@Article{info:doi/10.2196/58375, author="Madrid, Julian and Diehl, Philipp and Selig, Mischa and Rolauffs, Bernd and Hans, Patricius Felix and Busch, Hans-J{\"o}rg and Scheef, Tobias and Benning, Leo", title="Performance of Plug-In Augmented ChatGPT and Its Ability to Quantify Uncertainty: Simulation Study on the German Medical Board Examination", journal="JMIR Med Educ", year="2025", month="Mar", day="21", volume="11", pages="e58375", keywords="medical education", keywords="artificial intelligence", keywords="generative AI", keywords="large language model", keywords="LLM", keywords="ChatGPT", keywords="GPT-4", keywords="board licensing examination", keywords="professional education", keywords="examination", keywords="student", keywords="experimental", keywords="bootstrapping", keywords="confidence interval", abstract="Background: The GPT-4 is a large language model (LLM) trained and fine-tuned on an extensive dataset. After the public release of its predecessor in November 2022, the use of LLMs has seen a significant spike in interest, and a multitude of potential use cases have been proposed. In parallel, however, important limitations have been outlined. Particularly, current LLMs encounter limitations, especially in symbolic representation and accessing contemporary data. The recent version of GPT-4, alongside newly released plugin features, has been introduced to mitigate some of these limitations. Objective: Before this background, this work aims to investigate the performance of GPT-3.5, GPT-4, GPT-4 with plugins, and GPT-4 with plugins using pretranslated English text on the German medical board examination. Recognizing the critical importance of quantifying uncertainty for LLM applications in medicine, we furthermore assess this ability and develop a new metric termed ``confidence accuracy'' to evaluate it. Methods: We used GPT-3.5, GPT-4, GPT-4 with plugins, and GPT-4 with plugins and translation to answer questions from the German medical board examination. Additionally, we conducted an analysis to assess how the models justify their answers, the accuracy of their responses, and the error structure of their answers. Bootstrapping and CIs were used to evaluate the statistical significance of our findings. Results: This study demonstrated that available GPT models, as LLM examples, exceeded the minimum competency threshold established by the German medical board for medical students to obtain board certification to practice medicine. Moreover, the models could assess the uncertainty in their responses, albeit exhibiting overconfidence. Additionally, this work unraveled certain justification and reasoning structures that emerge when GPT generates answers. Conclusions: The high performance of GPTs in answering medical questions positions it well for applications in academia and, potentially, clinical practice. Its capability to quantify uncertainty in answers suggests it could be a valuable artificial intelligence agent within the clinical decision-making loop. Nevertheless, significant challenges must be addressed before artificial intelligence agents can be robustly and safely implemented in the medical domain. ", doi="10.2196/58375", url="https://mededu.jmir.org/2025/1/e58375" } @Article{info:doi/10.2196/59210, author="Monzon, Noahlana and Hays, Alan Franklin", title="Leveraging Generative Artificial Intelligence to Improve Motivation and Retrieval in Higher Education Learners", journal="JMIR Med Educ", year="2025", month="Mar", day="11", volume="11", pages="e59210", keywords="educational technology", keywords="retrieval practice", keywords="flipped classroom", keywords="cognitive engagement", keywords="personalized learning", keywords="generative artificial intelligence", keywords="higher education", keywords="university education", keywords="learners", keywords="instructors", keywords="curriculum structure", keywords="learning", keywords="technologies", keywords="innovation", keywords="academic misconduct", keywords="gamification", keywords="self-directed", keywords="socio-economic disparities", keywords="interactive approach", keywords="medical education", keywords="chatGPT", keywords="machine learning", keywords="AI", keywords="large language models", doi="10.2196/59210", url="https://mededu.jmir.org/2025/1/e59210" } @Article{info:doi/10.2196/60255, author="Nykiel-Bailey, Sydney and Burrows, Kathryn and Szafarowicz, E. Bianca and Moquin, Rachel", title="Faculty Perceptions on the Roles of Mentoring, Advising, and Coaching in an Anesthesiology Residency Program: Mixed Methods Study", journal="JMIR Med Educ", year="2025", month="Jan", day="21", volume="11", pages="e60255", keywords="coaching", keywords="faculty perceptions", keywords="mentoring", keywords="perception", keywords="medical education", keywords="anesthesia", keywords="modality", keywords="support", keywords="Washington University", keywords="university", keywords="coaching skills", keywords="training", keywords="culture change", keywords="culture", keywords="flexibility", keywords="systematic framework", abstract="Background: Mentoring, advising, and coaching are essential components of resident education and professional development. Despite their importance, there is limited literature exploring how anesthesiology faculty perceive these practices and their role in supporting residents. Objective: This study aims to investigate anesthesiology faculty perspectives on the significance, implantation strategies, and challenges associated with mentorship, advising, and coaching in resident education. Methods: A comprehensive survey was administrated to 93 anesthesiology faculty members at Washington University School of Medicine. The survey incorporated quantitative Likert-scale questions and qualitative short-answer responses to assess faculty perceptions of the value, preferred formats, essential skills, and capacity for fulfilling multiple roles in these support practices. Additional areas of focus included the impact of staffing shortages, training requirements, and the potential of these practices to enhance faculty recruitment and retention. Results: The response rate was 44\% (n=41). Mentoring was identified as the most important aspect, with 88\% (n=36) of faculty respondents indicating its significance, followed by coaching, which was highlighted by 78\% (n=32) of respondents. The majority felt 1 faculty member can effectively hold multiple roles for a given trainee. The respondents desired additional training for roles and found roles to be rewarding. All roles were seen as facilitating recruitment and retention. Barriers included faculty burnout; confusion between roles; time constraints; and desire for specialized training, especially in coaching skills. Conclusions: Implementing structured mentoring, advising, and coaching can profoundly impact resident education but requires role clarity, protected time, culture change, leadership buy-in, and faculty development. Targeted training and operational investments could enable programs to actualize immense benefits from high-quality resident support modalities. Respondents emphasized that resident needs evolve over time, necessitating flexibility in appropriate faculty guidance. While coaching demands unique skills, advising hinges on expertise and mentoring depends on relationship-building. Systematic frameworks of coaching, mentoring, and advising programs could unlock immense potential. However, realizing this vision demands surmounting barriers such as burnout, productivity pressures, confusion about logistics, and culture change. Ultimately, prioritizing resident support through high-quality personalized guidance can recenter graduate medical education. ", doi="10.2196/60255", url="https://mededu.jmir.org/2025/1/e60255" } @Article{info:doi/10.2196/56850, author="Wang, Ying-Mei and Shen, Hung-Wei and Chen, Tzeng-Ji and Chiang, Shu-Chiung and Lin, Ting-Guan", title="Performance of ChatGPT-3.5 and ChatGPT-4 in the Taiwan National Pharmacist Licensing Examination: Comparative Evaluation Study", journal="JMIR Med Educ", year="2025", month="Jan", day="17", volume="11", pages="e56850", keywords="artificial intelligence", keywords="ChatGPT", keywords="chat generative pre-trained transformer", keywords="GPT-4", keywords="medical education", keywords="educational measurement", keywords="pharmacy licensure", keywords="Taiwan", keywords="Taiwan national pharmacist licensing examination", keywords="learning model", keywords="AI", keywords="Chatbot", keywords="pharmacist", keywords="evaluation and comparison study", keywords="pharmacy", keywords="statistical analyses", keywords="medical databases", keywords="medical decision-making", keywords="generative AI", keywords="machine learning", abstract="Background: OpenAI released versions ChatGPT-3.5 and GPT-4 between 2022 and 2023. GPT-3.5 has demonstrated proficiency in various examinations, particularly the United States Medical Licensing Examination. However, GPT-4 has more advanced capabilities. Objective: This study aims to examine the efficacy of GPT-3.5 and GPT-4 within the Taiwan National Pharmacist Licensing Examination and to ascertain their utility and potential application in clinical pharmacy and education. Methods: The pharmacist examination in Taiwan consists of 2 stages: basic subjects and clinical subjects. In this study, exam questions were manually fed into the GPT-3.5 and GPT-4 models, and their responses were recorded; graphic-based questions were excluded. This study encompassed three steps: (1) determining the answering accuracy of GPT-3.5 and GPT-4, (2) categorizing question types and observing differences in model performance across these categories, and (3) comparing model performance on calculation and situational questions. Microsoft Excel and R software were used for statistical analyses. Results: GPT-4 achieved an accuracy rate of 72.9\%, overshadowing GPT-3.5, which achieved 59.1\% (P<.001). In the basic subjects category, GPT-4 significantly outperformed GPT-3.5 (73.4\% vs 53.2\%; P<.001). However, in clinical subjects, only minor differences in accuracy were observed. Specifically, GPT-4 outperformed GPT-3.5 in the calculation and situational questions. Conclusions: This study demonstrates that GPT-4 outperforms GPT-3.5 in the Taiwan National Pharmacist Licensing Examination, particularly in basic subjects. While GPT-4 shows potential for use in clinical practice and pharmacy education, its limitations warrant caution. Future research should focus on refining prompts, improving model stability, integrating medical databases, and designing questions that better assess student competence and minimize guessing. ", doi="10.2196/56850", url="https://mededu.jmir.org/2025/1/e56850" } @Article{info:doi/10.2196/50060, author="Ramos-Garc{\'i}a, Vanesa and Rivero-Santana, Amado and Pe{\~n}ate-Castro, Wenceslao and {\'A}lvarez-P{\'e}rez, Yolanda and Duarte-D{\'i}az, Andrea and Torres-Casta{\~n}o, Alezandra and Trujillo-Mart{\'i}n, Mar Mar{\'i}a del and Gonz{\'a}lez-Gonz{\'a}lez, Isabel Ana and Serrano-Aguilar, Pedro and Perestelo-P{\'e}rez, Lilisbeth", title="A Brief Web-Based Person-Centered Care Group Training Program for the Management of Generalized Anxiety Disorder: Feasibility Randomized Controlled Trial in Spain", journal="JMIR Med Educ", year="2025", month="Jan", day="16", volume="11", pages="e50060", keywords="person-centered care", keywords="primary care", keywords="shared decision-making", keywords="anxiety disorder", keywords="training program", keywords="SDM", abstract="Background: Shared decision-making (SDM) is a crucial aspect of patient-centered care. While several SDM training programs for health care professionals have been developed, evaluation of their effectiveness is scarce, especially in mental health disorders such as generalized anxiety disorder. Objective: This study aims to assess the feasibility and impact of a brief training program on the attitudes toward SDM among primary care professionals who attend to patients with generalized anxiety disorder. Methods: A feasibility randomized controlled trial was conducted. Health care professionals recruited in primary care centers were randomized to an intervention group (training program) or a control group (waiting list). The intervention consisted of 2 web-based sessions applied by 2 psychologists (VR and YA), based on the integrated elements of the patient-centered care model and including group dynamics and video viewing. The outcome variable was the Leeds Attitudes Towards Concordance scale, second version (LATCon II), assessed at baseline and after the second session (3 months). After the randomized controlled trial phase, the control group also received the intervention and was assessed again. Results: Among 28 randomized participants, 5 withdrew before the baseline assessment. The intervention significantly increased their scores compared with the control group in the total scale (b=0.57; P=.018) and 2 subscales: communication or empathy (b=0.74; P=.036) and shared control (ie, patient participation in decisions: b=0.68; P=.040). The control group also showed significant pre-post changes after receiving the intervention. Conclusions: For a future effectiveness trial, it is necessary to improve the recruitment and retention strategies. The program produced a significant improvement in participants' attitude toward the SDM model, but due to this study's limitations, mainly the small sample size, more research is warranted. ", doi="10.2196/50060", url="https://mededu.jmir.org/2025/1/e50060" } @Article{info:doi/10.2196/58037, author="Pei, Tao and Ding, Yinan and Tang, Jinsong and Liao, Yanhui", title="Evaluating the Effectiveness of a Multimodal Psychotherapy Training Program for Medical Students in China: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Jan", day="3", volume="14", pages="e58037", keywords="multimodal teaching", keywords="psychotherapy training", keywords="Chinese medical students", keywords="randomized controlled trial", abstract="Background: Psychotherapy is central to the treatment of mental disorders, highlighting the importance of medical students and residents developing competencies in this area. Chinese medical residents have expressed a strong need for psychotherapy training, yet they are generally dissatisfied with the current offerings. This paper presents the protocol for an evidence-based, well-structured psychotherapy teaching program aimed at medical students and residents. Objective: This study involves a randomized controlled trial of a 2-day multimodal intensive educational intervention designed to evaluate the effectiveness of a new psychotherapy teaching program for medical students and residents in China. The primary outcomes include participants' knowledge and utilization of psychotherapy, training program acceptability, self-reported self-efficacy, and motivation to apply psychotherapy. Methods: This 2-arm randomized controlled trial was conducted at Sir Run Run Shaw Hospital. The study aimed to recruit approximately 160 medical students and residents, with about 80 participants in the intervention group and 80 in the control group. Both groups completed a baseline survey before participation, reporting their psychotherapy knowledge, utilization of psychotherapy, self-efficacy, and self-motivation. The intervention group received a 2-day multimodal intensive educational intervention (supervision-based online teaching), while the waitlist control group did not receive any intervention during this period. Both groups were followed up for 8 weeks, completing the same survey administered at baseline. At the end of the study, the control group received the intervention. The primary outcome measure was the change in trainees' psychotherapy knowledge before and after the intervention training. Secondary outcome measures included changes in the trainees' utilization of psychotherapy, self-reported self-efficacy, and self-reported motivation for psychotherapy. Additionally, training program acceptability was assessed. Analysis of covariance was used to analyze the primary outcomes. Pearson correlations and regression analysis explored factors associated with the knowledge score at baseline. The secondary outcomes, including participants' psychotherapy utilization, confidence, and motivation, were analyzed using the same methods as for knowledge. All tests were 2-tailed, with a significance level set at P<.05. Results: A total of 160 participants were recruited and randomized between January 4 and 12, 2024. Baseline assessments were conducted from January 28 to February 1, 2024. The psychotherapy training program for the intervention group took place on February 3 and 4, 2024. Posttraining assessments were conducted starting April 1, 2024. Due to withdrawals, incomplete surveys, and data loss, we had a total of 113 participants: 57 in the intervention group and 56 in the control group. The amount of data varied across measures. The data analysis was finished in August 2024. Conclusions: This study aims to evaluate the effectiveness of the multimodal psychotherapy training program for medical students in China. If this brief, cognitive behavioral therapy--based psychotherapy skill training proves effective, the potential mental health impact of its nationwide expansion could be significant. Trial Registration: ClinicalTrials.gov NCT06258460; https://clinicaltrials.gov/ct2/show/NCT06258460 International Registered Report Identifier (IRRID): DERR1-10.2196/58037 ", doi="10.2196/58037", url="https://www.researchprotocols.org/2025/1/e58037", url="http://www.ncbi.nlm.nih.gov/pubmed/39752191" } @Article{info:doi/10.2196/60223, author="Tobiaszewska, Ma?gorzata and Koweszko, Tytus and Jurek, Jonasz and Miko?ap, Karolina and Gierus, Jacek and Mikulski, Jantoni and Waszkiewicz, Napoleon", title="Personality Types of Medical Students in Terms of Their Choice of Medical Specialty: Cross-Sectional Study", journal="Interact J Med Res", year="2024", month="Dec", day="31", volume="13", pages="e60223", keywords="personality type", keywords="characteristics", keywords="traits", keywords="psychology", keywords="psychometric", keywords="medical students", keywords="university", keywords="burnout", keywords="gender", keywords="preferences", keywords="professional", keywords="job", keywords="career", keywords="specialty", keywords="survey", keywords="questionnaire", abstract="Background: Research on personality types among doctors reveals its impact on medical specialty choices, suggesting that considering personality in career planning may enhance work satisfaction and reduce burnout risks. Objective: This study, encompassing 2104 medical students, explores how personality types, traits, and gender relate to specialty preferences. Methods: Participants of this study were medical students from various universities in Poland. The study surveyed 2104 participants. Each participant completed a general questionnaire and a NERIS Type Explorer personality test, based on the Myers-Briggs Type Indicator inventory and the ``Big Five'' personality traits concept. The questionnaire was distributed on social media groups for medical students from all Polish universities. An exploratory statistical analysis was performed to find relationships. For each tested relationship a Fisher exact test was conducted and the significance level was P<.05. Each test resulted in a P value and odds ratio (OR) with a CI. To ensure we included undecided students and obtained meaningful data, we allowed participants to select up to three medical specialties from the 77 available in Poland at the time of the study. Results: The findings unveil significant relationships between gender, personality types, traits, and specialty preferences. Women tended to favor Neonatology (OR 9.15, 95\% CI 3.02-45.46), while men leaned toward Orthopedics and traumatology of the locomotor system (OR 7.53, 95\% CI 4.87-11.94). Extroverted, Intuitive, Feeling, Prospecting, and Turbulent students showed a heightened interest in Psychiatry (OR 2.23, 95\% CI 1.64-3.01), whereas Introverted, Observant, Feeling, Judging, and Turbulent types favored Family Medicine (OR 2.98, 95\% CI 2.08-4.24) and Pediatrics (OR 2.13, 95\% CI 1.51-2.99). Conclusions: In conclusion, this research establishes a link between personality and medical specialty selection. Taking into account the significant role of personality traits, it should be considered to integrate them into the process of selecting a medical career or designing a medical curriculum. This approach may allow for the customization of programs to match students' traits, thereby cultivating improved clinical communication skills, fostering interprofessional collaboration and ultimately enhancing treatment outcomes and professional fulfillment among physicians. The main limitation of this study is that it was conducted on medical students, who lack the full knowledge of the work as a specific specialist. A study surveying medical doctors with longer internships across different wards could be conducted to check for any variabilities. Moreover, there are other significant factors that influence one's medical specialty choice. Certainly, this area could be further explored. ", doi="10.2196/60223", url="https://www.i-jmr.org/2024/1/e60223" } @Article{info:doi/10.2196/60767, author="Wang, Y. Ellen and Qian, Daniel and Zhang, Lijin and Li, S-K Brian and Ko, Brian and Khoury, Michael and Renavikar, Meghana and Ganesan, Avani and Caruso, J. Thomas", title="Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study", journal="JMIR Med Educ", year="2024", month="Dec", day="23", volume="10", pages="e60767", keywords="virtual reality", keywords="technology assessment", keywords="graduate medical education trainees", keywords="medical education", keywords="technology adoption", keywords="Technology Acceptance Model", keywords="factor analysis", keywords="VR", keywords="TAM", keywords="United Theory of Acceptance and Use of Technology", keywords="UTAUT", abstract="Background: Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. Objective: The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Methods: Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. Results: In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9\% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. Conclusions: This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model's reliability within specialties in different geographic locations. ", doi="10.2196/60767", url="https://mededu.jmir.org/2024/1/e60767" } @Article{info:doi/10.2196/59927, author="Xie, Yao and Fadahunsi, Philip Kayode and Flynn, Paul and Taylor-Robinson, Simon and Gallagher, Joseph and Cullen, Walter and O'Donoghue, John", title="Barriers and Facilitators of International Health Care Students' Well-Being in Higher Education: Protocol for a Systematic Integrative Review", journal="JMIR Res Protoc", year="2024", month="Dec", day="11", volume="13", pages="e59927", keywords="integrative review", keywords="higher education", keywords="international students", keywords="educational migrants", keywords="barriers", keywords="facilitators", keywords="well-being", keywords="mixed methods synthesis", keywords="health care students", keywords="health care education", abstract="Background: International health care students encounter unique hurdles as they pursue education in foreign countries. These challenges, stemming from adjustment to new cultural environments and stressful academic programs, significantly impact their well-being. Understanding the barriers and facilitators experienced by international health care students is crucial for ensuring their successful integration into academic and professional spheres. Most existing reviews focus on specific populations or disciplines, thus limiting their generalizability. Objective: This systematic integrative review aims to provide a comprehensive understanding of barriers and facilitators of international health care students' well-being in higher education. Methods: The protocol follows the Joanna Briggs Institute's guidance for a mixed methods systematic review. The main information sources will include PubMed, Scopus, Web of Science, and EBSCOhost, supplemented with manual reference search and citation tracking using Google Scholar. The study selection will be done independently by 2 reviewers based on predetermined eligibility criteria. The study population will consist of international higher education students enrolled in human health--related disciplines including medicine, pharmacy, nursing, and allied health care fields. Qualitative and quantitative data relating to barriers and facilitators of international health care students' well-being will be extracted using a customized data extraction template in Covidence review management software. Quantitative data will be ``qualitized'' and integrated with qualitative data using a convergent integrated approach, as described in the Joanna Briggs Institute's guidance. The integrated data will then be synthesized using a thematic analysis approach to provide a comprehensive understanding of barriers and facilitators of international health care students' well-being. Results: The initial literature search yielded 2408 papers from the selected databases. The findings of this review will be presented in a narrative format, supported by visualizations such as tables and diagrams. The review is expected to be completed by December 2024. Conclusions: This systematic integrative review will identify barriers and facilitators of international health care students' well-being in higher education. The findings could inform the development of targeted