="1", pages="e6", keywords="blood coagulation disorders", keywords="smartphone", keywords="diagnosis", keywords="hematology", keywords="differential diagnosis", abstract="Background: Patients with coagulation disorders may present to a variety of physician specialties; however, accurate and efficient diagnosis can be challenging for physicians not specialized in hematology, due to identified gaps in knowledge around appropriate laboratory assays and interpretation of test results. Coags Uncomplicated was developed to fill this unmet educational need by increasing practical knowledge of coagulation disorders among nonexpert physicians and other health care professionals (HCPs) in a point-of-care (POC) setting. Objective: The aim of this study was to assess patterns of use of the mobile app Coags Uncomplicated, a tool designed to support education regarding accurate and efficient diagnosis of bleeding disorders. Methods: App metrics were obtained by tracking registered user data. Additionally, a survey was distributed to registered users, to assess circumstances and frequency of use. Results: The most common specialties of 7596 registered US users were hematology-oncology (n=1534, 20.19\%), hematology (n=1014, 13.35\%), and emergency medicine (n=1222, 16.09\%); most identified as physicians (n=4082, 53.74\%). Specialties accounting for the greatest numbers of screen views were hematology-oncology (99,390 views), hematology (47,808 views), emergency medicine (23,121 views), and internal medicine (22,586 views). The most common diagnostic endpoints reached were disseminated intravascular coagulation (DIC; 2713 times), liver disease effect (2108 times), and vitamin K deficiency (1584 times). Of 3424 users asked to take the survey, 262 responded (7.65\%); most were physicians in direct clinical care (71\%) and specialized in hematology-oncology (39\%) or emergency medicine (21\%). Most frequent use was reported by hematologists (69\%, ?6 times) and hematologists-oncologists (38\%, ?6 times). Most physicians (89.2\%) reported using the app for patient-case-related education around appropriate use of laboratory tests in diagnostic evaluation. Physicians rated Lab Value Analyzer (mean 4.43) and Lab Test Algorithm (mean 4.46) tools highly on a 5-point ``how helpful'' scale and were likely to recommend the app to colleagues. Conclusions: App use among physicians and other HCPs is consistent with value as a POC educational tool, which may facilitate differential diagnoses and appropriate early consultation with hematologists. ", doi="10.2196/mededu.6858", url="http://mededu.jmir.org/2017/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28420603" } @Article{info:doi/10.2196/jmir.6052, author="Christ, Hildegard and Franklin, Jeremy and Griebenow, Reinhard and Baethge, Christopher", title="An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers", journal="J Med Internet Res", year="2017", month="Apr", day="03", volume="19", number="4", pages="e49", keywords="education", keywords="medical", keywords="continuing interactive tutorial", keywords="journal article", abstract="Background: Physicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches {\"A}rzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians. Objective: The aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants. Methods: Using obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association. Results: A total of 128,398 physicians and therapists (male: 54.64\%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33\% (44,064/357,252) and 16.15\% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53\%, 1,041,931/2,339,802) as well as over the weekend (28.70\%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25\%, 23,434/128,392), general medicine (16.38\%, 21,033/128,392), anesthesiology (10.00\%, 12,840/128,392), and surgery (7.06\%, 9059/128,392). Participants rated the CME articles as intelligible to a wider medical audience and filling clinically relevant knowledge gaps; 78.57\% (1,838,358/2,339,781) of the sample gave the CME articles very good or good marks. Cluster analysis revealed three groups, one comprised of only women, with two-thirds working in private practice. Conclusions: The CME article series of Deutsches {\"A}rzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for physicians in private practice and those who want to participate from their homes and on weekends. Although many physicians emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts professional performance and patient outcomes. ", doi="10.2196/jmir.6052", url="http://www.jmir.org/2017/4/e49/", url="http://www.ncbi.nlm.nih.gov/pubmed/28373156" } @Article{info:doi/10.2196/jmir.6971, author="Bond, Evan Stuart and Crowther, P. Shelley and Adhikari, Suman and Chubaty, J. Adriana and Yu, Ping and Borchard, P. Jay and Boutlis, Steven Craig and Yeo, Winston Wilfred and Miyakis, Spiros", title="Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin", journal="J Med Internet Res", year="2017", month="Mar", day="30", volume="19", number="3", pages="e93", keywords="nursing education", keywords="pharmacy education", keywords="medical education", keywords="continuing education", keywords="vancomycin", keywords="survey methods", keywords="anti-bacterial agents", abstract="Background: Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context. Objectives: The study aimed to (1) determine health professionals' experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area. Methods: We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals' knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected. Results: From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0\%, 433/577) and rate of administration (64.9\%, 375/577) were answered most correctly, followed by timing of first level (49\%, 283/577), maintenance dose (41.9\%, 242/577), and loading dose (38.0\%, 219/577). Self-reported ``very'' and ``reasonably'' experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65\% for nurses (n=63), 68\% for doctors (n=86), and 82\% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2\% correct on first attempt; 64/163), timing of first trough level (50.3\%, 82/163), and subsequent trough levels (47.9\%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of ``entertaining,'' ``engaging,'' and ``fun'' identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers. Conclusions: A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations. ", doi="10.2196/jmir.6971", url="http://www.jmir.org/2017/3/e93/", url="http://www.ncbi.nlm.nih.gov/pubmed/28360025" } @Article{info:doi/10.2196/mededu.6357, author="Maloney, Stephen and Tunnecliff, Jacqueline and Morgan, Prue and Gaida, James and Keating, Jennifer and Clearihan, Lyn and Sadasivan, Sivalal and Ganesh, Shankar and Mohanty, Patitapaban and Weiner, John and Rivers, George and Ilic, Dragan", title="Continuing Professional Development via Social Media or Conference Attendance: A Cost Analysis", journal="JMIR Med Educ", year="2017", month="Mar", day="30", volume="3", number="1", pages="e5", keywords="social media", keywords="knowledge translation", keywords="continuing medical education", abstract="Background: Professional development is essential in the health disciplines. Knowing the cost and value of educational approaches informs decisions and choices about learning and teaching practices. Objective: The primary aim of this study was to conduct a cost analysis of participation in continuing professional development via social media compared with live conference attendance. Methods: Clinicians interested in musculoskeletal care were invited to participate in the study activities. Quantitative data were obtained from an anonymous electronic questionnaire. Results: Of the 272 individuals invited to contribute data to this study, 150 clinicians predominantly from Australia, United States, United Kingdom, India, and Malaysia completed the outcome measures. Half of the respondents (78/150, 52.0\%) believed that they would learn more with the live conference format. The median perceived participation costs for the live conference format was Aus \$1596 (interquartile range, IQR 172.50-2852.00). The perceived cost of participation for equivalent content delivered via social media was Aus \$15 (IQR 0.00-58.50). The majority of the clinicians (114/146, 78.1\%, missing data n=4) indicated that they would pay for a subscription-based service, delivered by social media, to the median value of Aus \$59.50. Conclusions: Social media platforms are evolving into an acceptable and financially sustainable medium for the continued professional development of health professionals. When factoring in the reduced costs of participation and the reduced loss of employable hours from the perspective of the health service, professional development via social media has unique strengths that challenge the traditional live conference delivery format. ", doi="10.2196/mededu.6357", url="http://mededu.jmir.org/2017/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/28360023" } @Article{info:doi/10.2196/mededu.6415, author="Badran, Hani and Pluye, Pierre and Grad, Roland", title="When Educational Material Is Delivered: A Mixed Methods Content Validation Study of the Information Assessment Method", journal="JMIR Med Educ", year="2017", month="Mar", day="14", volume="3", number="1", pages="e4", keywords="validity and reliability", keywords="continuing education", keywords="Internet", keywords="electronic mail", keywords="physicians, family", keywords="knowledge translation", keywords="primary health care", abstract="Background: The Information Assessment Method (IAM) allows clinicians to report the cognitive impact, clinical relevance, intention to use, and expected patient health benefits associated with clinical information received by email. More than 15,000 Canadian physicians and pharmacists use the IAM in continuing education programs. In addition, information providers can use IAM ratings and feedback comments from clinicians to improve their products. Objective: Our general objective was to validate the IAM questionnaire for the delivery of educational material (ecological and logical content validity). Our specific objectives were to measure the relevance and evaluate the representativeness of IAM items for assessing information received by email. Methods: A 3-part mixed methods study was conducted (convergent design). In part 1 (quantitative longitudinal study), the relevance of IAM items was measured. Participants were 5596 physician members of the Canadian Medical Association who used the IAM. A total of 234,196 ratings were collected in 2012. The relevance of IAM items with respect to their main construct was calculated using descriptive statistics (relevance ratio R). In part 2 (qualitative descriptive study), the representativeness of IAM items was evaluated. A total of 15 family physicians completed semistructured face-to-face interviews. For each construct, we evaluated the representativeness of IAM items using a deductive-inductive thematic qualitative data analysis. In part 3 (mixing quantitative and