interventions and support initiatives in higher education institutions globally, with the ultimate goal of enhancing the well-being as well as the academic and professional success of international health care students. Trial Registration: PROSPERO CRD42024372785; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42024372785 International Registered Report Identifier (IRRID): PRR1-10.2196/59927 ", doi="10.2196/59927", url="https://www.researchprotocols.org/2024/1/e59927" } @Article{info:doi/10.2196/52068, author="Yokokawa, Daiki and Shikino, Kiyoshi and Nishizaki, Yuji and Fukui, Sho and Tokuda, Yasuharu", title="Evaluation of a Computer-Based Morphological Analysis Method for Free-Text Responses in the General Medicine In-Training Examination: Algorithm Validation Study", journal="JMIR Med Educ", year="2024", month="Dec", day="5", volume="10", pages="e52068", keywords="General Medicine In-Training Examination", keywords="free-text response", keywords="morphological analysis", keywords="Situation, Background, Assessment, and Recommendation", keywords="video-based question", abstract="Background: The General Medicine In-Training Examination (GM-ITE) tests clinical knowledge in a 2-year postgraduate residency program in Japan. In the academic year 2021, as a domain of medical safety, the GM-ITE included questions regarding the diagnosis from medical history and physical findings through video viewing and the skills in presenting a case. Examinees watched a video or audio recording of a patient examination and provided free-text responses. However, the human cost of scoring free-text answers may limit the implementation of GM-ITE. A simple morphological analysis and word-matching model, thus, can be used to score free-text responses. Objective: This study aimed to compare human versus computer scoring of free-text responses and qualitatively evaluate the discrepancies between human- and machine-generated scores to assess the efficacy of machine scoring. Methods: After obtaining consent for participation in the study, the authors used text data from residents who voluntarily answered the GM-ITE patient reproduction video-based questions involving simulated patients. The GM-ITE used video-based questions to simulate a patient's consultation in the emergency room with a diagnosis of pulmonary embolism following a fracture. Residents provided statements for the case presentation. We obtained human-generated scores by collating the results of 2 independent scorers and machine-generated scores by converting the free-text responses into a word sequence through segmentation and morphological analysis and matching them with a prepared list of correct answers in 2022. Results: Of the 104 responses collected---63 for postgraduate year 1 and 41 for postgraduate year 2---39 cases remained for final analysis after excluding invalid responses. The authors found discrepancies between human and machine scoring in 14 questions (7.2\%); some were due to shortcomings in machine scoring that could be resolved by maintaining a list of correct words and dictionaries, whereas others were due to human error. Conclusions: Machine scoring is comparable to human scoring. It requires a simple program and calibration but can potentially reduce the cost of scoring free-text responses. ", doi="10.2196/52068", url="https://mededu.jmir.org/2024/1/e52068" } @Article{info:doi/10.2196/50664, author="Wang, Difan and Lin, Bingyan and Zhang, Shuangxi and Xu, Wei and Liu, Xinying", title="Effectiveness of an Internet-Based Self-Help Acceptance and Commitment Therapy Program on Medical Students' Mental Well-Being: Follow-Up Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e50664", keywords="internet-delivered self-help acceptance and commitment therapy", keywords="depression", keywords="anxiety", keywords="stress", keywords="psychological inflexibility", keywords="obsessive-compulsive symptoms", keywords="medical students", keywords="iACT 2.0 program", abstract="Background: Psychological distress is a growing problem among medical students worldwide. This highlights the need for psychological interventions to focus on mental health and improve well-being in this population. Objective: This study developed an internet-based, self-help, acceptance and commitment therapy program (iACT 2.0), aiming to examine its effectiveness in reducing depression, anxiety, stress, psychological inflexibility (PI), and obsessive-compulsive symptoms (OCSs) among medical students. Methods: A total of 520 Chinese postgraduate medical students were randomly assigned to either an iACT 2.0 intervention group (n=260; six online lessons, once every 5 days) or a control condition (n=260; without intervention). Participants completed questionnaires including the 21-item Depression Anxiety Stress Scale, the revised Obsessive-Compulsive Inventory, and the Multidimensional Psychological Flexibility Inventory at the preintervention (T1), postintervention (T2), and 1-month follow-up time points (T3). No therapist support was provided during the 1-month iACT 2.0 intervention period. Data were collected via an online platform and analyzed using repeated-measures ANOVA. Results: Participants in the intervention group demonstrated a significant decrease in depression, anxiety, stress, PI, and OCSs compared to the control group after the intervention (F=22.9-672.04, all P<.001). Specifically, the intervention group showed significant reductions in all measured outcomes from the preintervention to postintervention time point and at the 1-month follow-up (all P<.001). In contrast, no significant changes were observed in the control group over the same period (all P>.05). The groups did not differ significantly at baseline (all P>.05). Significant differences were noted at both the postintervention and follow-up time points (all P<.001). Conclusions: This study demonstrated that the newly developed iACT 2.0 was effective in reducing depression, anxiety, stress, PI, and OCSs. Notably, the positive effects of the intervention persisted at the 1-month follow-up. This program can offer a useful addition to existing mental illness treatment and lead to improvements in clinical and psychotherapy planning while simultaneously reducing the burden on traditional counseling and services. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300070725; https://tinyurl.com/2h75wx8n ", doi="10.2196/50664", url="https://www.jmir.org/2024/1/e50664" } @Article{info:doi/10.2196/57451, author="Jin, Kyung Hye and Kim, EunYoung", title="Performance of GPT-3.5 and GPT-4 on the Korean Pharmacist Licensing Examination: Comparison Study", journal="JMIR Med Educ", year="2024", month="Dec", day="4", volume="10", pages="e57451", keywords="GPT-3.5", keywords="GPT-4", keywords="Korean", keywords="Korean Pharmacist Licensing Examination", keywords="KPLE", abstract="Background: ChatGPT, a recently developed artificial intelligence chatbot and a notable large language model, has demonstrated improved performance on medical field examinations. However, there is currently little research on its efficacy in languages other than English or in pharmacy-related examinations. Objective: This study aimed to evaluate the performance of GPT models on the Korean Pharmacist Licensing Examination (KPLE). Methods: We evaluated the percentage of correct answers provided by 2 different versions of ChatGPT (GPT-3.5 and GPT-4) for all multiple-choice single-answer KPLE questions, excluding image-based questions. In total, 320, 317, and 323 questions from the 2021, 2022, and 2023 KPLEs, respectively, were included in the final analysis, which consisted of 4 units: Biopharmacy, Industrial Pharmacy, Clinical and Practical Pharmacy, and Medical Health Legislation. Results: The 3-year average percentage of correct answers was 86.5\% (830/960) for GPT-4 and 60.7\% (583/960) for GPT-3.5. GPT model accuracy was highest in Biopharmacy (GPT-3.5 77/96, 80.2\% in 2022; GPT-4 87/90, 96.7\% in 2021) and lowest in Medical Health Legislation (GPT-3.5 8/20, 40\% in 2022; GPT-4 12/20, 60\% in 2022). Additionally, when comparing the performance of artificial intelligence with that of human participants, pharmacy students outperformed GPT-3.5 but not GPT-4. Conclusions: In the last 3 years, GPT models have performed very close to or exceeded the passing threshold for the KPLE. This study demonstrates the potential of large language models in the pharmacy domain; however, extensive research is needed to evaluate their reliability and ensure their secure application in pharmacy contexts due to several inherent challenges. Addressing these limitations could make GPT models more effective auxiliary tools for pharmacy education. ", doi="10.2196/57451", url="https://mededu.jmir.org/2024/1/e57451" } @Article{info:doi/10.2196/63188, author="Luo, Yuan and Miao, Yiqun and Zhao, Yuhan and Li, Jiawei and Chen, Yuling and Yue, Yuexue and Wu, Ying", title="Comparing the Accuracy of Two Generated Large Language Models in Identifying Health-Related Rumors or Misconceptions and the Applicability in Health Science Popularization: Proof-of-Concept Study", journal="JMIR Form Res", year="2024", month="Dec", day="2", volume="8", pages="e63188", keywords="rumor", keywords="misconception", keywords="health science popularization", keywords="health education", keywords="large language model", keywords="LLM", keywords="applicability", keywords="accuracy", keywords="effectiveness", keywords="health related", keywords="education", keywords="health science", keywords="proof of concept", abstract="Background: Health-related rumors and misconceptions are spreading at an alarming rate, fueled by the rapid development of the internet and the exponential growth of social media platforms. This phenomenon has become a pressing global concern, as the dissemination of false information can have severe consequences, including widespread panic, social instability, and even public health crises. Objective: The aim of the study is to compare the accuracy of rumor identification and the effectiveness of health science popularization between 2 generated large language models in Chinese (GPT-4 by OpenAI and Enhanced Representation through Knowledge Integration Bot [ERNIE Bot] 4.0 by Baidu). Methods: In total, 20 health rumors and misconceptions, along with 10 health truths, were randomly inputted into GPT-4 and ERNIE Bot 4.0. We prompted them to determine whether the statements were rumors or misconceptions and provide explanations for their judgment. Further, we asked them to generate a health science popularization essay. We evaluated the outcomes in terms of accuracy, effectiveness, readability, and applicability. Accuracy was assessed by the rate of correctly identifying health-related rumors, misconceptions, and truths. Effectiveness was determined by the accuracy of the generated explanation, which was assessed collaboratively by 2 research team members with a PhD in nursing. Readability was calculated by the readability formula of Chinese health education materials. Applicability was evaluated by the Chinese Suitability Assessment of Materials. Results: GPT-4 and ERNIE Bot 4.0 correctly identified all health rumors and misconceptions (100\% accuracy rate). For truths, the accuracy rate was 70\% (7/10) and 100\% (10/10), respectively. Both mostly provided widely recognized viewpoints without obvious errors. The average readability score for the health essays was 2.92 (SD 0.85) for GPT-4 and 3.02 (SD 0.84) for ERNIE Bot 4.0 (P=.65). For applicability, except for the content and cultural appropriateness category, significant differences were observed in the total score and scores in other dimensions between them (P<.05). Conclusions: ERNIE Bot 4.0 demonstrated similar accuracy to GPT-4 in identifying Chinese rumors. Both provided widely accepted views, despite some inaccuracies. These insights enhance understanding and correct misunderstandings. For health essays, educators can learn from readable language styles of GLLMs. Finally, ERNIE Bot 4.0 aligns with Chinese expression habits, making it a good choice for a better Chinese reading experience. ", doi="10.2196/63188", url="https://formative.jmir.org/2024/1/e63188" } @Article{info:doi/10.2196/60830, author="Dixon, Eric and Pannu, Jayden and Dhaliwal, Kabir and Cheng, Rachel and Deol, Gurpal and Frangos, Sophie and Tawil, Emma and Oliveira, Ana and Wojkowski, Sarah and Quach, Shirley", title="Effects of Interprofessional Education on Readiness for Interprofessional Learning in Rehabilitation Science Students From Professional Health Care Programs: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="20", volume="13", pages="e60830", keywords="interprofessional education", keywords="rehabilitation science", keywords="health care students", keywords="interprofessional collaboration", keywords="prelicensure health care professionals", keywords="patient care", keywords="interdisciplinary education", keywords="rehabilitation education", keywords="curriculum development", keywords="team-based learning", abstract="Background: The World Health Organization defines interprofessional education (IPE) as a process in which students from different health care programs work together to provide effective care while deepening their knowledge of each other's roles. Previous literature shows a strong argument for early exposure to IPE as a facilitator for high quality patient care. The goal of IPE is to improve interprofessional collaboration (IPC), the ``gold standard'' of care to enhance patients' quality of life, functional ability, and health status, especially for patients who require expertise from a variety of health care professionals. IPC has shown improvements in quality of life, functional ability, and health status. IPE can occur in the form of structured interventions or spontaneously in student placements. Literature has demonstrated that IPE facilitates skill, knowledge development, teamwork, communication skills, and mutual respect among health care professional students. Objective: This systematic review aims to examine IPE outcomes, including readiness for IPC, IPE perceptions, attitudes toward collaborative learning, student confidence, practice efficiency, and team dynamics after IPE interventions in rehabilitation science students. Methods: The study will be conducted as outlined by the Cochrane Handbook for Systematic Reviews and will be reported per the PRISMA (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses) 2015 guidelines. Students have performed literature searches across the databases MEDLINE, Embase, CINAHL, ERIC, Web of Science, and AMED. Studies will be included if their IPE intervention included multiple prelicensure health care professional students in a health care or health care education setting. Based on timelines presented in the Institute of Medicine's report on the impacts of IPE, relevant studies from 2016 to the present will be included. The Risk of Bias 2 tool will be used to study sources of bias. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) working group's methods will be used to evaluate the quality of the evidence presented. The final 3 authors are assisting as supervisors, providing oversight and feedback as needed. Any deviations from this protocol will be reported in the final paper. Results: The search strategy was finalized and searched across the databases by March 8, 2024. The systematic review was registered with PROSPERO on March 31, 2024. A total of 10,692 citations were retrieved for abstract and title screening, beginning in March 2024, and 756 were eligible for full-text screening in April 2024. Six articles were considered for inclusion and data extraction, which began in July 2024. Finalization of the extracted data and paper will occur in September 2024. Conclusions: This systematic review will provide a summary of the effects of IPE interventions in prelicensure rehabilitation science students. It will provide educators, health care providers, and students with valuable information for understanding the relevance of IPE. It will also shed light on research gaps and highlight areas for further study. Trial Registration: PROSPERO CRD42024506081; https://tinyurl.com/3tf2h9er International Registered Report Identifier (IRRID): PRR1-10.2196/60830 ", doi="10.2196/60830", url="https://www.researchprotocols.org/2024/1/e60830" } @Article{info:doi/10.2196/59047, author="Lee, Allison and Goodman, Stephanie and Chen, Miao Chen and Landau, Ruth and Chatterji, Madhabi", title="Electronic Feedback Alone Versus Electronic Feedback Plus in-Person Debriefing for a Serious Game Designed to Teach Novice Anesthesiology Residents to Perform General Anesthesia for Cesarean Delivery: Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Nov", day="19", volume="12", pages="e59047", keywords="general anesthesia", keywords="cesarean delivery", keywords="multiple choice questions", keywords="serious game", keywords="debriefing", keywords="feedback", keywords="anesthesia", keywords="anesthesiology", keywords="anesthesiologist", keywords="anesthetist", keywords="cesarean", keywords="EmergenCSim", keywords="randomized controlled trial", abstract="Background: EmergenCSim is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia for emergent cesarean delivery for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared with using electronic feedback alone. Objective: We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. Methods: Novice first-year anesthesiology residents (CA-1; n=51) (1) watched a recorded lecture on general anesthesia for emergent cesarean delivery, (2) took a 26-item multiple-choice question pretest, and (3) played EmergenCSim (maximum score of 196.5). They were randomized to either the control group that experienced the electronic feedback alone (group EF, n=26) or the intervention group that experienced the SG-embedded electronic feedback and an in-person debriefing (group IPD+EF, n=25). All participants played the SG a second time, with instructions to try to increase their score, and then they took a 26-item multiple-choice question posttest. Pre- and posttests (maximum score of 26 points each) were validated parallel forms. Results: For groups EF and IPD+EF, respectively, mean pretest scores were 18.6 (SD 2.5) and 19.4 (SD 2.3), and mean posttest scores were 22.6 (SD 2.2) and 22.1 (SD 1.6; F1,49=1.8, P=.19). SG scores for groups EF and IPD+EF, respectively, were---mean first play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean second play SG scores of 163.1 (SE 2.9) and 173.3 (SE 2.9; F1,49=137.7, P<.001). Conclusions: Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools. ", doi="10.2196/59047", url="https://games.jmir.org/2024/1/e59047" } @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/10.2196/57760, author="Martinengo, Laura and Ng, Peng Matthew Song and Ng, Rong Tony De and Ang, Yi-Ian and Jabir, Ishqi Ahmad and Kyaw, Myint Bhone and Tudor Car, Lorainne", title="Spaced Digital Education for Health Professionals: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Oct", day="10", volume="26", pages="e57760", keywords="digital education", keywords="e-learning", keywords="spaced education", keywords="spaced learning", keywords="spaced digital education", keywords="spaced simulation", keywords="health care professionals", keywords="continuous medical education", keywords="systematic review", keywords="meta-analysis", abstract="Background: Spaced digital education applies digital tools to deliver educational content via multiple, repeated learning sessions separated by prespecified time intervals. Spaced digital education appears to promote acquisition and long-term retention of knowledge, skills, and change in clinical behavior. Objective: The aim of this review was to assess the effectiveness of spaced digital education in improving pre- and postregistration health care professionals' knowledge, skills, attitudes, satisfaction, and change in clinical behavior. Methods: This review followed Cochrane's methodology and PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) reporting guidelines. We searched MEDLINE, Embase, Web of Science, ERIC, PsycINFO, CINAHL, CENTRAL, and ProQuest Dissertation and Theses databases from January 1990 to February 2023. We included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs comparing spaced digital education with nonspaced education, spaced nondigital education, traditional learning, or no intervention for pre- or postregistration health care professionals. Study selection, data extraction, study quality, and certainty of evidence were assessed by 2 independent reviewers. Meta-analyses were conducted using random effect models. Results: We included 23 studies evaluating spaced online education (n=17, 74\%) or spaced digital simulation (n=6, 26\%) interventions. Most studies assessed 1 or 2 outcomes, including knowledge (n=15, 65\%), skills (n=9, 39\%), attitudes (n=8, 35\%), clinical behavior change (n=8, 35\%), and satisfaction (n=7, 30\%). Most studies had an unclear or a high risk of bias (n=19, 83\%). Spaced online education was superior to massed online education for postintervention knowledge (n=9, 39\%; standardized mean difference [SMD] 0.32, 95\% CI 0.13-0.51, I2=66\%, moderate certainty of evidence). Spaced online education (n=3, 13\%) was superior to massed online education (n=2, 9\%) and no intervention (n=1, 4\%; SMD 0.67, 95\% CI 0.43-0.91, I2=5\%, moderate certainty of evidence) for postintervention clinical behavior change. Spaced digital simulation was superior to massed simulation for postintervention surgical skills (n=2, 9\%; SMD 1.15, 95\% CI 0.34-1.96, I2=74\%, low certainty of evidence). Spaced digital education positively impacted confidence and satisfaction with the intervention. Conclusions: Spaced digital education is effective in improving knowledge, particularly in substantially improving surgical skills and promoting clinical behavior change in pre- and postregistration health care professionals. Our findings support the use of spaced digital education interventions in undergraduate and postgraduate health profession education.Trial Registration: PROSPERO CRD42021241969; Trial Registration: PROSPERO CRD42021241969; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=241969 ", doi="10.2196/57760", url="https://www.jmir.org/2024/1/e57760" } @Article{info:doi/10.2196/59009, author="Khamisy-Farah, Rola and Biras, Eden and Shehadeh, Rabie and Tuma, Ruba and Atwan, Hisham and Siri, Anna and Converti, Manlio and Chirico, Francesco and Szarpak, ?ukasz and Biz, Carlo and Farah, Raymond and Bragazzi, Nicola", title="Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Oct", day="8", volume="10", pages="e59009", keywords="gender medicine", keywords="medical education", keywords="clinical practice", keywords="gender-sensitive care", keywords="gender awareness", keywords="sexuality awareness", keywords="awareness", keywords="medical education and practice", keywords="healthcare", keywords="patient outcomes", keywords="patient", keywords="patients", keywords="medical professionals", keywords="training", keywords="educational interventions", keywords="status-based", keywords="survey", keywords="effectiveness", keywords="medical workforce", abstract="Background: The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery. Objective: The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel. Methods: This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants' replies. Results: The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions. Conclusions: The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce. ", doi="10.2196/59009", url="https://mededu.jmir.org/2024/1/e59009", url="http://www.ncbi.nlm.nih.gov/pubmed/39152652" } @Article{info:doi/10.2196/53577, author="Wang, Yun and Fu, Junzuo and Wang, Shaoping and Wang, Huijuan and Gao, Wei and Huang, Lina", title="Impact of Video-Based Error Correction Learning for Cardiopulmonary Resuscitation Training: Quasi-Experimental Study", journal="JMIR Serious Games", year="2024", month="Oct", day="3", volume="12", pages="e53577", keywords="video-based error correction", keywords="video-prompting", keywords="cardiopulmonary resuscitation training", keywords="anesthesiology resident", keywords="quasi-experimental study", keywords="anesthesiology", keywords="cardiopulmonary", keywords="cardiopulmonary resuscitation", keywords="training", keywords="video", keywords="learning", keywords="residents", keywords="CPR training", keywords="CPR", keywords="video prompting", abstract="Background: Video-based error correction (VBEC) in medical education could offer immediate feedback, promote enhanced learning retention, and foster reflective practice. However, its application in cardiopulmonary resuscitation (CPR) training has not been investigated. Objective: The objective of this study is to assess whether the VBEC procedure could improve the training performance of CPR among anesthesiology residents. Methods: A quasi-experimental study was conducted among anesthesiology residents between December 2022 and April 2023. Primary outcomes included a posttraining knowledge test and practical assessment scores. Secondary outcomes included the number of residents who correctly conducted CPR at each step, the rate of common mistakes during the CPR process, and the self-assessment results. A total of 80 anesthesiology residents were divided into a VBEC group (n=40) and a control group (n=40). The VBEC group underwent a 15-minute VBEC CPR training, whereas the control group underwent a 15-minute video-prompting CPR training. Results: The posttraining knowledge test score of the VBEC group was significantly higher than that of the control group (73, SD 10.5 vs 65.1, SD 11.4; P=.002). The residents in the VBEC group had lower error rates in ``failure to anticipate the next move'' (n=3, 7.5\% vs n=13, 32.5\%; P=.01) and ``failure to debrief or problem solve after the code'' (n=2, 5\% vs n=11, 27.5\%; P=.01), as well as better performance in the ``secure own safety'' step (n=34, 85\% vs n=18, 45\%; P<.001) than those in the control group. The VBEC group showed significantly higher confidence in CPR than the control group (n=?, 62.5\% vs n=?, 35\%; P=.03). Conclusions: VBEC may be a promising strategy compared to video prompting for CPR training among anesthesiology residents. ", doi="10.2196/53577", url="https://games.jmir.org/2024/1/e53577" } @Article{info:doi/10.2196/54427, author="Lee, Hwa Kye and Lee, Ho Jae and Lee, Yura and Lee, Hyunna and Lee, Sung Ji and Jang, Jeon Hye and Lee, Hee Kun and Han, Hyun Jeong and Jang, SuJung", title="Impact of Health Informatics Analyst Education on Job Role, Career Transition, and Skill Development: Survey Study", journal="JMIR Med Educ", year="2024", month="Sep", day="25", volume="10", pages="e54427", keywords="health informatics", keywords="health informatics training", keywords="informatics training", keywords="professional development", keywords="training program", keywords="digital health technology", keywords="informatics workforce", keywords="informatics competencies", keywords="competencies", keywords="job skills", keywords="continuing education", keywords="data science", abstract="Background: Professionals with expertise in health informatics play a crucial role in the digital health sector. Despite efforts to train experts in this field, the specific impact of such training, especially for individuals from diverse academic backgrounds, remains undetermined. Objective: This study therefore aims to evaluate the effectiveness of an intensive health informatics training program on graduates with respect to their job roles, transitions, and competencies and to provide insights for curriculum design and future research. Methods: A survey was conducted among 206 students who completed the Advanced Health Informatics Analyst program between 2018 and 2022. The questionnaire comprised four categories: (1) general information about the respondent, (2) changes before and after program completion, (3) the impact of the program on professional practice, and (4) continuing education requirements. Results: The study received 161 (78.2\%) responses from the 206 students. Graduates of the program had diverse academic backgrounds and consequently undertook various informatics tasks after their training. Most graduates (117/161, 72.7\%) are now involved in tasks such as data preprocessing, visualizing results for better understanding, and report writing for data processing and analysis. Program participation significantly improved job performance (P=.03), especially for those with a master's degree or higher (odds ratio 2.74, 95\% CI 1.08?6.95) and those from regions other than Seoul or Gyeonggi-do (odds ratio 10.95, 95\% CI 1.08?6.95). A substantial number of respondents indicated that the training had a substantial influence on their career transitions, primarily by providing a better understanding of job roles and generating intrinsic interest in the field. Conclusions: The integrated practical education program was effective in addressing the diverse needs of trainees from various fields, enhancing their capabilities, and preparing them for the evolving industry demands. This study emphasizes the value of providing specialized training in health informatics for graduates regardless of their discipline. ", doi="10.2196/54427", url="https://mededu.jmir.org/2024/1/e54427" } @Article{info:doi/10.2196/57187, author="Byon, Do Ha and Park, Sunbok and Quatrara, A. Beth and Taggart, Jessica and Wheeler, Buford Lindsay", title="Examining the Evidence on the Statistics Prerequisite for Admission to Doctor of Nursing Practice Programs: Retrospective Cohort Study", journal="Asian Pac Isl Nurs J", year="2024", month="Sep", day="9", volume="8", pages="e57187", keywords="Doctor of Nursing Practice", keywords="admission prerequisite", keywords="statistics requirement", keywords="biostatistics", keywords="nursing education", abstract="Background: Doctor of Nursing Practice (DNP) programs in the United States confer the highest practice degree in nursing. The proportion of racial and ethnic minority DNP students, including those of Asian descent, keeps increasing in the United States. Statistics is commonly required for DNP programs. However, there is insufficient evidence regarding the number of years within which statistics should be taken and the minimum grade required for admission to the program. Objective: This study aimed to examine the associations of statistics prerequisite durations and grades for admission with the course performances within the DNP program. We also explored whether a postadmission statistics overview course can prepare students for a DNP statistics course as well as a required statistics prerequisite course. Methods: A retrospective cohort study was conducted with a sample of 31 DNP students at a large university in the Mid-Atlantic region. Statistical analysis of data collected over 5 years, between 2018 and 2022, was performed to examine the associations, using Spearman rank correlation analysis and Mann-Whitney U test (U). Results: The performance of students in a DNP statistics course was not associated with prerequisite duration. There was no significant association between the duration and the DNP statistics course letter grades ($\rho$=0.12; P=.66), neither with exam 1 ($\rho$=0.03; P=.91) nor with exam 2 scores ($\rho$=0.01; P=.97). Prerequisite grades were positively associated with exam 1 grades ($\rho$=0.59; P=.02), but not exam 2 ($\rho$=0.35; P=.19) or course grades ($\rho$=0.40; P=.12). In addition, no difference was found in the performance of students whether meeting the prerequisite requirements or taking a 1-month, self-paced overview course (exam 1: U=159, P=.13; exam 2: U=102, P=.50; course letter grade: U=117, P=.92). Conclusions: No evidence was found to support the need for limits on when prerequisites are completed or grade requirements. Opting for a statistics overview course after admission can serve as a viable alternative to the statistics prerequisite, effectively preparing students for advanced quantitative data analysis in a DNP program. ", doi="10.2196/57187", url="https://apinj.jmir.org/2024/1/e57187", url="http://www.ncbi.nlm.nih.gov/pubmed/39250220" } @Article{info:doi/10.2196/53258, author="Kleib, Manal and Arnaert, Antonia and Nagle, M. Lynn and Sugars, Rebecca and da Costa, Daniel", title="Newly Qualified Canadian Nurses' Experiences With Digital Health in the Workplace: Comparative Qualitative Analysis", journal="JMIR Med Educ", year="2024", month="Aug", day="19", volume="10", pages="e53258", keywords="digital health", keywords="new graduate nurses", keywords="nursing practice", keywords="workplace", keywords="informatics", abstract="Background: Clinical practice settings have increasingly become dependent on the use of digital or eHealth technologies such as electronic health records. It is vitally important to support nurses in adapting to digitalized health care systems; however, little is known about nursing graduates' experiences as they transition to the workplace. Objective: This study aims to (1) describe newly qualified nurses' experiences with digital health in the workplace, and (2) identify strategies that could help support new graduates' transition and practice with digital health. Methods: An exploratory descriptive qualitative design was used. A total of 14 nurses from Eastern and Western Canada participated in semistructured interviews and data were analyzed using inductive content analysis. Results: Three themes were identified: (1) experiences before becoming a registered nurse, (2) experiences upon joining the workplace, and (3) suggestions for bridging the gap in transition to digital health practice. Findings revealed more similarities than differences between participants with respect to gaps in digital health education, technology-related challenges, and their influence on nursing practice. Conclusions: Digital health is the foundation of contemporary health care; therefore, comprehensive education during nursing school and throughout professional nursing practice, as well as organizational support and policy, are critical pillars. Health systems investing in digital health technologies must create supportive work environments for nurses to thrive in technologically rich environments and increase their capacity to deliver the digital health future. ", doi="10.2196/53258", url="https://mededu.jmir.org/2024/1/e53258" } @Article{info:doi/10.2196/58170, author="Kleib, Manal and Arnaert, Antonia and Nagle, M. Lynn and Ali, Shamsa and Idrees, Sobia and Costa, da Daniel and Kennedy, Megan and Darko, Mirekuwaa Elizabeth", title="Digital Health Education and Training for Undergraduate and Graduate Nursing Students: Scoping Review", journal="JMIR Nursing", year="2024", month="Jul", day="17", volume="7", pages="e58170", keywords="curriculum", keywords="digital health", keywords="health informatics", keywords="nursing education", keywords="nursing students", keywords="undergraduate", keywords="graduate", abstract="Background: As technology will continue to play a pivotal role in modern-day health care and given the potential impact on the nursing profession, it is vitally important to examine the types and features of digital health education in nursing so that graduates are better equipped with the necessary knowledge and skills needed to provide safe and quality nursing care and to keep abreast of the rapidly evolving technological revolution. Objective: In this scoping review, we aimed to examine and report on available evidence about digital health education and training interventions for nursing students at the undergraduate and graduate levels. Methods: This scoping review was conducted using the Joanna Briggs Institute methodological framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search strategy was developed and applied to identified bibliographic databases including MEDLINE (Ovid; 1946 to present), Embase (Ovid; 1974 to present), CINAHL (EBSCOhost; 1936 to present), ERIC (EBSCOhost; 1966 to present), Education Research Complete (EBSCOhost; inception to present), and Scopus (1976 to present). The initial search was conducted on March 3, 2022, and updated searches were completed on January 11, 2023, and October 31, 2023. For gray literature sources, the websites of select professional organizations were searched to identify relevant digital health educational programs or courses available to support the health workforce development. Two reviewers screened and undertook the data extraction process. The review included studies focused on the digital health education of students at the undergraduate or graduate levels or both in a nursing program. Studies that discussed instructional strategies, delivery processes, pedagogical theory and frameworks, and evaluation strategies for digital health education; applied quantitative, qualitative, and mixed methods; and were descriptive or discussion papers, with the exception of review studies, were included. Opinion pieces, editorials, and conference proceedings were excluded. Results: A total of 100 records were included in this review. Of these, 94 records were identified from database searches, and 6 sources were identified from the gray literature. Despite improvements, there are significant gaps and limitations in the scope of digital health education at the undergraduate and graduate levels, consequently posing challenges for nursing students to develop competencies needed in modern-day nursing practice. Conclusions: There is an urgent need to expand the understanding of digital health in the context of nursing education and practice and to better articulate its scope in nursing curricula and enforce its application across professional nursing practice roles at all levels and career trajectories. Further research is also needed to examine the impact of digital health education on improving patient outcomes, the quality of nursing care, and professional nursing role advancement. International Registered Report Identifier (IRRID): RR2-10.11124/JBIES-22-00266 ", doi="10.2196/58170", url="https://nursing.jmir.org/2024/1/e58170", url="http://www.ncbi.nlm.nih.gov/pubmed/39018092" } @Article{info:doi/10.2196/52243, author="Nxumalo, Thembelenkosini Celenkosini and Pillay, Pavitra and Mchunu, Gladness Gugu", title="The Durban University of Technology Faculty of Health Sciences Decentralized Clinical Training Project: Protocol for an Implementation Study in KwaZulu-Natal, South Africa", journal="JMIR Res Protoc", year="2024", month="Jun", day="3", volume="13", pages="e52243", keywords="decentralized clinical training programs", keywords="curriculum", keywords="clinical education", keywords="health science education", keywords="university of technology", keywords="pedagogy", keywords="transformative education", keywords="teaching", keywords="higher education", keywords="South Africa", abstract="Background: The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. Objective: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. Methods: Participatory action research comprising various designs---namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design---will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programs---namely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescue---will be part of the project's pilot phase. Findings from the project's pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the university's strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. Results: The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. Conclusions: This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. International Registered Report Identifier (IRRID): PRR1-10.2196/52243 ", doi="10.2196/52243", url="https://www.researchprotocols.org/2024/1/e52243", url="http://www.ncbi.nlm.nih.gov/pubmed/38829695" } @Article{info:doi/10.2196/52207, author="Kataoka, Koshi and Nishizaki, Yuji and Shimizu, Taro and Yamamoto, Yu and Shikino, Kiyoshi and Nojima, Masanori and Nagasaki, Kazuya and Fukui, Sho and Nishiguchi, Sho and Katayama, Kohta and Kurihara, Masaru and Ueda, Rieko and Kobayashi, Hiroyuki and Tokuda, Yasuharu", title="Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study", journal="JMIR Med Educ", year="2024", month="May", day="30", volume="10", pages="e52207", keywords="clinical knowledge support system", keywords="GM-ITE", keywords="postgraduate clinical resident", keywords="in-training examination performance", keywords="exam", keywords="exams", keywords="examination", keywords="examinations", keywords="resident", keywords="residents", keywords="cross-sectional", keywords="national", keywords="nationwide", keywords="postgraduate", keywords="decision support", keywords="point-of-care", keywords="UpToDate", keywords="DynaMed", keywords="knowledge support", keywords="medical education", keywords="performance", keywords="information behavior", keywords="information behaviour", keywords="information seeking", keywords="teaching", keywords="pedagogy", keywords="pedagogical", keywords="log", keywords="logs", keywords="usage", keywords="evidence-based medicine", keywords="EBM", keywords="educational", keywords="decision support system", keywords="clinical decision support", keywords="Japan", keywords="General Medicine In-Training Examination", abstract="Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year--1 and --2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95\% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95\% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes. ", doi="10.2196/52207", url="https://mededu.jmir.org/2024/1/e52207" } @Article{info:doi/10.2196/56005, author="Friche, Pauline and Moulis, Lionel and Du Thanh, Aur{\'e}lie and Dereure, Olivier and Duflos, Claire and Carbonnel, Francois", title="Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study", journal="JMIR Form Res", year="2024", month="May", day="13", volume="8", pages="e56005", keywords="dermoscopy", keywords="dermatoscope", keywords="dermatoscopes", keywords="dermatological", keywords="skin", keywords="training", keywords="GP", keywords="family practitioner", keywords="family practitioners", keywords="family physician", keywords="family physicians", keywords="general practice", keywords="family medicine", keywords="primary health care", keywords="internship and residency", keywords="education", keywords="e-learning", keywords="eLearning", keywords="dermatology", keywords="resident", keywords="residency", keywords="intern", keywords="interns", keywords="internship", keywords="internships", abstract="Background: Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60\% to 90\%, but its use is limited due to lack of training. The characteristics of ``ideal'' dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy. Objective: This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training. Methods: We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-N{\^i}mes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question. Results: In total, 134 residents were included, and 66.4\% (n=89) and 47\% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1\% (n=82) of participants for module 1 and 87.3\% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6\%) with the training course, and 96.3\% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident's initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001). Conclusions: The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors. ", doi="10.2196/56005", url="https://formative.jmir.org/2024/1/e56005", url="http://www.ncbi.nlm.nih.gov/pubmed/38739910" } @Article{info:doi/10.2196/41573, author="Noori, Sofia and Khasnavis, Siddharth and DeCroce-Movson, Eliza and Blay-Tofey, Morkeh and Vitiello, Evan", title="A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study", journal="JMIR Form Res", year="2024", month="May", day="13", volume="8", pages="e41573", keywords="digital psychiatry", keywords="digital mental health", keywords="didactic curriculum", keywords="residency training", keywords="psychiatry residency", keywords="training classes", keywords="trainee response", keywords="residency curriculum", keywords="trainee feedback", abstract="Background: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. Objective: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Methods: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Results: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03),?assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed ``somewhat comfortable'' on any of the above measures. Conclusions: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum. ", doi="10.2196/41573", url="https://formative.jmir.org/2024/1/e41573", url="http://www.ncbi.nlm.nih.gov/pubmed/38739423" } @Article{info:doi/10.2196/55595, author="Wang, Shangqiguo and Mo, Changgeng and Chen, Yuan and Dai, Xiaolu and Wang, Huiyi and Shen, Xiaoli", title="Exploring the Performance of ChatGPT-4 in the Taiwan Audiologist Qualification Examination: Preliminary Observational Study Highlighting the Potential of AI Chatbots in Hearing Care", journal="JMIR Med Educ", year="2024", month="Apr", day="26", volume="10", pages="e55595", keywords="ChatGPT", keywords="medical education", keywords="artificial intelligence", keywords="AI", keywords="audiology", keywords="hearing care", keywords="natural language processing", keywords="large language model", keywords="Taiwan", keywords="hearing", keywords="hearing specialist", keywords="audiologist", keywords="examination", keywords="information accuracy", keywords="educational technology", keywords="healthcare services", keywords="chatbot", keywords="health care services", abstract="Background: Artificial intelligence (AI) chatbots, such as ChatGPT-4, have shown immense potential for application across various aspects of medicine, including medical education, clinical practice, and research. Objective: This study aimed to evaluate the performance of ChatGPT-4 in the 2023 Taiwan Audiologist Qualification Examination, thereby preliminarily exploring the potential utility of AI chatbots in the fields of audiology and hearing care services. Methods: ChatGPT-4 was tasked to provide answers and reasoning for the 2023 Taiwan Audiologist Qualification Examination. The examination encompassed six subjects: (1) basic auditory science, (2) behavioral audiology, (3) electrophysiological audiology, (4) principles and practice of hearing devices, (5) health and rehabilitation of the auditory and balance systems, and (6) auditory and speech communication disorders (including professional ethics). Each subject included 50 multiple-choice questions, with the exception of behavioral audiology, which had 49 questions, amounting to a total of 299 questions. Results: The correct answer rates across the 6 subjects were as follows: 88\% for basic auditory science, 63\% for behavioral audiology, 58\% for electrophysiological audiology, 72\% for principles and practice of hearing devices, 80\% for health and rehabilitation of the auditory and balance systems, and 86\% for auditory and speech communication disorders (including professional ethics). The overall accuracy rate for the 299 questions was 75\%, which surpasses the examination's passing criteria of an average 60\% accuracy rate across all subjects. A comprehensive review of ChatGPT-4's responses indicated that incorrect answers were predominantly due to information errors. Conclusions: ChatGPT-4 demonstrated a robust performance in the Taiwan Audiologist Qualification Examination, showcasing effective logical reasoning skills. Our results suggest that with enhanced information accuracy, ChatGPT-4's performance could be further improved. This study indicates significant potential for the application of AI chatbots in audiology and hearing care services. ", doi="10.2196/55595", url="https://mededu.jmir.org/2024/1/e55595" } @Article{info:doi/10.2196/52679, author="Thiesmeier, Robert and Orsini, Nicola", title="Rolling the DICE (Design, Interpret, Compute, Estimate): Interactive Learning of Biostatistics With Simulations", journal="JMIR Med Educ", year="2024", month="Apr", day="15", volume="10", pages="e52679", keywords="learning statistics", keywords="Monte Carlo simulation", keywords="simulation-based learning", keywords="survival analysis", keywords="Weibull", doi="10.2196/52679", url="https://mededu.jmir.org/2024/1/e52679", url="http://www.ncbi.nlm.nih.gov/pubmed/38619866" } @Article{info:doi/10.2196/54401, author="Shikino, Kiyoshi and Nishizaki, Yuji and Fukui, Sho and Yokokawa, Daiki and Yamamoto, Yu and Kobayashi, Hiroyuki and Shimizu, Taro and Tokuda, Yasuharu", title="Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study", journal="JMIR Med Educ", year="2024", month="Feb", day="29", volume="10", pages="e54401", keywords="discrimination index", keywords="General Medicine In-Training Examination", keywords="clinical simulation video", keywords="postgraduate medical education", keywords="video", keywords="videos", keywords="training", keywords="examination", keywords="examinations", keywords="medical education", keywords="resident", keywords="residents", keywords="postgraduate", keywords="postgraduates", keywords="simulation", keywords="simulations", keywords="diagnosis", keywords="diagnoses", keywords="diagnose", keywords="general medicine", keywords="general practice", keywords="general practitioner", keywords="skill", keywords="skills", abstract="Background: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. Objective: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. Methods: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ?0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. Results: Of the 56 participants, 6 (11\%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52\%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78\%) affirmed the realism of the video simulation, and 17 (74\%) indicated that the experience increased their motivation to learn. Conclusions: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education. ", doi="10.2196/54401", url="https://mededu.jmir.org/2024/1/e54401", url="http://www.ncbi.nlm.nih.gov/pubmed/38421691" } @Article{info:doi/10.2196/46740, author="Acharya, Amish and Black, Claire Ruth and Smithies, Alisdair and Darzi, Ara", title="Evaluating the Impact of the National Health Service Digital Academy on Participants' Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Feb", day="21", volume="10", pages="e46740", keywords="digital leadership", keywords="professional identity", keywords="dissertation of practice", abstract="Background: The key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership. Objective: This study aims to examine the impact of the NHSDA program on participants' perceptions of themselves as digital health leaders. Methods: We recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals' perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework. Results: Of the 41 participants, 42\% (17/41) were in clinical roles, 34\% (14/41) were in program delivery or management roles, 20\% (8/41) were in data science roles, and 5\% (2/41) were in ``other'' roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants' values and direction within the wider digital health community. According