qualitative parts), results from quantitative and qualitative analyses were reviewed, juxtaposed in a table, discussed with experts, and integrated. Thus, our final results are derived from the views of users (ecological content validation) and experts (logical content validation). Results: Of the 23 IAM items, 21 were validated for content, while 2 were removed. In part 1 (quantitative results), 21 items were deemed relevant, while 2 items were deemed not relevant (R=4.86\% [N=234,196] and R=3.04\% [n=45,394], respectively). In part 2 (qualitative results), 22 items were deemed representative, while 1 item was not representative. In part 3 (mixing quantitative and qualitative results), the content validity of 21 items was confirmed, and the 2 nonrelevant items were excluded. A fully validated version was generated (IAM-v2014). Conclusions: This study produced a content validated IAM questionnaire that is used by clinicians and information providers to assess the clinical information delivered in continuing education programs. ", doi="10.2196/mededu.6415", url="http://mededu.jmir.org/2017/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28292738" } @Article{info:doi/10.2196/jmir.6948, author="Wlodarczyk, Dorota and Chyli?ska, Joanna and Lazarewicz, Magdalena and Rzadkiewicz, Marta and Jaworski, Mariusz and Adamus, Miroslawa and Haugan, G{\o}rill and Lillefjell, Monica and Espnes, Arild Geir", title="Enhancing Doctors' Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study", journal="J Med Internet Res", year="2017", month="Feb", day="22", volume="19", number="2", pages="e45", keywords="health services for the aged", keywords="active aging", keywords="e-learning", keywords="general practioners", keywords="professional competence", keywords="psychosocial competencies", keywords="health communication", keywords="seniors' expectations", keywords="seniors' attitude toward treatment and health", abstract="Background: Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. Objective: Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. Methods: The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7\%) and 503 GPs (response rate 503/996, 50.5\%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1\%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. Results: GPs participating in e-learning demonstrated a significant rise in their perception of older patients' expectations for disease explanation (Wald $\chi$2=19.7, P<.001) and in perception of motivational aspect of older patients' attitude toward treatment and health (Wald $\chi$2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald $\chi$2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility's organizational structure. Conclusions: Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors' reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients' proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients. ", doi="10.2196/jmir.6948", url="http://www.jmir.org/2017/2/e45/", url="http://www.ncbi.nlm.nih.gov/pubmed/28228370" } @Article{info:doi/10.2196/mededu.7042, author="Blok, C. Amanda and May, N. Christine and Sadasivam, S. Rajani and Houston, K. Thomas", title="Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations", journal="JMIR Med Educ", year="2017", month="Feb", day="15", volume="3", number="1", pages="e3", keywords="virtual patients", keywords="interdisciplinary health teams", keywords="clinical staff engagement", keywords="environment design", keywords="health promotion", keywords="tobacco use cessation", abstract="Background: Engaging health care staff in new quality improvement programs is challenging. Objective: We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. Methods: Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). Results: A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0\%), nurse professionals (19/146, 13.0\%), primary care technicians (5/146, 3.4\%), managerial staff (67/146, 45.9\%), and receptionists (20/146, 13.7\%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high-performing practices that referred 20 or more smokers to the ePortal (13/76), the majority of clinic staff were motivated by or liked the virtual patient (20/26, 77\%). Conclusions: Medical providers are more likely motivated by VPs that are similar to their patient population, while nurses and other staff may prefer avatars that are more similar to them. ", doi="10.2196/mededu.7042", url="http://mededu.jmir.org/2017/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28202429" } @Article{info:doi/10.2196/mededu.5993, author="Dawkins, Rachel and King, D. William and Boateng, Beatrice and Nichols, Michele and Desselle, C. Bonnie", title="Pediatric Residents' Perceptions of Potential Professionalism Violations on Social Media: A US National Survey", journal="JMIR Med Educ", year="2017", month="Jan", day="31", volume="3", number="1", pages="e2", keywords="social media", keywords="professionalism", keywords="resident education", keywords="pediatrics", keywords="graduate medical education", abstract="Background: The ubiquitous use of social media by physicians poses professionalism challenges. Regulatory bodies have disseminated guidelines related to physicians' use of social media. Objective: This study had 2 objectives: (1) to understand what pediatric residents view as appropriate social media postings, and (2) to recognize the degree to which these residents are exposed to postings that violate social media professionalism guidelines. Methods: We distributed an electronic survey to pediatric residents