to the questionnaire, after graduation, 59\% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46\% (11/24) reporting that the course was a strong determinant of this change. Conclusions: A digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development. ", doi="10.2196/46740", url="https://mededu.jmir.org/2024/1/e46740", url="http://www.ncbi.nlm.nih.gov/pubmed/38381477" } @Article{info:doi/10.2196/45919, author="Ulin, Lindsey and Bernstein, A. Simone and Nunes, C. Julio and Gu, Alex and Hammoud, M. Maya and Gold, A. Jessica and Mirza, M. Kamran", title="Improving Transparency in the Residency Application Process: Survey Study", journal="JMIR Form Res", year="2023", month="Dec", day="25", volume="7", pages="e45919", keywords="data elaboration", keywords="information transparency", keywords="medical school", keywords="residency application", keywords="residency programs", keywords="resident", abstract="Background: Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process. Objective: This study aims to determine the information applicants find most beneficial from residency programs when deciding where to apply, by type of medical school education background. Methods: Match 2023 applicants voluntarily completed an anonymous survey through the Twitter and Instagram social media platforms. We asked the respondents to select 3 top factors from a multiple-choice list of what information they would like from residency programs to help determine if the characteristics of their application align with program values. We examined differences in helpful factors selected by medical school backgrounds using ANOVA. Results: There were 4649 survey respondents. When responses were analyzed by United States-allopathic (US-MD), doctor of osteopathic medicine (DO), and international medical graduate (IMG) educational backgrounds, respondents chose different factors as most helpful: minimum United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Step 2 scores (565/3042, 18.57\% US-MD; 485/3042, 15.9\% DO; and 1992/3042, 65.48\% IMG; P<.001), resident hometown region (281/1132, 24.82\% US-MD; 189/1132, 16.7\% DO; and 662/1132, 58.48\% IMG; P=.02), resident medical school region (476/2179, 22\% US-MD; 250/2179, 11.5\% DO; and 1453/2179, 66.7\% IMG; P=.002), and percent of residents or attendings underrepresented in medicine (417/1815, 22.98\% US-MD; 158/1815, 8.71\% DO; and 1240/1815, 68.32\% IMG; P<.001). Conclusions: When applying to residency programs, this study found that the factors that respondents consider most helpful from programs in deciding where to apply differ by educational background. Across all educational groups, respondents want transparency around standardized exam scores, geography, and the racial or ethnic backgrounds of residents and attendings. ", doi="10.2196/45919", url="https://formative.jmir.org/2023/1/e45919", url="http://www.ncbi.nlm.nih.gov/pubmed/38145482" } @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/10.2196/50109, 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/10.2196/39831, author="Dunn, Tyler and Patel, Shyam and Milam, J. Adam and Brinkman, Joseph and Gorlin, Andrew and Harbell, W. Monica", title="Influence of Social Media on Applicant Perceptions of Anesthesiology Residency Programs During the COVID-19 Pandemic: Quantitative Survey", journal="JMIR Med Educ", year="2023", month="Jun", day="29", volume="9", pages="e39831", keywords="anesthesiology residency", keywords="application", keywords="COVID-19 pandemic", keywords="social media", keywords="impact", keywords="residency", keywords="anesthesia", keywords="anesthesiology", keywords="pandemic", keywords="effectiveness", keywords="restrictions", keywords="barriers", keywords="rotations", keywords="visits", keywords="interviews", keywords="applicants", keywords="perception", keywords="students", keywords="program", abstract="Background: Social media may be an effective tool in residency recruitment, given its ability to engage a broad audience; however, there are limited data regarding the influence of social media on applicants' evaluation of anesthesiology residency programs. Objective: This study evaluates the influence of social media on applicants' perceptions of anesthesiology residency programs during the COVID-19 pandemic to allow programs to evaluate the importance of a social media presence for residency recruitment. The study also sought to understand if there were differences in the use of social media by applicant demographic characteristics (eg, race, ethnicity, gender, and age). We hypothesized that given the COVID-19 pandemic restrictions on visiting rotations and the interview process, the social media presence of anesthesiology residency programs would have a positive impact on the recruitment process and be an effective form of communication about program characteristics. Methods: All anesthesiology residency applicants who applied to Mayo Clinic Arizona were emailed a survey in October 2020 along with statements regarding the anonymity and optional nature of the survey. The 20-item Qualtrics survey included questions regarding subinternship rotation completion, social media resource use and impact (eg, ``residency-based social media accounts positively impacted my opinion of the program''), and applicant demographic characteristics. Descriptive statistics were examined, and perceptions of social media were stratified by gender, race, and ethnicity; a factor analysis was performed, and the resulting scale was regressed on race, ethnicity, age, and gender. Results: The survey was emailed to 1091 individuals who applied to the Mayo Clinic Arizona anesthesiology residency program; there were 640 unique responses recorded (response rate=58.6\%). Nearly 65\% of applicants reported an inability to complete 2 or more planned subinternships due to COVID-19 restrictions (n=361, 55.9\%), with 25\% of applicants reporting inability to do any visiting student rotations (n=167). Official program websites (91.5\%), Doximity (47.6\%), Instagram (38.5\%), and Twitter (19.4\%) were reported as the most used resources by applicants. The majority of applicants (n=385, 67.3\%) agreed that social media was an effective means to inform applicants, and 57.5\% (n=328) of them indicated that social media positively impacted their perception of the program. An 8-item scale with good reliability was created, representing the importance of social media (Cronbach $\alpha$=.838). There was a positive and statistically significant relationship such that male applicants (standardized $\beta$=.151; P=.002) and older applicants ($\beta$=.159; P<.001) had less trust and reliance in social media for information regarding anesthesiology residency programs. The applicants' race and ethnicity were not associated with the social media scale ($\beta$=--.089; P=.08). Conclusions: Social media was an effective means to inform applicants, and generally positively impacted applicants' perception of programs. Thus, residency programs should consider investing time and resources toward building a social media presence to improve resident recruitment. ", doi="10.2196/39831", url="https://mededu.jmir.org/2023/1/e39831", url="http://www.ncbi.nlm.nih.gov/pubmed/37205642" } @Article{info:doi/10.2196/45992, author="Ferreira, Tomas and Collins, M. Alexander and Horvath, Rita", title="Ascertaining the Career Intentions of Medical Students (AIMS) in the United Kingdom Post Graduation: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="19", volume="12", pages="e45992", keywords="medical students", keywords="NHS", keywords="National Health Service", keywords="career intent", keywords="attitude", keywords="opinion", keywords="workforce", keywords="workforce planning", keywords="medical education", keywords="career", keywords="doctor", keywords="medical training", keywords="medical graduate", keywords="cross-sectional", keywords="thematic analysis", keywords="degree", keywords="rotation", abstract="Background: Among doctors in the United Kingdom, there is growing sentiment regarding delaying specialist training, emigrating to practice medicine abroad, or leaving the profession altogether. This trend may have substantial implications for the future of the profession in the United Kingdom. The extent to which this sentiment is also present in the medical student population is not well understood. Objective: Our primary outcome is to determine current medical students' career intentions after graduation and upon completing the foundation program and to establish the motivations behind these intentions. Secondary outcomes include determining which, if any, demographic factors alter the propensity to pursue different career paths available to a medical graduate, determining which specialties medical students plan on pursuing, and understanding current views on the prospect of working in the National Health Service (NHS). Methods: The Ascertaining the Career Intentions of Medical Students (AIMS) study is a national, multi-institution, and cross-sectional study in which all medical students at all medical schools in the United Kingdom are eligible to participate. It was administered via a novel, mixed methods, and web-based questionnaire and disseminated through a collaborative network of approximately 200 students recruited for this purpose. Both quantitative and thematic analyses will be performed. Results: The study was launched nationally on January 16, 2023. Data collection was closed on March 27, 2023, and data analysis has commenced. The results are expected to be available later in the year. Conclusions: Doctors' career satisfaction within the NHS is a well-researched topic; however, there is a shortage of high-powered studies that are able to offer insight into medical students' outlook on their future careers. It is anticipated that the results of this study will bring clarity to this issue. Identified areas of improvement in medical training or within the NHS could be targeted to improve doctors' working conditions and help retain medical graduates. Results may also aid future workforce-planning efforts. International Registered Report Identifier (IRRID): DERR1-10.2196/45992 ", doi="10.2196/45992", url="https://www.researchprotocols.org/2023/1/e45992", url="http://www.ncbi.nlm.nih.gov/pubmed/37335615" } @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/10.2196/44246, author="Kobak, Kenneth and Shear, Katherine M. and Skritskaya, A. Natalia and Bloom, Colleen and Bottex, Gaelle", title="A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study", journal="JMIR Med Educ", year="2023", month="Mar", day="27", volume="9", pages="e44246", keywords="grief", keywords="prolonged grief disorder", keywords="evidence-based practice", keywords="mental health training", keywords="therapist training", keywords="new technology", keywords="web-based training", keywords="dissemination", keywords="e-learning", abstract="Background: Prolonged grief disorder (PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural or social expectations and interferes with functioning. The COVID-19 epidemic has resulted in increased rates of PGD, and few clinicians feel confident in treating this condition. PGD therapy (PGDT) is a simple, short-term, and evidence-based treatment developed in tandem with the validation of the PGD diagnosis. To facilitate the dissemination of PGDT training, we developed a web-based therapist tutorial that includes didactic training on PGDT concepts and principles as well as web-based multimedia patient scenarios and examples of clinical implementation of PGDT. Objective: We aimed to evaluate user satisfaction with the tutorial and whether the tutorial increased trainees' knowledge of PGDT principles and procedures. Moreover, we included a small number of pilot questions to evaluate the PGDT-related clinical skills. Methods: This study evaluated tutorial learning using a pre- and poststudy design. Participants were recruited from professional organization mailing lists, announcements to graduates of the Columbia School of Social Work, and through word of mouth. After signing consent, participants completed a brief demographic survey, a 55-item multiple-choice prestudy test on the concepts and principles of PGD and PGDT covered in the tutorial, and a 4-item pilot web-based prestudy test to gauge PGD clinical implementation skills. The link to the course content was then activated, and participants were given 8 weeks to complete the 11-module tutorial containing information, web-based exercises, simulated patient and video examples, and self-tests. Results: Overall, 406 clinicians signed consent, and 236 (58.1\%) started the tutorial. Of these, 83.1\% (196/236) completed all 11 modules. Trainee scores on our PDGT assessment improved substantially from pretraining to the postmodule assessment, with the total number of correct answers increasing from a mean of 29 (SD 5.5; 52.7\% correct) to 36.7 (SD 5.2; 66.7\% correct; t195=18.93; P<.001). In addition, the trainee's implementation scores on 4 clinical vignettes increased from 2.6 (SD 0.7) correct out of 4 to 3.1 (SD 0.4) out of 4 (t188=7.02; P<.001). Effect sizes (Cohen d) were 1.44 (95\% CI 1.23-1.65) for PDGT assessment and 1.06 (95\% CI 0.84-1.29) for implementation. Trainees found the tutorial interesting, enjoyable, clearly presented, and useful for professional development. They endorsed a mean score of 3.7 (SD 0.47) on a 1 to 4 scale of agreement with recommending the course to others and feeling satisfied with the tutorial, and a mean of 3.3 (SD 0.57) with feeling able to apply the skills with clients. Conclusions: This pilot study provides support for the usefulness of this web-based training for teaching clinicians how to administer PGDT. The addition of patient scenarios for clinical implementation strategies holds promise for increasing the effectiveness of PGDT training and other evidence-based treatments. Trial Registration: ClinicalTrials.gov NCT05121792; https://www.clinicaltrials.gov/ct2/show/NCT05121792 ", doi="10.2196/44246", url="https://mededu.jmir.org/2023/1/e44246", url="http://www.ncbi.nlm.nih.gov/pubmed/36972105" } @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/10.2196/39794, author="Chartash, David and Rosenman, Marc and Wang, Karen and Chen, Elizabeth", title="Informatics in Undergraduate Medical Education: Analysis of Competency Frameworks and Practices Across North America", journal="JMIR Med Educ", year="2022", month="Sep", day="13", volume="8", number="3", pages="e39794", keywords="undergraduate medical education", keywords="medical informatics", keywords="curriculum", keywords="medical education", keywords="education", keywords="North America", keywords="framework", keywords="clinical", keywords="informatics", keywords="Canada", keywords="United States", keywords="US", keywords="teaching", keywords="management", keywords="cognitive", abstract="Background: With the advent of competency-based medical education, as well as Canadian efforts to include clinical informatics within undergraduate medical education, competency frameworks in the United States have not emphasized the skills associated with clinical informatics pertinent to the broader practice of medicine. Objective: By examining the competency frameworks with which undergraduate medical education in clinical informatics has been developed in Canada and the United States, we hypothesized that there is a gap: the lack of a unified competency set and frame for clinical informatics education across North America. Methods: We performed directional competency mapping between Canadian and American graduate clinical informatics competencies and general graduate medical education competencies. Directional competency mapping was performed between Canadian roles and American common program requirements using keyword matching at the subcompetency and enabling competency levels. In addition, for general graduate medical education competencies, the Physician Competency Reference Set developed for the Liaison Committee on Medical Education was used as a direct means of computing the ontological overlap between competency frameworks. Results: Upon mapping Canadian roles to American competencies via both undergraduate and graduate medical education competency frameworks, the difference in focus between the 2 countries can be thematically described as a difference between the concepts of clinical and management reasoning. Conclusions: We suggest that the development or deployment of informatics competencies in undergraduate medical education should focus on 3 items: the teaching of diagnostic reasoning, such that the information tasks that comprise both clinical and management reasoning can be discussed; precision medical education, where informatics can provide for more fine-grained evaluation; and assessment methods to support traditional pedagogical efforts (both at the bedside and beyond). Assessment using cases or structured assessments (eg, Objective Structured Clinical Examinations) would help students draw parallels between clinical informatics and fundamental clinical subjects and would better emphasize the cognitive techniques taught through informatics. ", doi="10.2196/39794", url="https://mededu.jmir.org/2022/3/e39794", url="http://www.ncbi.nlm.nih.gov/pubmed/36099007" } @Article{info:doi/10.2196/35585, author="Vuku{\vs}i{\'c} Rukavina, Tea and Machala Popla{\vs}en, Lovela and Majer, Marjeta and Reli{\'c}, Danko and Viski{\'c}, Jo{\vs}ko and Mareli{\'c}, Marko", title="Defining Potentially Unprofessional Behavior on Social Media for Health Care Professionals: Mixed Methods Study", journal="JMIR Med Educ", year="2022", month="Aug", day="9", volume="8", number="3", pages="e35585", keywords="professionalism", keywords="e-professionalism", keywords="internet", keywords="social media", keywords="social networking", keywords="medicine", keywords="dental medicine", keywords="health care professionals", keywords="students", keywords="faculty", abstract="Background: Social media presence among health care professionals is ubiquitous and largely beneficial for their personal and professional lives. New standards are forming in the context of e-professionalism, which are loosening the predefined older and offline terms. With these benefits also come dangers, with exposure to evaluation on all levels from peers, superiors, and the public, as witnessed in the \#medbikini movement. Objective: The objectives of this study were to develop an improved coding scheme (SMePROF coding scheme) for the assessment of unprofessional behavior on Facebook of medical or dental students and faculty, compare reliability between coding schemes used in previous research and SMePROF coding scheme, compare gender-based differences for the assessment of the professional content on Facebook, validate the SMePROF coding scheme, and assess the level of and to characterize web-based professionalism on publicly available Facebook profiles of medical or dental students and faculty. Methods: A search was performed via a new Facebook account using a systematic probabilistic sample of students and faculty in the University of Zagreb School of Medicine and School of Dental Medicine. Each profile was subsequently assessed with regard to professionalism based on previously published criteria and compared using the SMePROF coding scheme developed for this study. Results: Intercoder reliability increased when the SMePROF coding scheme was used for the comparison of gender-based coding results. Results showed an increase in the gender-based agreement of the final codes for the category professionalism, from 85\% in the first phase to 96.2\% in the second phase. Final results of the second phase showed that there was almost no difference between female and male coders for coding potentially unprofessional content for students (7/240, 2.9\% vs 5/203, 2.5\%) or for coding unprofessional content for students (11/240, 4.6\% vs 11/203, 5.4\%). Comparison of definitive results between the first and second phases indicated an understanding of web-based professionalism, with unprofessional content being very low, both for students (9/222, 4.1\% vs 12/206, 5.8\%) and faculty (1/25, 4\% vs 0/23, 0\%). For assessment of the potentially unprofessional content, we observed a 4-fold decrease, using the SMePROF rubric, for students (26/222, 11.7\% to 6/206, 2.9\%) and a 5-fold decrease for faculty (6/25, 24\% to 1/23, 4\%). Conclusions: SMePROF coding scheme for assessing professionalism of health-care professionals on Facebook is a validated and more objective instrument. This research emphasizes the role that context plays in the perception of unprofessional and potentially unprofessional content and provides insight into the existence of different sets of rules for web-based and offline interaction that marks behavior as unprofessional. The level of e-professionalism on Facebook profiles of medical or dental students and faculty available for public viewing has shown a high level of understanding of e-professionalism. ", doi="10.2196/35585", url="https://mededu.jmir.org/2022/3/e35585", url="http://www.ncbi.nlm.nih.gov/pubmed/35758" } @Article{info:doi/10.2196/33767, author="Allen, Gary and Garris, Jenna and Lawson, Luan and Reeder, Timothy and Crotty, Jennifer and Hannan, Johanna and Brewer, Kori", title="An Innovative Use of Twitter to Disseminate and Promote Medical Student Scholarship During the COVID-19 Pandemic: Usability Study", journal="JMIR Med Educ", year="2022", month="Jul", day="13", volume="8", number="3", pages="e33767", keywords="medical education", keywords="social media", keywords="web-based learning", keywords="innovation", keywords="Twitter", keywords="dissemination", keywords="scholarship", keywords="medical student", keywords="platform", keywords="academic promotion", keywords="COVID-19", abstract="Background: Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-person learning activities forced every aspect of medical education and student engagement to pivot to a web-based format, including activities supporting the performance and dissemination of scholarly work. At that time, social media had been used to augment in-person conference learning, but it had not been used as the sole platform for scholarly abstract presentations. Objective: Our aim was to assess the feasibility of using Twitter to provide a completely web-based forum for real-time dissemination of and engagement with student scholarly work as an alternative to a traditional in-person poster presentation session. Methods: The Brody School of Medicine at East Carolina University launched an online Medical Student Scholarship Forum, using Twitter as a platform for students to present scholarly work and prepare for future web-based presentations. A single student forum participant created posts using a standardized template that incorporated student research descriptions, uniform promotional hashtags, and individual poster presentations. Tweets were released over 5 days and analytic data were collected from the Twitter platform. Outcome measures included impressions, engagements, retweets, likes, media engagements, and average daily engagement rate. Results: During the conference, the student leader published 63 tweets promoting the work of 58 students (55 medical and 3 dental students) over 5 days. During the forum and the following week, tweets from the @BrodyDistinctly Twitter account received 63,142 impressions and 7487 engagements, including 187 retweets, 1427 likes, and 2082 media engagements. During the 5 days of the forum, the average daily engagement rate was 12.72\%. Conclusions: Using Twitter as a means of scholarly dissemination resulted in a larger viewing community compared to a traditional in-person event. Early evidence suggests that social media platforms may be an alternative to traditional scholarly presentations. Presenting via Twitter allowed students to receive instantaneous feedback and effectively network with wider academic communities. Additional research is needed to evaluate the effectiveness of knowledge uptake, feedback, and networking. ", doi="10.2196/33767", url="https://mededu.jmir.org/2022/3/e33767", url="http://www.ncbi.nlm.nih.gov/pubmed/35759753" } @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/10.2196/30537, author="Yilmaz, Yusuf and Jurado Nunez, Alma and Ariaeinejad, Ali and Lee, Mark and Sherbino, Jonathan and Chan, M. Teresa", title="Harnessing Natural Language Processing to Support Decisions Around Workplace-Based Assessment: Machine Learning Study of Competency-Based Medical Education", journal="JMIR Med Educ", year="2022", month="May", day="27", volume="8", number="2", pages="e30537", keywords="natural language processing", keywords="machine learning algorithms", keywords="competency-based medical education", keywords="assessment", keywords="medical education", keywords="medical residents", keywords="machine learning", keywords="work performance", keywords="prediction models", abstract="Background: Residents receive a numeric performance rating (eg, 1-7 scoring scale) along with a narrative (ie, qualitative) feedback based on their performance in each workplace-based assessment (WBA). Aggregated qualitative data from WBA can be overwhelming to process and fairly adjudicate as part of a global decision about learner competence. Current approaches with qualitative data require a human rater to maintain attention and appropriately weigh various data inputs within the constraints of working memory before rendering a global judgment of performance. Objective: This study explores natural language processing (NLP) and machine learning (ML) applications