across the United States. The survey consisted of 5 postings from a hypothetical resident's personal Facebook page. The vignettes highlighted common scenarios that challenge published social media professionalism guidelines. We asked 2 questions for each vignette regarding (1) the resident's opinion of the posting's appropriateness, and (2) their frequency of viewing similar posts. We also elicited demographic data (age, sex, postgraduate year level), frequency of Facebook use, awareness of their institutional policies, and prior social media training. Results: Of 1628 respondents, 1498 (92.01\%) of the pediatric residents acknowledged having a Facebook account, of whom 888/1628 (54.55\%) reported daily use and 346/1628 (21.25\%) reported using Facebook a few times a week. Residents frequently viewed posts that violated professionalism standards, including use of derogatory remarks about patients (1756/3256, 53.93\%) and, much less frequently, about attending physicians (114/1628, 7.00\%). The majority of the residents properly identified these postings as inappropriate. Residents had frequently viewed a post similar to one showing physicians drinking alcoholic beverages while in professional attire or scrubs and were neutral on this post's appropriateness. Residents also reported a lack of knowledge about institutional policies on social media (651/1628, or 40.00\%, were unaware of a policy; 204/1628, or 12.53\%, said that no policy existed). A total of 372/1628 respondents (22.85\%) stated that they had never received any structured training on social media professionalism. Conclusions: Today's residents, like others of their generation, use social media sites to converse with peers without considering the implications for the profession. The frequent use of social media by learners needs to change the emphasis educators and regulatory bodies place on social media guidelines and teaching professionalism in the digital age. ", doi="10.2196/mededu.5993", url="http://mededu.jmir.org/2017/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/28143804" } @Article{info:doi/10.2196/mededu.6442, author="Dion, Maxime and Diouf, Thiab Ndeye and Robitaille, Hubert and Turcotte, St{\'e}phane and Adekpedjou, Rh{\'e}da and Labrecque, Michel and Cauchon, Michel and L{\'e}gar{\'e}, France", title="Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial", journal="JMIR Med Educ", year="2016", month="Dec", day="19", volume="2", number="2", pages="e17", keywords="decision making", keywords="patient participation", keywords="education, medical, graduate", keywords="educational measurement", keywords="program evaluation", keywords="computer-assisted instruction", abstract="Background: DECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Universit{\'e} Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation. Objective: The objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition. Methods: We identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents' participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores. Results: The tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8\%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2\%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents' scores and therefore could tell us little about its effect on increasing their knowledge. Conclusion: Residents' use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved. ", doi="10.2196/mededu.6442", url="http://mededu.jmir.org/2016/2/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/27993760" } @Article{info:doi/10.2196/mededu.6288, author="De Angelis, Gino and Davies, Barbara and King, Judy and McEwan, Jessica and Cavallo, Sabrina and Loew, Laurianne and Wells, A. George and Brosseau, Lucie", title="Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review", journal="JMIR Med Educ", year="2016", month="Nov", day="30", volume="2", number="2", pages="e16", keywords="health information technologies", keywords="electronic mail", keywords="email", keywords="Web 2.0", keywords="practice guidelines", keywords="health professions", keywords="information dissemination", abstract="Background: The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. Objective: The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. Methods: We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). Results: Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. Conclusions: The findings suggest that health professionals' perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines. ", doi="10.2196/mededu.6288", url="http://mededu.jmir.org/2016/2/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/27903488" } @Article{info:doi/10.2196/mededu.5318, author="Barnett, Stephen and Jones, C. Sandra and Bennett, Sue and Iverson, Don and Robinson, Laura", title="A Virtual Community of Practice for General Practice Training: A Preimplementation Survey", journal="JMIR Med Educ", year="2016", month="Aug", day="18", volume="2", number="2", pages="e13", keywords="medical informatics", keywords="e-learning", keywords="virtual communities of practice", abstract="Background: Professional isolation is an important factor in low rural health workforce retention. Objective: The aim of this study was to gain insights to inform the development of an implementation plan for a virtual community of practice (VCoP) for general practice (GP) training in regional Australia. The study also aimed to assess the applicability of the findings of an existing framework in developing this plan. This included ascertaining the main drivers of usage, or usefulness, of the VCoP for users and establishing the different priorities between user groups. Methods: A survey study, based on the seven-step health VCoP framework, was conducted with general practice supervisors and registrars---133 usable responses; 40\% estimated response rate. Data was analyzed using the t test and the chi-square test for comparisons between groups. Factor analysis and generalized linear regression modeling were used to ascertain factors which may independently predict intention to use the VCoP. Results: In establishing a VCoP, facilitation was seen as important. Regarding stakeholders, the GP training provider was an important sponsor. Factor analysis showed a single goal of usefulness. Registrars had a higher intention to use the VCoP (P<.001) and to perceive it as useful (P<.001) than supervisors. Usefulness independently predicted intention to actively use the VCoP (P<.001). Regarding engagement of a broad church of users, registrars were more likely than supervisors to want allied health professional and specialist involvement (P<.001). A supportive environment was deemed important, but most important was the quality of the content. Participants wanted regular feedback about site activity. Regarding technology and community, training can be online, but trust is better built face-to-face. Supervisors were significantly more likely than registrars to perceive that registrars needed help with knowledge (P=.01) and implementation of knowledge (P<.001). Conclusions: Important factors for a GP training VCoP include the following: facilitation covering administration and expertise, the perceived usefulness of the community, focusing usefulness around knowledge sharing, and overcoming professional isolation with high-quality content. Knowledge needs of different users should be acknowledged and help can be provided online, but trust is better built face-to-face. In conclusion, the findings of the health framework for VCoPs are relevant when developing an implementation plan for a VCoP for GP training. The main driver of success for a GP training VCoP is the perception of its usefulness by participants. Overcoming professional isolation for GP registrars using a VCoP has implications for training and retention of health workers in rural areas. ", doi="10.2196/mededu.5318", url="http://mededu.jmir.org/2016/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731864" } @Article{info:doi/10.2196/jmir.3284, author="Selby, Peter and Goncharenko, Karina and Barker, Megan and Fahim, Myra and Timothy, Valerie and Dragonetti, Rosa and Kemper, Katherine and Herie, Marilyn and Hays, Taylor J.", title="Review and Evaluation of Online Tobacco Dependence Treatment Training Programs for Health Care Practitioners", journal="J Med Internet Res", year="2015", month="Apr", day="17", volume="17", number="4", pages="e97", keywords="distance education", keywords="tobacco use", keywords="health care", keywords="smoking cessation", keywords="tobacco dependence", keywords="program evaluation", keywords="continuing medical education", abstract="Background: Training health care professionals is associated with increased capacity to deliver evidence-based smoking cessation interventions and increased quit rates among their patients. Online training programs hold promise to provide training but questions remain regarding the quality and usability of available programs. Objective: The aim was to assess the quality of English-language online courses in tobacco dependence treatment using a validated instrument. Methods: An environmental scan was conducted using the Google search engine to identify available online tobacco dependence treatment courses. The identified courses were then evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. It also has clear and concise criteria descriptions to ensure uniformity of evaluations by trained experts. Results: A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor's role, and assessment and evaluation. Evaluation results and suggestions for improvement were shared with course administrators. Conclusions: Based on the courses evaluated in this review, course developers are encouraged to employ best practices in instructional design, such as cohesiveness of material, linearity of design, practice exercises, problem solving, and ongoing evaluation to improve existing courses and in the design of new online learning opportunities. ", doi="10.2196/jmir.3284", url="http://www.jmir.org/2015/4/e97/", url="http://www.ncbi.nlm.nih.gov/pubmed/25887187" } @Article{info:doi/10.2196/jmir.3773, author="Badran, Hani and Pluye, Pierre and Grad, Roland", title="Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint", journal="J Med Internet Res", year="2015", month="Feb", day="27", volume="17", number="2", pages="e49", keywords="theory of planned behavior", keywords="continuing medical education", keywords="educational email alerts", keywords="electronic knowledge resources", keywords="family physicians", keywords="health informatics", keywords="knowledge translation", keywords="primary health care", abstract="Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians' knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants' suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the ``Knowledge, Attitude, Behavior'' model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results: All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. ", doi="10.2196/jmir.3773", url="http://www.jmir.org/2015/2/e49/", url="http://www.ncbi.nlm.nih.gov/pubmed/25803184" }