for identifying trainees at risk using a large WBA narrative comment data set associated with numerical ratings. Methods: NLP was performed retrospectively on a complete data set of narrative comments (ie, text-based feedback to residents based on their performance on a task) derived from WBAs completed by faculty members from multiple hospitals associated with a single, large, residency program at McMaster University, Canada. Narrative comments were vectorized to quantitative ratings using the bag-of-n-grams technique with 3 input types: unigram, bigrams, and trigrams. Supervised ML models using linear regression were trained with the quantitative ratings, performed binary classification, and output a prediction of whether a resident fell into the category of at risk or not at risk. Sensitivity, specificity, and accuracy metrics are reported. Results: The database comprised 7199 unique direct observation assessments, containing both narrative comments and a rating between 3 and 7 in imbalanced distribution (scores 3-5: 726 ratings; and scores 6-7: 4871 ratings). A total of 141 unique raters from 5 different hospitals and 45 unique residents participated over the course of 5 academic years. When comparing the 3 different input types for diagnosing if a trainee would be rated low (ie, 1-5) or high (ie, 6 or 7), our accuracy for trigrams was 87\%, bigrams 86\%, and unigrams 82\%. We also found that all 3 input types had better prediction accuracy when using a bimodal cut (eg, lower or higher) compared with predicting performance along the full 7-point rating scale (50\%-52\%). Conclusions: The ML models can accurately identify underperforming residents via narrative comments provided for WBAs. The words generated in WBAs can be a worthy data set to augment human decisions for educators tasked with processing large volumes of narrative assessments. ", doi="10.2196/30537", url="https://mededu.jmir.org/2022/2/e30537", url="http://www.ncbi.nlm.nih.gov/pubmed/35622398" } @Article{info:doi/10.2196/34990, author="Landis-Lewis, Zach and Flynn, Allen and Janda, Allison and Shah, Nirav", title="A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="May", day="10", volume="11", number="5", pages="e34990", keywords="learning health system", keywords="audit and feedback", keywords="anesthesiology", keywords="knowledge-based system", keywords="human-centered design", abstract="Background: Health care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A\&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A\&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric's level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A\&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A\&F. From an informatics perspective, precision A\&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels. Objective: This study aims to implement and evaluate a demonstration system for precision A\&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium. Methods: We propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A\&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes. Results: The proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024. Conclusions: The proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective. International Registered Report Identifier (IRRID): PRR1-10.2196/34990 ", doi="10.2196/34990", url="https://www.researchprotocols.org/2022/5/e34990", url="http://www.ncbi.nlm.nih.gov/pubmed/35536637" } @Article{info:doi/10.2196/34575, author="Yan, Hui and Rahgozar, Arya and Sethuram, Claire and Karunananthan, Sathya and Archibald, Douglas and Bradley, Lindsay and Hakimjavadi, Ramtin and Helmer-Smith, Mary and Jolin-Dahel, Kheira and McCutcheon, Tess and Puncher, Jeffrey and Rezaiefar, Parisa and Shoppoff, Lina and Liddy, Clare", title="Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="May", day="2", volume="11", number="5", pages="e34575", keywords="digital learning tools", keywords="medical education", keywords="primary care", keywords="digital learning", keywords="scoping review", keywords="family medicine", keywords="bibliometric", keywords="scientometric", keywords="natural language processing", keywords="e-learning", keywords="medical curriculum", keywords="medical curricula", keywords="medical school", abstract="Background: The COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learning needs of trainees. Objective: This scoping review will aim to explore and organize the breadth of knowledge regarding digital learning tools in family medicine training. Methods: This scoping review follows the 6 stages of the methodological framework outlined first by Arksey and O'Malley, then refined by Levac et al, including a search of published academic literature in 6 databases (MEDLINE, ERIC, Education Source, Embase, Scopus, and Web of Science) and gray literature. Following title and abstract and full text screening, characteristics and main findings of the included studies and resources will be tabulated and summarized. Thematic analysis and natural language processing (NLP) will be conducted in parallel using a 9-step approach to identify common themes and synthesize the literature. Additionally, NLP will be employed for bibliometric and scientometric analysis of the identified literature. Results: The search strategy has been developed and launched. As of October 2021, we have completed stages 1, 2, and 3 of the scoping review. We identified 132 studies for inclusion through the academic literature search and 127 relevant studies in the gray literature search. Further refinement of the eligibility criteria and data extraction has been ongoing since September 2021. Conclusions: In this scoping review, we will identify and consolidate information and evidence related to the use and effectiveness of existing digital learning tools in postgraduate family medicine training. Our findings will improve the understanding of the current landscape of digital learning tools, which will be of great value to educators and trainees interested in using existing tools, innovators looking to design digital learning tools that meet current needs, and researchers involved in the study of digital tools. Trial Registration: OSF Registries osf.io/wju4k; https://osf.io/wju4k International Registered Report Identifier (IRRID): DERR1-10.2196/34575 ", doi="10.2196/34575", url="https://www.researchprotocols.org/2022/5/e34575", url="http://www.ncbi.nlm.nih.gov/pubmed/35499861" } @Article{info:doi/10.2196/32657, author="Beverly, Elizabeth and Rigot, Brooke and Love, Carrie and Love, Matt", title="Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals", journal="JMIR Med Educ", year="2022", month="Apr", day="29", volume="8", number="2", pages="e32657", keywords="virtual reality", keywords="qualitative", keywords="medical education", keywords="health care", keywords="digital learning", keywords="learning platform", keywords="health care providers", abstract="Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals' experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67\%, women; n=22, 92\%, White; and n=4, 17\%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character's frustrations and disappointments; perceived ease of use of cine-VR: 96\% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. ", doi="10.2196/32657", url="https://mededu.jmir.org/2022/2/e32657", url="http://www.ncbi.nlm.nih.gov/pubmed/35486427" } @Article{info:doi/10.2196/30988, author="White, A. Andrew and King, M. Ann and D'Addario, E. Angelo and Brigham, Berg Karen and Dintzis, Suzanne and Fay, E. Emily and Gallagher, H. Thomas and Mazor, M. Kathleen", title="Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory", journal="JMIR Med Educ", year="2022", month="Apr", day="29", volume="8", number="2", pages="e30988", keywords="medical error disclosure", keywords="simulation studies", keywords="communication assessment", keywords="graduate medical education", keywords="crowdsourcing", keywords="patient-centered care", keywords="generalizability theory", keywords="medical education", keywords="medical error", keywords="communication", abstract="Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents' error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates' and crowdsourced laypeople's ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. ", doi="10.2196/30988", url="https://mededu.jmir.org/2022/2/e30988", url="http://www.ncbi.nlm.nih.gov/pubmed/35486423" } @Article{info:doi/10.2196/31464, author="Lauffenburger, C. Julie and DiFrancesco, F. Matthew and Barlev, A. Renee and Robertson, Ted and Kim, Erin and Coll, D. Maxwell and Haff, Nancy and Fontanet, P. Constance and Hanken, Kaitlin and Oran, Rebecca and Avorn, Jerry and Choudhry, K. Niteesh", title="Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Apr", day="27", volume="11", number="4", pages="e31464", keywords="pragmatic trial", keywords="behavioral science", keywords="prescribing", keywords="benzodiazepines", keywords="antipsychotics", keywords="impact evaluation", abstract="Background: Gaps between rational thought and actual decisions are increasingly recognized as a reason why people make suboptimal choices in states of heightened emotion, such as stress. These observations may help explain why high-risk medications continue to be prescribed to acutely ill hospitalized older adults despite widely accepted recommendations against these practices. Role playing and other efforts, such as simulation training, have demonstrated benefits to help people avoid decisional gaps but have not been tested to reduce overprescribing of high-risk medications. Objective: This study aims to evaluate the impact of a simulation-based training program designed to address decisional gaps on prescribing of high-risk medications compared with control. Methods: In this 2-arm pragmatic trial, we are randomizing at least 36 first-year medical resident physicians (ie, interns) who provide care on inpatient general medicine services at a large academic medical center to either intervention (simulation-based training) or control (online educational training). The intervention comprises a 40-minute immersive individual simulation training consisting of a reality-based patient care scenario in a simulated environment at the beginning of their inpatient service rotation. The simulation focuses on 3 types of high-risk medications, including benzodiazepines, antipsychotics, and sedative hypnotics (Z-drugs), in older adults, and is specifically designed to help the physicians identify their reactions and prescribing decisions in stressful situations that are common in the inpatient setting. The simulation scenario is followed by a semistructured debriefing with an expert facilitator. The trial's primary outcome is the number of medication doses for any of the high-risk medications prescribed by the interns to patients aged 65 years or older who were not taking one of the medications upon admission. Secondary outcomes include prescribing by all providers on the care team, being discharged on 1 of the medications, and prescribing of related medications (eg, melatonin, trazodone), or the medications of interest for the control intervention. These outcomes will be measured using electronic health record data. Results: Recruitment of interns began on March 29, 2021. Recruitment for the trial ended in Q42021, with follow-up completed by Q12022. Conclusions: This trial will evaluate the impact of a simulation-based training program designed using behavioral science principles on prescribing of high-risk medications by junior physicians. If the intervention is shown to be effective, this approach could potentially be reproducible by others and for a broader set of behaviors. Trial Registration: ClinicalTrials.gov NCT04668248; https://clinicaltrials.gov/ct2/show/NCT04668248 International Registered Report Identifier (IRRID): PRR1-10.2196/31464 ", doi="10.2196/31464", url="https://www.researchprotocols.org/2022/4/e31464", url="http://www.ncbi.nlm.nih.gov/pubmed/35475982" } @Article{info:doi/10.2196/34781, author="Puladi, Behrus and Ooms, Mark and Bellgardt, Martin and Cesov, Mark and Lipprandt, Myriam and Raith, Stefan and Peters, Florian and M{\"o}hlhenrich, Christian Stephan and Prescher, Andreas and H{\"o}lzle, Frank and Kuhlen, Wolfgang Torsten and Modabber, Ali", title="Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study", journal="JMIR Serious Games", year="2022", month="Apr", day="25", volume="10", number="2", pages="e34781", keywords="digital health in surgery", keywords="surgical technique", keywords="surgical training", keywords="computer-assisted surgery", keywords="optical see-through head-mounted display", keywords="HoloLens", keywords="surgical navigation", keywords="medical regulation", keywords="open-source", keywords="AR", keywords="augmented reality", keywords="surgery", keywords="surgeon", keywords="cadaver", keywords="serious game", keywords="head-mounted display", abstract="Background: Although nearly one-third of the world's disease burden requires surgical care, only a small proportion of digital health applications are directly used in the surgical field. In the coming decades, the application of augmented reality (AR) with a new generation of optical-see-through head-mounted displays (OST-HMDs) like the HoloLens (Microsoft Corp) has the potential to bring digital health into the surgical field. However, for the application to be performed on a living person, proof of performance must first be provided due to regulatory requirements. In this regard, cadaver studies could provide initial evidence. Objective: The goal of the research was to develop an open-source system for AR-based surgery on human cadavers using freely available technologies. Methods: We tested our system using an easy-to-understand scenario in which fractured zygomatic arches of the face had to be repositioned with visual and auditory feedback to the investigators using a HoloLens. Results were verified with postoperative imaging and assessed in a blinded fashion by 2 investigators. The developed system and scenario were qualitatively evaluated by consensus interview and individual questionnaires. Results: The development and implementation of our system was feasible and could be realized in the course of a cadaver study. The AR system was found helpful by the investigators for spatial perception in addition to the combination of visual as well as auditory feedback. The surgical end point could be determined metrically as well as by assessment. Conclusions: The development and application of an AR-based surgical system using freely available technologies to perform OST-HMD--guided surgical procedures in cadavers is feasible. Cadaver studies are suitable for OST-HMD--guided interventions to measure a surgical end point and provide an initial data foundation for future clinical trials. The availability of free systems for researchers could be helpful for a possible translation process from digital health to AR-based surgery using OST-HMDs in the operating theater via cadaver studies. ", doi="10.2196/34781", url="https://games.jmir.org/2022/2/e34781", url="http://www.ncbi.nlm.nih.gov/pubmed/35468090" } @Article{info:doi/10.2196/34522, author="Kunkes, Taylor and Makled, Basiel and Norfleet, Jack and Schwaitzberg, Steven and Cavuoto, Lora", title="Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis", journal="JMIR Perioper Med", year="2022", month="Apr", day="21", volume="5", number="1", pages="e34522", keywords="knowledge elicitation", keywords="knowledge acquisition", keywords="medical simulation", keywords="medical training", keywords="medical assessment", keywords="critical care", keywords="cognitive task analysis", keywords="qualitative methods", keywords="qualitative", keywords="endotracheal intubation", keywords="preoperative", keywords="training", keywords="health care professional", keywords="medical education", keywords="cognitive skill", abstract="Background: Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. Objective: This study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties. Methods: A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task. Results: The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment. Conclusions: Although the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices. ", doi="10.2196/34522", url="https://periop.jmir.org/2022/1/e34522", url="http://www.ncbi.nlm.nih.gov/pubmed/35451970" } @Article{info:doi/10.2196/33630, author="Sanavro, M. Sanne and van der Worp, Henk and Jansen, Danielle and Koning, Paul and Blanker, H. Marco and ", title="Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study", journal="JMIR Hum Factors", year="2022", month="Apr", day="1", volume="9", number="2", pages="e33630", keywords="primary care", keywords="digital consultation", keywords="interdisciplinary", keywords="specialist care", abstract="Background: Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective: This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods: We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results: In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions: Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking. ", doi="10.2196/33630", url="https://humanfactors.jmir.org/2022/2/e33630", url="http://www.ncbi.nlm.nih.gov/pubmed/35363155" } @Article{info:doi/10.2196/31080, author="Nozari, Ala and Mukerji, Shivali and Lok, Ling-Ling and Gu, Qingrou and Buhl, Lauren and Jain, Sanjay and Ortega, Rafael", title="Perception of Web-Based Didactic Activities During the COVID-19 Pandemic Among Anesthesia Residents: Pilot Questionnaire Study", journal="JMIR Med Educ", year="2022", month="Mar", day="31", volume="8", number="1", pages="e31080", keywords="resident education", keywords="COVID-19", keywords="barriers to education", keywords="didactic", keywords="medical education", keywords="online education", keywords="web-based education", keywords="virtual training", keywords="anesthesiology residents", keywords="medical residents", keywords="pandemic", keywords="virtual didactics", abstract="Background: Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. Objective: In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineate the perceived barriers to the successful implementation of web-based medical education. Methods: A 19-item survey was compiled and distributed electronically using Qualtrics. This anonymous survey included information on the training level of each resident, their participation in formal didactics before and during the pandemic, and their perception of the ease and limitations of virtual didactics. The resident's opinions on specific educational resources were assessed, and the effectiveness of new delivery methods on resident engagement and learning was examined. Results: Thirty anesthesiology residents were surveyed, 19 of whom agreed to participate in the pilot study. One participant with incomplete responses was excluded, yielding a final cohort of 18 respondents. Most residents (56\%, 10/18) reported that the COVID-19 pandemic negatively affected their residency training. The time spent on didactic training and independent studies was, nevertheless, not affected by the pandemic for 90\% (16/18) of respondents. Nonetheless, 72\% (13/18) of residents were less engaged during virtual lectures in comparison to in-person didactics. Important limitations included distraction from the physical environment (67\%, 12/18), internet instability (67\%, 12/18), less obligation to participate (44\%, 8/18), technical difficulty and unmuted microphones (33\%, 6/18, each), and people speaking over each other (28\%, 5/18). Despite these limitations, most residents stated that they would like to keep a combination of virtual didactics including live Zoom lectures (56\%, 10/18), prerecorded web didactics (56\%, 10/18), and virtual ground rounds via Zoom (50\%, 9/18) as the ``new normal.'' Conclusions: Despite important limitations listed in this report, anesthesia residents would like to keep a combination of virtual lectures and presentations as the new normal after the COVID-19 pandemic. ", doi="10.2196/31080", url="https://mededu.jmir.org/2022/1/e31080", url="http://www.ncbi.nlm.nih.gov/pubmed/35275840" } @Article{info:doi/10.2196/30653, author="Li, Yaning and Ye, Hongqiang and Wu, Siyu and Zhao, Xiaohan and Liu, Yunsong and Lv, Longwei and Zhang, Ping and Zhang, Xiao and Zhou, Yongsheng", title="Mixed Reality and Haptic--Based Dental Simulator for Tooth Preparation: Research, Development, and Preliminary Evaluation", journal="JMIR Serious Games", year="2022", month="Mar", day="9", volume="10", number="1", pages="e30653", keywords="dental education", keywords="simulator", keywords="mixed reality", keywords="tooth preparation", abstract="Background: Virtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR. Objective: This study aimed to describe the research and development of a newly developed MR and haptic--based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity. Methods: A prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator. Results: Of the participants, 74\% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90\% (31/34, 91\%) agreed that it could stimulate their interest in learning, and 82\% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator's ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD's resolution (P=.03) and simulation of the preparation process (P=.001). Conclusions: The newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills. ", doi="10.2196/30653", url="https://games.jmir.org/2022/1/e30653", url="http://www.ncbi.nlm.nih.gov/pubmed/35262501" } @Article{info:doi/10.2196/35199, author="Tamblyn, Robert and Brieva, Jorge and Cain, Madeleine and Martinez, Eduardo F.", title="The Effects of Introducing a Mobile App--Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="7", volume="9", number="1", pages="e35199", keywords="logbook", keywords="education", keywords="training", keywords="central venous catheter", keywords="CVC", keywords="intensive care", keywords="smartphone", keywords="mobile phone", keywords="mobile apps", keywords="mHealth", keywords="mobile health", keywords="accreditation program", keywords="digital health", keywords="digital record", abstract="Background: To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU). Objective: The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook. Methods: This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients' electronic medical records appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor's signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. Results: Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72\%) were included and separated into cohorts before and after the app's introduction. Following the introduction of the app-based logbook, the percentage of CVC insertions appearing as logbook entries increased from 3.6\% (38/1059) to 20.5\% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor's signature before and after the introduction of the app, with 76.3\% (29/38) and 83.2\% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3\% (13/85) to 62.8\% (54/86; P<.001). Adherence to one's logbook was similar in both groups with 60\% (6/10) of first-time users in the before group and 79.5\% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU. Conclusions: The addition of an electronic app-based logbook to a preexisting paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook use observed without a reduction in the quality of logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted. ", doi="10.2196/35199", url="https://humanfactors.jmir.org/2022/1/e35199", url="http://www.ncbi.nlm.nih.gov/pubmed/35051900" } @Article{info:doi/10.2196/33390, author="Teng, Minnie and Singla, Rohit and Yau, Olivia and Lamoureux, Daniel and Gupta, Aurinjoy and Hu, Zoe and Hu, Ricky and Aissiou, Amira and Eaton, Shane and Hamm, Camille and Hu, Sophie and Kelly, Dayton and MacMillan, M. Kathleen and Malik, Shamir and Mazzoli, Vienna and Teng, Yu-Wen and Laricheva, Maria and Jarus, Tal and Field, S. Thalia", title="Health Care Students' Perspectives on Artificial Intelligence: Countrywide Survey in Canada", journal="JMIR Med Educ", year="2022", month="Jan", day="31", volume="8", number="1", pages="e33390", keywords="medical education", keywords="artificial intelligence", keywords="allied health education", keywords="medical students", keywords="health care students", keywords="medical curriculum", keywords="education", abstract="Background: Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development. Objective: This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum. Methods: The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools. Results: A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77\% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5\% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula. Conclusions: We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions. ", doi="10.2196/33390", url="https://mededu.jmir.org/2022/1/e33390", url="http://www.ncbi.nlm.nih.gov/pubmed/35099397" } @Article{info:doi/10.2196/30600, author="Jung, Younhyun", title="Virtual Reality Simulation for Disaster Preparedness Training in Hospitals: Integrated Review", journal="J Med Internet Res", year="2022", month="Jan", day="28", volume="24", number="1", pages="e30600", keywords="virtual reality", keywords="in-hospital disaster preparedness training", keywords="mass casualty incidents", keywords="hospitals", abstract="Background: A critical component of disaster preparedness in hospitals is experiential education and training of health care professionals. A live drill is a well-established, effective training approach, but cost restraints and logistic constraints make clinical implementation challenging, and training opportunities with live drills may be severely limited. Virtual reality simulation (VRS) technology may offer a viable training alternative with its inherent features of reproducibility, just-in-time training, and repeatability. Objective: This integrated review examines the scientific evidence pertaining to the effectiveness of VRS and its practical usefulness in training health care professionals for in-hospital disaster preparedness. Methods: A well-known 4-stage methodology was used for the integrated review process. It consisted of problem identification, a literature search and inclusion criteria determination, 2-stage validation and analysis of searched studies, and presentation of findings. A search of diverse publication repositories was performed. They included Web of Science (WOS), PubMed (PMD), and Embase (EMB). Results: The integrated review process resulted in 12 studies being included. Principle findings identified 3 major capabilities of VRS: (1) to realistically simulate the clinical environment and medical practices related to different disaster scenarios, (2) to develop learning effects on increased confidence and enhanced knowledge acquisition, and (3) to enable cost-effective implementation of training programs. Conclusions: The findings from the integrated review suggested that VRS could be a competitive, cost-effective adjunct to existing training approaches. Although the findings demonstrated the applicability of VRS to different training scenarios, these do not entirely cover all disaster scenarios that could happen in hospitals. This integrated review expects that the recent advances of VR technologies can be 1 of the catalysts to enable the wider adoption of VRS training on challenging clinical scenarios that require sophisticated modeling and environment depiction. ", doi="10.2196/30600", url="https://www.jmir.org/2022/1/e30600", url="http://www.ncbi.nlm.nih.gov/pubmed/35089144" } @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/10.2196/29748, author="Massanelli, Jackson and Sexton, W. Kevin and Lesher, T. Chris and Jensen, K. Hanna and Kimbrough, K. Mary and Privratsky, Anna and Taylor, R. John and Bhavaraju, Avi", title="Integration of Web Analytics Into Graduate Medical Education: Usability Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e29748", keywords="graduate medical education", keywords="website analysis", keywords="residency recruitment", keywords="medical education", keywords="website", keywords="analytics", keywords="usage", keywords="usability", keywords="user engagement", keywords="user-centered design", keywords="website design", abstract="Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department's website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70\% vs 0.23\%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website's efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. ", doi="10.2196/29748", url="https://formative.jmir.org/2021/12/e29748", url="http://www.ncbi.nlm.nih.gov/pubmed/34898459" } @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/10.2196/25654, author="Xie, X. Deborah and Boss, F. Emily and Stewart, Matthew C.", title="Audience of Academic Otolaryngology on Twitter: Cross-sectional Study", journal="JMIR Med Educ", year="2021", month="Dec", day="8", volume="7", number="4", pages="e25654", keywords="Twitter", keywords="otolaryngology", keywords="residency", keywords="medical education", keywords="social media", keywords="internet", abstract="Background: Despite the ubiquity of social media, the utilization and audience reach of this communication method by otolaryngology-head and neck surgery (OHNS) residency programs has not been investigated. Objective: The purpose of this study was to evaluate the content posted to a popular social media platform (Twitter) by OHNS residency programs. Methods: In this cross-sectional study, we identified Twitter accounts for accredited academic OHNS residency programs. Tweets published over a 6-month period (March to August 2019) were extracted. Tweets were categorized and analyzed for source (original versus retweet) and target audience (medical versus layman). A random sample of 100 tweets was used to identify patterns of content, which were then used to categorize additional tweets. We quantified the total number of likes or retweets by health care professionals. Results: Of the 121 accredited programs, 35 (28.9\%) had Twitter accounts. Of the 2526 tweets in the 6-month period, 1695 (67.10\%) were original-content tweets. The majority of tweets (1283/1695, 75.69\%) were targeted toward health care workers, most of which did not directly contain medical information (954/1283, 74.36\%). These tweets contained information about the department's trainees and education (349/954, 36.6\%), participation at conferences (263/954, 27.6\%), and research publications (112/954, 11.7\%). Two-thirds of all tweets did not contain medical information. Medical professionals accounted for 1249/1362 (91.70\%) of retweets and 5616/6372 (88.14\%) of likes on original-content tweets. Conclusions: The majority of Twitter usage by OHNS residency programs is for intra and interprofessional communication, and only a minority of tweets contain information geared toward the public. Communication and information sharing with patients is not the focus of OHNS departments on Twitter. ", doi="10.2196/25654", url="https://mededu.jmir.org/2021/4/e25654", url="http://www.ncbi.nlm.nih.gov/pubmed/34889748" } @Article{info:doi/10.2196/25770, author="Vuku{\vs}i{\'c} Rukavina, Tea and Viski{\'c}, Jo{\vs}ko and Machala Popla{\vs}en, Lovela and Reli{\'c}, Danko and Mareli{\'c}, Marko and Jokic, Drazen and Sedak, Kristijan", title="Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review", journal="J Med Internet Res", year="2021", month="Nov", day="17", volume="23", number="11", pages="e25770", keywords="e-professionalism", keywords="social media", keywords="internet", keywords="health care professionals", keywords="physicians", keywords="nurses", keywords="students", keywords="medicine", keywords="dental medicine", keywords="nursing", abstract="Background: As we are witnessing the evolution of social media (SM) use worldwide among the general population, the popularity of SM has also been embraced by health care professionals (HCPs). In the context of SM evolution and exponential growth of users, this scoping review summarizes recent findings of the e-professionalism of HCPs. Objective: The purpose of this scoping review is to characterize the recent original peer-reviewed research studies published between November 1, 2014, to December 31, 2020, on e-professionalism of HCPs; to assess the quality of the methodologies and approaches used; to explore the impact of SM on e-professionalism of HCPs; to recognize the benefits and dangers of SM; and to provide insights to guide future research in this area. Methods: A search of the literature published from November 1, 2014, to December 31, 2020, was performed in January 2021 using 3 databases (PubMed, CINAHL, and Scopus). The searches were conducted using the following defined search terms: ``professionalism'' AND ``social media'' OR ``social networks'' OR ``Internet'' OR ``Facebook'' OR ``Twitter'' OR ``Instagram'' OR ``TikTok.'' The search strategy was limited to studies published in English. This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: Of the 1632 retrieved papers, a total of 88 studies were finally included in this review. Overall, the quality of the studies was satisfactory. Participants in the reviewed studies were from diverse health care professions. Medical health professionals were involved in about three-quarters of the studies. Three key benefits of SM on e-professionalism of HCPs were identified: (1) professional networking and collaboration, (2) professional education and training, and (3) patient education and health promotion. For the selected studies, there were five recognized dangers of SM on e-professionalism of HCPs: (1) loosening accountability, (2) compromising confidentiality, (3) blurred professional boundaries, (4) depiction of unprofessional behavior, and (5) legal issues and disciplinary consequences. This scoping review also recognizes recommendations for changes in educational curricula regarding e-professionalism as opportunities for improvement and barriers that influence HCPs use of SM in the context of e-professionalism. Conclusions: Findings in the reviewed studies indicate the existence of both benefits and dangers of SM on e-professionalism of HCPs. Even though there are some barriers recognized, this review has highlighted existing recommendations for including e-professionalism in the educational curricula of HCPs. Based on all evidence provided, this review provided new insights and guides for future research on this area. There is a clear need for robust research to investigate new emerging SM platforms, the efficiency of guidelines and educational interventions, and the specifics of each profession regarding their SM potential and use. ", doi="10.2196/25770", url="https://www.jmir.org/2021/11/e25770", url="http://www.ncbi.nlm.nih.gov/pubmed/34662284" } @Article{info:doi/10.2196/32356, author="Peng, R. Cynthia and Schertzer, A. Kimberly and Caretta-Weyer, A. Holly and Sebok-Syer, S. Stefanie and Lu, William and Tansomboon, Charissa and Gisondi, A. Michael", title="Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study", journal="JMIR Med Educ", year="2021", month="Nov", day="17", volume="7", number="4", pages="e32356", keywords="simulation", keywords="graduate medical education", keywords="assessment", keywords="gamification", keywords="entrustable professional activities", keywords="emergency medicine", keywords="undergraduate medical education", abstract="Background: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 ``look for'' statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results: All participants had at least one missing critical action, and 40\% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54\%). Other errors included selecting incorrect documentation passages (6/15, 40\%) and indiscriminately applying oxygen (9/15, 60\%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans. ", doi="10.2196/32356", url="https://mededu.jmir.org/2021/4/e32356", url="http://www.ncbi.nlm.nih.gov/pubmed/34787582" } @Article{info:doi/10.2196/17670, author="Zuo, Tianming and Sun, Baozhi and Guan, Xu and Zheng, Bin and Qu, Bo", title="Evidence of Construct Validity of Computer-Based Tests for Clinical Reasoning: Instrument Validation Study", journal="JMIR Serious Games", year="2021", month="Nov", day="9", volume="9", number="4", pages="e17670", keywords="medical education", keywords="assessment", keywords="computer-based test", keywords="clinical reasoning", keywords="validity", abstract="Background: Clinical reasoning (CR) is a fundamental skill for all medical students. In our medical education system, however, there are shortcomings in the conventional methods of teaching CR. New technology is needed to enhance our CR teaching, especially as we are facing an influx of new health trainees. China Medical University (CMU), in response to this need, has developed a computer-based CR training system (CMU-CBCRT). Objective: We aimed to find evidence of construct validity of the CMU-CBCRT. Methods: We recruited 385 students from fifth year undergraduates to postgraduate year (PGY) 3 to complete the test on CMU-CBCRT. The known-groups technique was used to evaluate the construct validity of the CBCRT by comparing the test scores among 4 training levels (fifth year MD, PGY-1, PGY-2, and PGY-3). Results: We found that test scores increased with years of training. Significant differences were found in the test scores on information collection, diagnosis, and treatment and total scores among different training years of participants. However, significant results were not found for treatment errors. Conclusions: We provided evidence of construct validity of the CMU-CBCRT, which could determine the CR skills of medical students at varying early stage in their careers. ", doi="10.2196/17670", url="https://games.jmir.org/2021/4/e17670", url="http://www.ncbi.nlm.nih.gov/pubmed/34751658" } @Article{info:doi/10.2196/30736, author="Yan, Qi and Jensen, Katherine and Field, Alyssa and Goei, Christian and Dao Campi, E. Haisar and Logue, Alicia and Perry, Brian W. and Davies, G. Mark", title="Critical Evaluation of the Efficiency of Colorectal Fellowship Websites: Cross-sectional Study", journal="JMIR Med Educ", year="2021", month="Oct", day="15", volume="7", number="4", pages="e30736", keywords="recruitment", keywords="GME", keywords="social media", keywords="websites", keywords="content", keywords="accessibility", keywords="online information", keywords="fellowship information", keywords="colorectal", keywords="graduate education", keywords="graduate medical education", abstract="Background: Websites are an important source of information for fellowship applicants, as they can influence ongoing interest and potential program selection. Objective: This study aims to evaluate the current state of colorectal fellowship websites. Methods: This cross-sectional study evaluates the quantity and quality of information available on websites of colorectal fellowship programs verified by the Accreditation Council for Graduate Medical Education in 2019. Results: A total of 63 colorectal fellowships were included for evaluation. Websites were surveyed for content items that previous studies have found to be influential to program applicants. The 58 (91\%) programs with a functional website were evaluated using an information index (calculated as a function of availability of content items concerning education, application, personnel, and benefits) and an interactive index (calculated as a function of accessibility and usability of the webpage). Programs had a median total score of 27.8 (IQR 21.5-34.5) of 79. The median score for the interactive index was 7.5 of 15 and for the information index was 20 of 64. The median scores for website application, education, personnel, and benefits or life considerations were 5, 5.5, 3.3, and 4 of 13, 24, 13, and 14, respectively. There was no difference in total score between programs in different geographical regions (P=.46). Conclusions: Currently, colorectal surgery fellowship program websites do not provide enough content for applicants to make informed decisions. All training programs, regardless of specialty, should evaluate and improve their digital footprint to ensure their websites are accessible and provide the information desired by applicants. ", doi="10.2196/30736", url="https://mededu.jmir.org/2021/4/e30736", url="http://www.ncbi.nlm.nih.gov/pubmed/34652282" } @Article{info:doi/10.2196/29486, author="Naaseh, Ariana and Thompson, Sean and Tohmasi, Steven and Wiechmann, Warren and Toohey, Shannon and Wray, Alisa and Boysen-Osborn, Megan", title="Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study", journal="JMIR Med Educ", year="2021", month="Oct", day="5", volume="7", number="4", pages="e29486", keywords="residency application", keywords="social media", keywords="medical education", keywords="resident", keywords="medical student", keywords="perspective", keywords="residency recruitment", keywords="virtual application", keywords="virtual residency", abstract="Background: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media--based communication and dissemination of information. Objective: We sought to determine social media's impact on residency applicants during an entirely virtual application cycle. Methods: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. Results: A total of 72 participants (15.5\% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53\% (n=38) reported following prospective residency accounts on social media, and 89\% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53\% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26\%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74\%) increasing the number of programs to which they applied. Survey respondents ranked social media's effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86\%) felt that programs should use social media in future application cycles even if they are nonvirtual. Conclusions: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match. ", doi="10.2196/29486", url="https://mededu.jmir.org/2021/4/e29486", url="http://www.ncbi.nlm.nih.gov/pubmed/34591779" } @Article{info:doi/10.2196/24027, author="Yang, Lin and Zheng, Si and Xu, Xiaowei and Sun, Yueping and Wang, Xuwen and Li, Jiao", title="Medical Data Mining Course Development in Postgraduate Medical Education: Web-Based Survey and Case Study", journal="JMIR Med Educ", year="2021", month="Oct", day="1", volume="7", number="4", pages="e24027", keywords="medical data mining", keywords="course development", keywords="online teaching", keywords="postgraduate medical education", abstract="Background: Medical postgraduates' demand for data capabilities is growing, as biomedical research becomes more data driven, integrative, and computational. In the context of the application of big data in health and medicine, the integration of data mining skills into postgraduate medical education becomes important. Objective: This study aimed to demonstrate the design and implementation of a medical data mining course for medical postgraduates with diverse backgrounds in a medical school. Methods: We developed a medical data mining course called ``Practical Techniques of Medical Data Mining'' for postgraduate medical education and taught the course online at Peking Union Medical College (PUMC). To identify the background knowledge, programming skills, and expectations of targeted learners, we conducted a web-based questionnaire survey. After determining the instructional methods to be used in the course, three technical platforms---Rain Classroom, Tencent Meeting, and WeChat---were chosen for online teaching. A medical data mining platform called Medical Data Mining - R Programming Hub (MedHub) was developed for self-learning, which could support the development and comprehensive testing of data mining algorithms. Finally, we carried out a postcourse survey and a case study to demonstrate that our online course could accommodate a diverse group of medical students with a wide range of academic backgrounds and programming experience. Results: In total, 200 postgraduates from 30 disciplines participated in the precourse survey. Based on the analysis of students' characteristics and expectations, we designed an optimized course structured into nine logical teaching units (one 4-hour unit per week for 9 weeks). The course covered basic knowledge of R programming, machine learning models, clinical data mining, and omics data mining, among other topics, as well as diversified health care analysis scenarios. Finally, this 9-week course was successfully implemented in an online format from May to July in the spring semester of 2020 at PUMC. A total of 6 faculty members and 317 students participated in the course. Postcourse survey data showed that our course was considered to be very practical (83/83, 100\% indicated ``very positive'' or ``positive''), and MedHub received the best feedback, both in function (80/83, 96\% chose ``satisfied'') and teaching effect (80/83, 96\% chose ``satisfied''). The case study showed that our course was able to fill the gap between student expectations and learning outcomes. Conclusions: We developed content for a data mining course, with online instructional methods to accommodate the diversified characteristics of students. Our optimized course could improve the data mining skills of medical students with a wide range of academic backgrounds and programming experience. ", doi="10.2196/24027", url="https://mededu.jmir.org/2021/4/e24027", url="http://www.ncbi.nlm.nih.gov/pubmed/34596575" } @Article{info:doi/10.2196/28495, author="Raphaely, Shiri and Goldberg, B. Simon and Moreno, Megan and Stowe, Zachary", title="Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey", journal="JMIR Med Educ", year="2021", month="Sep", day="14", volume="7", number="3", pages="e28495", keywords="social media", keywords="screentime", keywords="problematic Internet use", keywords="psychiatric interview", keywords="psychiatric training", keywords="COVID-19", keywords="residency", keywords="training", keywords="survey", keywords="psychiatry", keywords="evaluation", keywords="quarantine", abstract="Background: Current research suggests that there is a nuanced relationship between mental well-being and social media. Social media offers opportunities for empowerment, information, and connection while also showing links with depression, high-risk behavior, and harassment. As this medium rapidly integrates into interpersonal interactions, incorporation of social media assessment into the psychiatric evaluation warrants attention. Furthermore, the COVID-19 pandemic and containment measures (ie, social distancing) led to increased dependence on social media, allowing an opportunity to assess the adaptation of psychiatric interviews in response to sociocultural changes. Objective: The first aim of this study was to evaluate if general psychiatry residents and child and adolescent psychiatry fellows assessed social media use as part of the clinical interview. Second, the study examined whether changes were made to the social media assessment in response to known increase of social media use secondary to social distancing measures during the COVID-19 pandemic. Methods: As part of a quality improvement project, the authors surveyed general psychiatry residents and child psychiatry fellows in a university-based training program (n=21) about their assessment of social media use in patient evaluations. Soon after the survey closed, ``stay-at-home'' orders related to the COVID-19 pandemic began. A subsequent survey was sent out with the same questions to evaluate if residents and fellows altered their interview practices in response to the dramatic sociocultural changes (n=20). Results: Pre-COVID-19 pandemic survey results found that 10\% (2/21) of respondents incorporated social media questions in patient evaluations. In a follow-up survey after the onset of the pandemic, 20\% (4/20) of respondents included any assessment of social media use. Among the 15 participants who completed both surveys, there was a nonsignificant increase in the likelihood of asking about social media use (2/15, 13\% vs 4/15, 27\%, for pre- and during COVID-19, respectively; McNemar $\chi$21=0.25, P=.617, Cohen d=0.33). Conclusions: These small survey results raise important questions relevant to the training of residents and fellows in psychiatry. The findings suggest that the assessment of social media use is a neglected component of the psychiatric interview by trainees. The burgeoning use and diversity of social media engagement warrant scrutiny with respect to how this is addressed in interview training. Additionally, given minimal adaptation of the interview in the midst of a pandemic, these findings imply an opportunity for improving psychiatric training that incorporates adapting clinical interviews to sociocultural change. ", doi="10.2196/28495", url="https://mededu.jmir.org/2021/3/e28495", url="http://www.ncbi.nlm.nih.gov/pubmed/34375297" } @Article{info:doi/10.2196/30821, author="El Shatanofy, Muhammad and Brown, Lauryn and Berger, Peter and Gu, Alex and Sharma, K. Abhinav and Campbell, Joshua and Tabaie, Sean", title="Orthopedic Surgery Residency Program Website Content and Accessibility During the COVID-19 Pandemic: Observational Study", journal="JMIR Med Educ", year="2021", month="Sep", day="10", volume="7", number="3", pages="e30821", keywords="orthopedic surgery residency programs", keywords="COVID-19", keywords="website", keywords="residency applicants", keywords="residency", keywords="medical student", keywords="content", keywords="accessibility", keywords="observational", keywords="surgery", abstract="Background: The exceptional competitiveness of the orthopedic surgery specialty, combined with the unclear impact of the COVID-19 pandemic on residency recruitment, has presented significant challenges to applicants and residency program directors. With limited in-person opportunities in the 2020-2021 application cycle, applicants have been pressed to gauge chances and best fit by browsing program websites. Objective: The aim of the study was to assess the accessibility and content of accredited orthopedic surgery residency program websites during the COVID-19 pandemic. Methods: Using the online database of the Electronic Residency Application Service (ERAS), we compiled a list of accredited orthopedic surgery residency programs in the United States. Program websites were evaluated across four domains: program overview, education, research opportunities, and application details. Each website was assessed twice in July 2020, during a period of adjustment to the COVID-19 pandemic, and twice in November 2020, following the October ERAS application deadline. Results: A total of 189 accredited orthopedic surgery residency programs were identified through ERAS. Of these programs, 3 (1.6\%) did not have functional website links on ERAS. Data analysis of content in each domain revealed that most websites included program details, a description of the didactic curriculum, and sample rotation schedules. Between the two evaluation periods in July and November 2020, the percentage of program websites containing informative videos and virtual tours rose from 12.2\% (23/189) to 48.1\% (91/189; P<.001) and from 0.5\% (1/189) to 13.2\% (25/189; P<.001), respectively. However, the number of programs that included information about a virtual subinternship or virtual interview on their websites did not change. Over the 4-month period, larger residency programs with 5 or more residents were significantly more likely to add a program video (P<.001) or virtual tour (P<.001) to their websites. Conclusions: Most residency program websites offered program details and an overview of educational and research opportunities; however, few addressed the virtual transition of interviews and subinternships during the COVID-19 pandemic. ", doi="10.2196/30821", url="https://mededu.jmir.org/2021/3/e30821", url="http://www.ncbi.nlm.nih.gov/pubmed/34449406" } @Article{info:doi/10.2196/23235, author="Azab, A. Mohammed and Hasaneen, Fawzy Sharef and Reda, Ahmed and Asous, Ashraf and Azzam, Y. Ahmed", title="Individual and Institutional Factors Preventing Completion of Research by Medical Graduate Students at Cairo University: Questionnaire Study", journal="JMIR Med Educ", year="2021", month="Aug", day="9", volume="7", number="3", pages="e23235", keywords="research", keywords="Cairo University", keywords="medical", keywords="nonpublication", abstract="Background: Medical research plays a significant role in advancing the level of health care worldwide. This research is a crucial part of the development of any educational system. In developing countries, the publication rate related to the medical sciences is lower than that in developed countries. Objective: The aim of this study was to explore the causes of delay in publishing research and the factors that hinder the completion of master's degree projects in a group of medical graduate students at Cairo University Faculty of Medicine. Methods: A web-based questionnaire was introduced to approximately 150 medical graduates in different specialties through social media. The questionnaire aimed to investigate the reasons for delays in publishing master's degree manuscripts after graduation among a group of medical graduates. Results: Of the graduates contacted, 130 responded to the web-based survey. The ages of the participants ranged from 23-38 years (SD 3.88); 72 of them were male, and 58 were female. Causes of noncompletion of manuscripts were analyzed; lack of proper research training and the absence of supportive mentorship were top reasons. We found a significant relationship between being married and failing to complete the assigned project from its start up to publication. Moreover, we found that the frequency of nonfulfillment increased among those who experienced poor mentorship. Conclusions: Several factors are contributing to the delay in publication of medical manuscripts related to research projects by medical graduates of the Cairo University Faculty of Medicine. Pensive supervision must be implemented to decipher the persistent institutional problems that obstruct research progress. ", doi="10.2196/23235", url="https://mededu.jmir.org/2021/3/e23235", url="http://www.ncbi.nlm.nih.gov/pubmed/33858818" } @Article{info:doi/10.2196/26325, author="Gopwani, R. Sumeet and Adams, Erin and Rooney, Alexandra and Tousimis, Eleni and Ramsey, Katherine and Warusha, Sohan", title="Impact of a Workflow-Integrated Web Tool on Resource Utilization and Information-Seeking Behavior in an Academic Anesthesiology Department: Longitudinal Cohort Survey Study", journal="JMIR Med Educ", year="2021", month="Jul", day="26", volume="7", number="3", pages="e26325", keywords="graduate medical education", keywords="learning technology", keywords="anesthesiology", keywords="information-seeking behavior", keywords="web tool", keywords="teaching", keywords="millennial learners", abstract="Background: Medical resident reading and information-seeking behavior is limited by time constraints as well as comfort in accessing and assessing evidence-based resources. Educational technology interventions, as the preferred method for millennial leaners, can reduce these barriers. We implemented an educational web tool, consisting of peer-reviewed articles as well as local and national protocols and policies, built into the daily workflow of a university-based anesthesiology department. We hypothesized that this web tool would increase resource utilization and overall perceptions of the educational environment. Objective: The goal of this study was to demonstrate that an educational web tool designed and built into the daily workflow of an academic anesthesia department for trainees could significantly decrease barriers to resource utilization, improve faculty-trainee teaching interactions, and improve the perceptions of the educational environment. Methods: Following Institutional Review Board approval, a longitudinal cohort survey study was conducted to assess trainee resource utilization, faculty evaluation of trainees' resource utilization, and trainee and faculty perceptions about the educational environment. The survey study was conducted in a pre-post fashion 3 months prior to web tool implementation and 3 months following implementation. Data were deidentified and analyzed unpaired using Student t tests for continuous data and chi-square tests for ordinal data. Results: Survey response rates were greater than 50\% in all groups: of the 43 trainees, we obtained 27 (63\%) preimplementation surveys and 22 (51\%) postimplementation surveys; of the 46 faculty members, we obtained 25 (54\%) preimplementation surveys and 23 (50\%) postimplementation surveys. Trainees showed a significant improvement in utilization of peer-reviewed articles (preimplementation mean 8.67, SD 6.45; postimplementation mean 18.27, SD 12.23; P=.02), national guidelines (preimplementation mean 2.3, SD 2.40; postimplementation mean 6.14, SD 5.01; P<.001), and local policies and protocols (preimplementation mean 2.23, SD 2.72; postimplementation mean 6.95, SD 6.09; P=.02). There was significant improvement in faculty-trainee educational interactions (preimplementation mean 1.67, SD 1.33; postimplementation mean 6.05, SD 8.74; P=.01). Faculty assessment of trainee resource utilization also demonstrated statistically significant improvements across all resource categories. Subgroups among trainees and faculty showed similar trends toward improvement. Conclusions: Learning technology interventions significantly decrease the barriers to resource utilization, particularly among millennial learners. Further investigation has been undertaken to assess how this may impact learning, knowledge retention, and patient outcomes. ", doi="10.2196/26325", url="https://mededu.jmir.org/2021/3/e26325", url="http://www.ncbi.nlm.nih.gov/pubmed/34309566" } @Article{info:doi/10.2196/29518, author="Herbst, Rachel and Rybak, Tiffany and Meisman, Andrea and Whitehead, Monica and Rosen, Brittany and Crosby, E. Lori and Klein, D. Melissa and Real, J. Francis", title="A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="29", volume="4", number="2", pages="e29518", keywords="resident education", keywords="virtual reality", keywords="behavioral health promotion", keywords="COVID-19", abstract="Background: Behavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines. Objective: This study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents. Methods: This mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents' perspectives on the curriculum's content and format. The interviews were analyzed using conventional content analysis. Results: Quantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79\%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills. Conclusions: Pilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families. ", doi="10.2196/29518", url="https://pediatrics.jmir.org/2021/2/e29518", url="http://www.ncbi.nlm.nih.gov/pubmed/34081601" } @Article{info:doi/10.2196/16463, author="Luo, Ping and Pang, Wenwen and Wang, Yingying and Liu, Minghui and Zhou, Shu and Liu, Shuai and Zhang, Xian and Liu, Li and Liu, Yanan and Zhou, Fuling", title="WeChat as a Platform for Problem-Based Learning Among Hematological Postgraduates: Feasibility and Acceptability Study", journal="J Med Internet Res", year="2021", month="May", day="25", volume="23", number="5", pages="e16463", keywords="problem-based learning", keywords="PBL", keywords="WeChat", keywords="hematology", keywords="postgraduate", keywords="education", abstract="Background: Hematological medicine is a practical discipline that is difficult to study. Problem-based learning (PBL) is an innovative student-centered teaching method wherein students define their own learning objectives from clinically based problems. Considering that WeChat is the most popular communication app in China, we selected it as a new platform for online PBL to reduce the limitations of traditional PBL in hematology teaching. Objective: This study aims to explore a new pedagogical method called WeChat-PBL, which is based on real micro clinical cases for postgraduates majoring in hematology and to demonstrate its feasibility and acceptability. Methods: A total of 48 hematological postgraduates and 7 tutors participated in this study. We divided the participants into 7 groups where students can learn theoretical knowledge. After each course, the members of each group were required to complete in-class quizzes. Moreover, the students and tutors were required to fill out periodic (after each class) and overall (after each semester) evaluations. Results: A total of 8 micro clinical cases were presented in WeChat-PBL. The average quiz score for acute myelogenous leukemia, chronic myeloid leukemia, multiple myeloma, acute promyelocytic leukemia, and lymphoma were 89.0\%, 86.0\%, 83.4\%, 88.8\%, and 77.5\%, respectively. Periodic evaluations showed that both students and tutors were satisfied with the process of WeChat-PBL. The overall evaluation results showed that WeChat-PBL was able to positively impact the learning experiences of hematological postgraduates. Conclusions: Our results indicate the feasibility and acceptability of the WeChat-PBL teaching method for postgraduates majoring in hematology. ", doi="10.2196/16463", url="https://www.jmir.org/2021/5/e16463", url="http://www.ncbi.nlm.nih.gov/pubmed/34032573" } @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/10.2196/19079, author="Tam, K. Emily and Dong, Xuezhi", title="Survey of Residency Directors' Views on Entrepreneurship", journal="JMIR Med Educ", year="2021", month="Apr", day="14", volume="7", number="2", pages="e19079", keywords="medical student education", keywords="medical student innovation", keywords="health innovation", keywords="program director", doi="10.2196/19079", url="https://mededu.jmir.org/2021/2/e19079", url="http://www.ncbi.nlm.nih.gov/pubmed/33851929" } @Article{info:doi/10.2196/18102, author="Carson, Y. Thaddeus and Hatzigeorgiou, Christos and Wyatt, R. Tasha and Egan, Sarah and Beidas, O. Sary", title="Development and Implementation of a Web-Based Learning Environment for an Inpatient Internal Medicine Team: Questionnaire Study", journal="JMIR Med Educ", year="2020", month="Dec", day="29", volume="6", number="2", pages="e18102", keywords="inpatient internal medicine", keywords="academic hospitalist", keywords="medical education", keywords="blended learning environment", keywords="social media", keywords="online education", keywords="internal medicine ward", keywords="internal medicine education", abstract="Background: The notion of anytime, anyplace communication is characteristic of the current generation of learners. Such communications have facilitated the growth and integration of a blended or hybrid learning platform in multiple educational settings. However, there are limited reports on the use of an anytime, anyplace communication platform in clinical inpatient medical education. Objective: The setting of a high-demand inpatient clinical rotation is ideal for the use of collaborative software, and this integration is expected to positively influence medical education. The purpose of this study is to evaluate medical students' and residents' educational experiences with incorporating a simple, web-based content management and file sharing platform into an internal medicine inpatient rotation. Methods: During an inpatient internal medicine rotation, faculty and learners jointly used collaborative software for educational purposes, and a postrotation survey tool was used to measure the educational influence of the software. Results: Based on the results of the postrotation survey, the integration of a collaborative software application during clinical rotations improved the learning experience. Learning climate, the communication of rotation goals, and self-directed learning all scored favorably, but feedback from the survey participants was mixed. The learners enthusiastically accepted the practical use of this tool for both communication and information sharing. Conclusions: This generation of learners is accustomed to frequent electronic communication. Based on our survey, these learners appear to be highly receptive to this web-based intervention design for improving clinical education during active patient care. Adding effective blended learning features to a traditional clinical setting is achievable. ", doi="10.2196/18102", url="http://mededu.jmir.org/2020/2/e18102/", url="http://www.ncbi.nlm.nih.gov/pubmed/33372895" } @Article{info:doi/10.2196/17922, author="R{\"o}ssler, Julian and Kaserer, Alexander and Albiez, Benjamin and Braun, Julia and Breckwoldt, Jan and Spahn, Rudolf Donat and N{\"o}thiger, Christoph and Tscholl, Werner David", title="Comparing Classroom Instruction to Individual Instruction as an Approach to Teach Avatar-Based Patient Monitoring With Visual Patient: Simulation Study", journal="JMIR Med Educ", year="2020", month="Apr", day="23", volume="6", number="1", pages="e17922", keywords="avatar", keywords="computer-assisted", keywords="diagnosis", abstract="Background: Visual Patient is an avatar-based alternative to standard patient monitor displays that significantly improves the perception of vital signs. Implementation of this technology in larger organizations would require it to be teachable by brief class instruction to large groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction to Visual Patient. Objective: In this study, we aimed to compare 2 different educational methods, one-on-one instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring. Methods: We presented 42 anesthesia providers with 30 minutes of class instruction on Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study who each received individual instruction (individual instruction group). After the instruction, the participants were shown monitors with either conventional displays or Visual Patient displays and were asked to interpret vital signs. In the class instruction group, the participants were shown scenarios for either 3 or 10 seconds, and the numbers of correct perceptions with each technology were compared. Then, the teaching efficacy of the class instruction was compared with that of the individual instruction in the historical sample by 2-way mixed analysis of variance and mixed regression. Results: In the class instruction group, when participants were presented with the 3-second scenario, there was a statistically significant median increase in the number of perceived vital signs when the participants were shown the Visual Patient compared to when they were shown the conventional display (3 vital signs, P<.001; effect size --0.55). No significant difference was found for the 10-second scenarios. There was a statistically significant interaction between the teaching intervention and display technology in the number of perceived vital signs (P=.04; partial $\eta$2=.076). The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95\% CI 1.41-2.52; P<.001) for individual instruction compared to class instruction as well as an OR of 3.03 (95\% CI 2.50-3.70; P<.001) for the Visual Patient compared to conventional monitoring. Conclusions: Although individual instruction on Visual Patient is slightly more effective, class instruction is a viable teaching method; thus, large-scale introduction of health care providers to this novel technology is feasible. ", doi="10.2196/17922", url="http://mededu.jmir.org/2020/1/e17922/", url="http://www.ncbi.nlm.nih.gov/pubmed/32205304" } @Article{info:doi/10.2196/14983, author="Torabi, Asad and Khemka, Abhishek and Bateman, V. Pantila", title="A Cardiology Handbook App to Improve Medical Education for Internal Medicine Residents: Development and Usability Study", journal="JMIR Med Educ", year="2020", month="Apr", day="16", volume="6", number="1", pages="e14983", keywords="mobile learning", keywords="medical reference app", keywords="cardiology", keywords="internal medicine", abstract="Background: At most institutions, internal medicine residents struggle with balancing clinical duties and learning opportunities, particularly during busy cardiology ward rotations. To improve learning experiences for residents, we helped develop a cardiology handbook app to supplement cardiology education. Objective: The aim of this study was to report the development, implementation, and preliminary impact of the Krannert Cardiology Handbook app on graduate medical education. Methods: In June 2017, 122 residents at Indiana University were invited to download the digital handbook in the Krannert app. The Krannert app featured a total of 13 chapters written by cardiology fellows and faculty at Indiana University. Residents were surveyed on their self-reported improvement in cardiology knowledge and level of satisfaction after using the Krannert app. Residents were also surveyed regarding their preference for a digital handbook app versus a paper handbook. Results: Of the 122 residents, 38 trainees (31.1\%) participated in survey evaluations. Among all respondents, 31 app users (82\%) reported that the app helped improve their cardiology knowledge base. The app had an overall favorable response. Conclusions: The Krannert app shows promise in augmenting clinical education in cardiology with mobile learning. Future work includes adding new topics, updating the content, and comparing the app to other learning modalities. ", doi="10.2196/14983", url="http://mededu.jmir.org/2020/1/e14983/", url="http://www.ncbi.nlm.nih.gov/pubmed/32297866" } @Article{info:doi/10.2196/15655, author="Hsiao, Cheng-Ting and Chou, ChihChen Fremen and Hsieh, Chih-Cheng and Chang, Chun Li and Hsu, Chih-Ming", title="Developing a Competency-Based Learning and Assessment System for Residency Training: Analysis Study of User Requirements and Acceptance", journal="J Med Internet Res", year="2020", month="Apr", day="14", volume="22", number="4", pages="e15655", keywords="competency-based learning", keywords="milestones", keywords="entrustable professional activities", keywords="assessment", keywords="learning platform", abstract="Background: The increasingly complex medical environment highlights the importance of milestones and entrustable professional activities (EPAs) to realize the ideals of competency-based medical education (CBME). However, if enormous amounts of assessment results need to be compiled, the development of a digital system to manage, integrate, and synthesize learning and assessment data will be necessary. Furthermore, this system should be able to facilitate real-time assessment with feedback and therefore enhance users' learning through coaching in the moment in the clinical workplace. Objective: The main purpose of this study was to develop a competency-based electronic platform system to provide resident physicians with clinical assessments and learning in order to enhance the learning of trainees and reduce the burden of assessments. Methods: A competency-based learning and assessment system (CBLAS) for residency training was designed, developed, and evaluated in this study. Opinion interviews and a focus group consensus meeting of key users, including trainees, clinical teachers, and administrative staff, were conducted as needs assessments. The structure of the CBLAS was designed according to the thematic analysis of needs assessments. Clinical teachers' acceptance of using CBME assessments, according to the constructs of attitude, perceived usefulness, and perceived ease of use, was surveyed in the beginning and half a year after implementation of the CBLAS. Additionally, the satisfaction of using the CBLAS, according to information, system, and service qualities, was surveyed after implementation. Results: The main functions of the CBLAS, including milestones, EPAs, learning portfolios, teacher/student feedback, e-books, learning materials, assessment progress tracking, and statistical analysis of assessment results, were designed and developed for responding to nine themes, which emerged from the needs assessments of the three user groups. Twenty clinical teachers responded to the CBME assessment acceptance surveys before and after CBLAS implementation, which revealed a significant improvement in the factor of ``attitude'' (P=.02) but no significant differences in the two factors of ``usefulness'' (P=.09) and ``ease of use'' (P=.58) for CBME assessments. Furthermore, satisfaction surveys were performed in 117 users, and 87.2\% (102/117) were satisfied with the CBLAS in terms of information, system, and service qualities. There was no significant difference in satisfaction among different user groups. Conclusions: The CBLAS is a user-centered platform that supports clinical teachers' assessment exercises and residents' learning, as well as administrative work for staff according to users' needs assessments and operationalized features of CBME assessments. With the system, clinical teachers had a more positive attitude to conduct the assessment activities of milestones and EPAs and learners could arrange their study schedules to enhance their learning effectiveness. The CBLAS sheds light on how to effectively design and develop a digital system to execute milestone- and EPA-based assessments for enhancing competency-based education among residents, according to our experiences in Taiwan. ", doi="10.2196/15655", url="https://www.jmir.org/2020/4/e15655", url="http://www.ncbi.nlm.nih.gov/pubmed/32286233" } @Article{info:doi/10.2196/13568, author="Hani, Selim and Chalouhi, Gihad and Lakissian, Zavi and Sharara-Chami, Rana", title="Introduction of Ultrasound Simulation in Medical Education: Exploratory Study", journal="JMIR Med Educ", year="2019", month="Sep", day="26", volume="5", number="2", pages="e13568", keywords="medical education", keywords="simulation training", keywords="ultrasonography", abstract="Background: Ultrasound is ubiquitous across all disciplines of medicine; it is one of the most commonly used noninvasive, painless diagnostic tools. However, not many are educated and trained well enough in its use. Ultrasound requires not only theoretical knowledge but also extensive practical experience. The simulated setting offers the safest environment for health care professionals to learn and practice using ultrasound. Objective: This study aimed to (1) assess health care professionals' need for and enthusiasm toward practicing using ultrasound via simulation and (2) gauge their perception and acceptance of simulation as an integral element of ultrasound education in medical curricula. Methods: A day-long intervention was organized at the American University of Beirut Medical Center (AUBMC) to provide a free-of-charge interactive ultrasound simulation workshop---using CAE Vimedix high-fidelity simulator---for health care providers, including physicians, nurses, ultrasound technicians, residents, and medical students. Following the intervention, attendees completed an evaluation, which included 4 demographic questions and 16 close-ended questions based on a Likert scale agree-neutral-disagree. The results presented are based on this evaluation form. Results: A total of 41 participants attended the workshop (46\% [19/41] physicians, 30\% [12/41] residents, 19\% [8/41] sonographers, and 5\% [2/41] medical students), mostly from AUBMC (88\%, 36/41), with an average experience of 2.27 (SD 3.45) years and 30 (SD 46) scans per attendee. Moreover, 15 out of 41 (36\%) participants were from obstetrics and gynecology, 11 (27\%) from internal medicine, 4 (10\%) from pediatrics, 4 (10\%) from emergency medicine, 2 (5\%) from surgery and family medicine, and 5 (12\%) were technicians. The majority of participants agreed that ultrasound provided a realistic setting (98\%, 40/41) and that it allowed for training and identification of pathologies (88\%, 36/41). Furthermore, 100\% (41/41) of the participants agreed that it should be part of the curriculum either in medical school or residency, and most of the participants approved it for training (98\%, 40/41) and teaching (98\%, 40/41). Conclusions: All attendees were satisfied with the intervention. There was a positive perception toward the use of simulation for training and teaching medical students and residents in using ultrasound, and there was a definite need and enthusiasm for its integration into curricula. Simulation offers an avenue not only for teaching but also for practicing the ultrasound technology by both medical students and health care providers. ", doi="10.2196/13568", url="http://mededu.jmir.org/2019/2/e13568/", url="http://www.ncbi.nlm.nih.gov/pubmed/31573944" } @Article{info:doi/10.2196/13004, author="de Leeuw, Robert and Scheele, Fedde and Walsh, Kieran and Westerman, Michiel", title="A 9-Step Theory- and Evidence-Based Postgraduate Medical Digital Education Development Model: Empirical Development and Validation", journal="JMIR Med Educ", year="2019", month="Jul", day="22", volume="5", number="2", pages="e13004", keywords="postgraduate medical e-learning", keywords="instructional design", keywords="e-learning", keywords="distance education", keywords="design model", keywords="education, medical", keywords="education, distance", keywords="models, educational", abstract="Background: Digital education tools (e-learning, technology-enhanced learning) can be defined as any educational intervention that is electronically mediated. Decveloping and applying such tools and interventions for postgraduate medical professionals who work and learn after graduation can be called postgraduate medical digital education (PGMDE), which is increasingly being used and evaluated. However, evaluation has focused mainly on reaching the learning goals and little on the design. Design models for digital education (instructional design models) help educators create a digital education curriculum, but none have been aimed at PGMDE. Studies show the need for efficient, motivating, useful, and satisfactory digital education. Objective: Our objective was (1) to create an empirical instructional design model for PGMDE founded in evidence and theory, with postgraduate medical professionals who work and learn after graduation as the target audience, and (2) to compare our model with existing models used to evaluate and create PGMDE. Methods: Previously we performed an integrative literature review, focus group discussions, and a Delphi procedure to determine which building blocks for such a model would be relevant according to experts and users. This resulted in 37 relevant items. We then used those 37 items and arranged them into chronological steps. After we created the initial 9-step plan, we compared these steps with other models reported in the literature. Results: The final 9 steps were (1) describe who, why, what, (2) select educational strategies, (3) translate to the real world, (4) choose the technology, (5) complete the team, (6) plan the budget, (7) plan the timing and timeline, (8) implement the project, and (9) evaluate continuously. On comparing this 9-step model with other models, we found that no other was as complete, nor were any of the other models aimed at PGMDE. Conclusions: Our 9-step model is the first, to our knowledge, to be based on evidence and theory building blocks aimed at PGMDE. We have described a complete set of evidence-based steps, expanding a 3-domain model (motivate, learn, and apply) to an instructional design model that can help every educator in creating efficient, motivating, useful, and satisfactory PGMDE. Although certain steps are more robust and have a deeper theoretical background in current research (such as education), others (such as budget) have been barely touched upon and should be investigated more thoroughly in order that proper guidelines may also be provided for them. ", doi="10.2196/13004", url="http://mededu.jmir.org/2019/2/e13004/", url="http://www.ncbi.nlm.nih.gov/pubmed/31333194" } @Article{info:doi/10.2196/12825, author="Clavier, Thomas and Ramen, Julie and Dureuil, Bertrand and Veber, Benoit and Hanouz, Jean-Luc and Dupont, Herv{\'e} and Lebuffe, Gilles and Besnier, Emmanuel and Compere, Vincent", title="Use of the Smartphone App WhatsApp as an E-Learning Method for Medical Residents: Multicenter Controlled Randomized Trial", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="09", volume="7", number="4", pages="e12825", keywords="education, medical, graduate/methods", keywords="educational measurement", keywords="anesthesiology", keywords="internship and residency", keywords="trauma", keywords="hemorrhage", keywords="mobile applications", keywords="WhatsApp", keywords="smartphone", keywords="teaching materials", keywords="mobile phone", abstract="Background: The WhatsApp smartphone app is the most widely used instant messaging app in the world. Recent studies reported the use of WhatsApp for educational purposes, but there is no prospective study comparing WhatsApp's pedagogical effectiveness to that of any other teaching modality. Objective: The main objective of this study was to measure the impact of a learning program via WhatsApp on clinical reasoning in medical residents. Methods: This prospective, randomized, multicenter study was conducted among first- and second-year anesthesiology residents (offline recruitment) from four university hospitals in France. Residents were randomized in two groups of online teaching (WhatsApp and control). The WhatsApp group benefited from daily delivery of teaching documents on the WhatsApp app and a weekly clinical case supervised by a senior physician. In the control group, residents had access to the same documents via a traditional computer electronic learning (e-learning) platform. Medical reasoning was self-assessed online by a script concordance test (SCT; primary parameter), and medical knowledge was assessed using multiple-choice questions (MCQs). The residents also completed an online satisfaction questionnaire. Results: In this study, 62 residents were randomized (32 to the WhatsApp group and 30 to the control group) and 22 residents in each group answered the online final evaluation. We found a difference between the WhatsApp and control groups for SCTs (60\% [SD 9\%] vs 68\% [SD 11\%]; P=.006) but no difference for MCQs (18/30 [SD 4] vs 16/30 [SD 4]; P=.22). Concerning satisfaction, there was a better global satisfaction rate in the WhatsApp group than in the control group (8/10 [interquartile range 8-9] vs 8/10 [interquartile range 8-8]; P=.049). Conclusions: Compared to traditional e-learning, the use of WhatsApp for teaching residents was associated with worse clinical reasoning despite better global appreciation. The use of WhatsApp probably contributes to the dispersion of attention linked to the use of the smartphone. The impact of smartphones on clinical reasoning should be studied further. ", doi="10.2196/12825", url="http://mhealth.jmir.org/2019/4/e12825/", url="http://www.ncbi.nlm.nih.gov/pubmed/30964435" } @Article{info:doi/10.2196/10464, author="Aylwin, Christopher", title="Faculty and Student Interaction in an Online Master's Course: Survey and Content Analysis", journal="JMIR Med Educ", year="2019", month="Apr", day="4", volume="5", number="1", pages="e10464", keywords="online learning", keywords="faculty \& student interaction", keywords="Community of Inquiry", keywords="medicine", abstract="Background: The provision of online educational courses has soared since the creation of the World Wide Web, with most universities offering some degree of distance-based programs. The social constructivist pedagogy is widely accepted as the framework to provide education, but it largely relies on the face-to-face presence of students and faculty to foster a learning environment. The concern with online courses is that this physical interaction is removed, and therefore learning may be diminished. Objective: The Community of Inquiry (CoI) is a framework designed to support the educational experience of such courses. This study aims to examine the characteristics of the CoI across the whole of an entirely online master's course. Methods: This research used a case study method, using a convergent parallel design to study the interactions described by the CoI model in an online master's program. The MSc program studied is a postgraduate medical degree for doctors or allied health professionals. Different data sources were used to corroborate this dataset including content analysis of both asynchronous and synchronous discussion forums. Results: This study found that a CoI can be created within the different learning activities of the course. The discussion forums integral to online courses are a rich source of interaction, with the ability to promote social interaction, teaching presence, and cognitive learning. Conclusions: The results show that meaningful interaction between faculty and student can be achieved in online courses, which is important to ensure deep learning and reflection. ", doi="10.2196/10464", url="http://mededu.jmir.org/2019/1/e10464/", url="http://www.ncbi.nlm.nih.gov/pubmed/30958274" } @Article{info:doi/10.2196/13128, author="de Leeuw, Robert and de Soet, Anneloes and van der Horst, Sabine and Walsh, Kieran and Westerman, Michiel and Scheele, Fedde", title="How We Evaluate Postgraduate Medical E-Learning: Systematic Review", journal="JMIR Med Educ", year="2019", month="Apr", day="05", volume="5", number="1", pages="e13128", keywords="distance education", keywords="learning", keywords="professional education", abstract="Background: Electronic learning (e-learning) in postgraduate medical education has seen a rapid evolution; however, we tend to evaluate it only on its primary outcome or learning aim, whereas its effectiveness also depends on its instructional design. We believe it is important to have an overview of all the methods currently used to evaluate e-learning design so that the preferred method may be identified and the next steps needed to continue to evaluate postgraduate medical e-learning may be outlined. Objective: This study aimed to identify and compare the outcomes and methods used to evaluate postgraduate medical e-learning. Methods: We performed a systematic literature review using the Web of Science, PubMed, Education Resources Information Center, and Cumulative Index of Nursing and Allied Health Literature databases. Studies that used postgraduates as participants and evaluated any form of e-learning were included. Studies without any evaluation outcome (eg, just a description of e-learning) were excluded. Results: The initial search identified 5973 articles, of which we used 418 for our analysis. The types of studies were trials, prospective cohorts, case reports, and reviews. The primary outcomes of the included studies were knowledge, skills, and attitude. A total of 12 instruments were used to evaluate a specific primary outcome, such as laparoscopic skills or stress related to training. The secondary outcomes mainly evaluated satisfaction, motivation, efficiency, and usefulness. We found 13 e-learning design methods across 19 studies (4\% 19/418). The methods evaluated usability, motivational characteristics, and the use of learning styles or were based on instructional design theories, such as Gagne's instructional design, the Heidelberg inventory, Kern's curriculum development steps, and a scale based on the cognitive load theory. Finally, 2 instruments attempted to evaluate several aspects of a design, based on the experience of creating e-learning. Conclusions: Evaluating the effect of e-learning design is complicated. Given the diversity of e-learning methods, there are many ways to carry out such an evaluation, and probably, many ways to do so correctly. However, the current literature shows us that we have yet to reach any form of consensus about which indicators to evaluate. There is a great need for an evaluation tool that is properly constructed, validated, and tested. This could be a more homogeneous way to compare the effects of e-learning and for the authors of e-learning to continue to improve their product. ", doi="10.2196/13128", url="http://mededu.jmir.org/2019/1/e13128/", url="http://www.ncbi.nlm.nih.gov/pubmed/30950805" } @Article{info:doi/10.2196/12127, author="Zhang, Wei and Li, Zheng-Rong and Li, Zhi", title="WeChat as a Platform for Problem-Based Learning in a Dental Practical Clerkship: Feasibility Study", journal="J Med Internet Res", year="2019", month="Mar", day="19", volume="21", number="3", pages="e12127", keywords="PBL", keywords="app", keywords="WeChat", keywords="clerkship", keywords="dental medicine", abstract="Background: Problem-Based-Learning (PBL) has been widely accepted in student-centered medical education. Since WeChat is the most popular communication app in China, we have chosen to use WeChat as new platform for online PBL in order to reduce the limitations of traditional PBL in dental practical clerkships. Objective: This study aims to demonstrate the feasibility and acceptability of online PBL using WeChat (WeChat-PBL) in a dental practical clerkship. Methods: A total of 72 students in a dental practical clerkship and 10 tutors participated in this study from June to August 2017. We created 10 WeChat groups to provide a communication platform for the PBL teaching, in which the students selected the PBL cases themselves from their practical clerkship. After each individual PBL case, group members were required to complete an evaluation on the PBL process itself. A final questionnaire survey was completed by the participants to summarize the long-term evaluation of the whole WeChat-PBL experience after the 3-month clerkship. Data from the PBL cases, WeChat messages, periodic evaluations, and long-term evaluations were collected for analysis. Results: There were 45 cases presented in the WeChat-PBL within the 3-month clerkship. All students had positive reactions to the communication within the PBL groups. The results of the periodic evaluation showed that the students and tutors were quite satisfied with the process of WeChat-PBL and appreciated the group members' contributions and performance. The final questionnaire results indicated that the WeChat-PBL had achieved positive effects. Conclusions: The results of this study indicate the feasibility and acceptability of the app, WeChat, for problem-based learning in a dental practical clerkship. ", doi="10.2196/12127", url="http://www.jmir.org/2019/3/e12127/", url="http://www.ncbi.nlm.nih.gov/pubmed/30888328" } @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/mededu.9081, author="Zhou, Leming and Parmanto, Bambang and Joshi, James", title="Development and Evaluation of a New Security and Privacy Track in a Health Informatics Graduate Program: Multidisciplinary Collaboration in Education", journal="JMIR Med Educ", year="2018", month="Dec", day="21", volume="4", number="2", pages="e19", keywords="information security", keywords="research projects", keywords="partnership and collaboration", abstract="Background: The widespread application of technologies such as electronic health record systems, mobile health apps, and telemedicine platforms, has made it easy for health care providers to collect relevant data and deliver health care regimens. While efficacious, these new technologies also pose serious security and privacy challenges. Objective: The training program described here aims at preparing well-informed health information security and privacy professionals with enhanced course materials and various approaches. Methods: A new educational track has been built within a health informatics graduate program. Several existing graduate courses have been enhanced with new security and privacy modules. New labs and seminars have been created, and students are being encouraged to participate in research projects and obtain real-world experience from industry partners. Students in this track receive both theoretical education and hands-on practice. Evaluations have been performed on this new track by conducting multiple surveys on a sample of students. Results: We have succeeded in creating a new security track and developing a pertinent curriculum. The newly created security materials have been implemented in multiple courses. Our evaluation indicated that students (N=72) believed that receiving security and privacy training was important for health professionals, the provided security contents were interesting, and having the enhanced security and privacy training in this program was beneficial for their future career. Conclusions: The security and privacy education for health information professionals in this new security track has been significantly enhanced. ", doi="10.2196/mededu.9081", url="http://mededu.jmir.org/2018/2/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578227" } @Article{info:doi/10.2196/games.9611, author="Motz, Patrick and Gray, Megan and Sawyer, Taylor and Kett, Jennifer and Danforth, Douglas and Maicher, Kellen and Umoren, Rachel", title="Virtual Antenatal Encounter and Standardized Simulation Assessment (VANESSA): Pilot Study", journal="JMIR Serious Games", year="2018", month="May", day="11", volume="6", number="2", pages="e8", keywords="prenatal counseling", keywords="simulation", keywords="ethics", abstract="Background: Prenatal counseling at the limits of newborn viability involves sensitive interactions between neonatal providers and families. Empathetic discussions are currently learned through practice in times of high stress. Decision aids may help improve provider communication but have not been universally adopted. Virtual standardized patients are increasingly recognized as a modality for education, but prenatal counseling simulations have not been described. To be valuable as a tool, a virtual patient would need to accurately portray emotions and elicit a realistic response from the provider. Objective: To determine if neonatal providers can accurately identify a standardized virtual prenatal patient's emotional states and examine the frequency of empathic responses to statements made by the patient. Methods: A panel of Neonatologists, Simulation Specialists, and Ethicists developed a dialogue and identified empathic responses. Virtual Antenatal Encounter and Standardized Simulation Assessment (VANESSA), a screen-based simulation of a woman at 23 weeks gestation, was capable of displaying anger, fear, sadness, and happiness through animations. Twenty-four neonatal providers, including a subgroup with an ethics interest, were asked to identify VANESSA's emotions 28 times, respond to statements, and answer open-ended questions. The emotions were displayed in different formats: without dialogue, with text dialogue, and with audio dialogue. Participants completed a post-encounter survey describing demographics and experience. Data were reported using descriptive statistics. Qualitative data from open ended questions (eg, ``What would you do?'') were examined using thematic analysis. Results: Half of our participants had over 10 years of clinical experience. Most participants reported using medical research (18/23, 78\%) and mortality calculators (17/23, 74\%). Only the ethics-interested subgroup (10/23, 43\%) listed counseling literature (7/10, 70\%). Of 672 attempts, participants accurately identified VANESSA's emotions 77.8\% (523/672) of the time, and most (14/23, 61\%) reported that they were confident in identifying these emotions. The ethics interest group was more likely to choose empathic responses (P=.002). Participants rated VANESSA as easy to use (22/23, 96\%) and reported that she had realistic dialogue (15/23, 65\%). Conclusions: This pilot study shows that a prenatal counseling simulation is feasible and can yield useful data on prenatal counseling communication. Our participants showed a high rate of emotion recognition and empathy in their responses. ", doi="10.2196/games.9611", url="http://games.jmir.org/2018/2/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/29752249" } @Article{info:doi/10.2196/mededu.9365, author="de Leeuw, Adrianus Robert and Walsh, Kieran and Westerman, Michiel and Scheele, Fedde", title="Consensus on Quality Indicators of Postgraduate Medical E-Learning: Delphi Study", journal="JMIR Med Educ", year="2018", month="Apr", day="26", volume="4", number="1", pages="e13", keywords="postgraduate medical education", keywords="continuing medical education", keywords="e-learning", keywords="distance education", keywords="quality tool", keywords="quality indicators", keywords="education, medical", keywords="education, medical, continuing", keywords="education, distance", abstract="Background: The progressive use of e-learning in postgraduate medical education calls for useful quality indicators. Many evaluation tools exist. However, these are diversely used and their empirical foundation is often lacking. Objective: We aimed to identify an empirically founded set of quality indicators to set the bar for ``good enough'' e-learning. Methods: We performed a Delphi procedure with a group of 13 international education experts and 10 experienced users of e-learning. The questionnaire started with 57 items. These items were the result of a previous literature review and focus group study performed with experts and users. Consensus was met when a rate of agreement of more than two-thirds was achieved. Results: In the first round, the participants accepted 37 items of the 57 as important, reached no consensus on 20, and added 15 new items. In the second round, we added the comments from the first round to the items on which there was no consensus and added the 15 new items. After this round, a total of 72 items were addressed and, of these, 37 items were accepted and 34 were rejected due to lack of consensus. Conclusions: This study produced a list of 37 items that can form the basis of an evaluation tool to evaluate postgraduate medical e-learning. This is, to our knowledge, the first time that quality indicators for postgraduate medical e-learning have been defined and validated. The next step is to create and validate an e-learning evaluation tool from these items. ", doi="10.2196/mededu.9365", url="http://mededu.jmir.org/2018/1/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/29699970" } @Article{info:doi/10.2196/mededu.9516, author="Al Nsour, Mohannad and Iblan, Ibrahim and Tarawneh, Rasoul Mohammed", title="Jordan Field Epidemiology Training Program: Critical Role in National and Regional Capacity Building", journal="JMIR Med Educ", year="2018", month="Apr", day="11", volume="4", number="1", pages="e12", keywords="field epidemiology", keywords="training program", keywords="education", keywords="capacity building", keywords="disease outbreaks", keywords="public health surveillance", keywords="epidemiological monitoring", keywords="Jordan", doi="10.2196/mededu.9516", url="http://mededu.jmir.org/2018/1/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/29643050" } @Article{info:doi/10.2196/mededu.9185, author="Vaysse, Charlotte and Chantalat, Elodie and Beyne-Rauzy, Odile and Morineau, Louise and Despas, Fabien and Bachaud, Jean-Marc and Caunes, Nathalie and Poublanc, Muriel and Serrano, Elie and Bugat, Roland and Roug{\'e} Bugat, Marie-Eve and Fize, Anne-Laure", title="The Impact of a Small Private Online Course as a New Approach to Teaching Oncology: Development and Evaluation", journal="JMIR Med Educ", year="2018", month="Mar", day="05", volume="4", number="1", pages="e6", keywords="oncology", keywords="health education", keywords="continuing education", keywords="e-learning", keywords="SPOC", keywords="small private online course", keywords="education, medical", keywords="education, medical, continuing", abstract="Background: Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. Objective: The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). Methods: A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants' satisfaction rate through a questionnaire and the success of the SPOC by participants' completion, success, and commitment rates. Results: Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients' associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7\% (90/446) had an independent medical practice, 38.5\% (140/446) worked in a public institution, and 36.8\% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9\% (384/446) thought they had learned new information, 90.8\% (405/446) felt their expectations were met, and 90.4\% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51\% (559/1574), the success rate was 71.47\% (1025/1574), and the commitment rate was 64.67\% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants. Conclusions: SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students' expectations. ", doi="10.2196/mededu.9185", url="http://mededu.jmir.org/2018/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/29506968" } @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/jmir.8336, author="Cooper, Zafra and Bailey-Straebler, Suzanne and Morgan, E. Katy and O'Connor, E. Marianne and Caddy, Caroline and Hamadi, Layla and Fairburn, G. Christopher", title="Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods", journal="J Med Internet Res", year="2017", month="Oct", day="18", volume="19", number="10", pages="e355", keywords="psychotherapy", keywords="training", keywords="Internet", keywords="eating disorders", keywords="cognitive therapy", abstract="Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise. Objective: The goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects. Methods: Eligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training. Results: A total of 160 therapists expressed interest in the study, and 156 (97.5\%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being --0.06 (95\% Cl --1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9\%) scored above the competence threshold; three-quarters (43/58, 74\%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95\% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95\% Cl --1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference --0.70, 95\% CI --1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95\% Cl 0.34 to 2.62; P=.92). Conclusions: Web-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments. ", doi="10.2196/jmir.8336", url="http://www.jmir.org/2017/10/e355/", url="http://www.ncbi.nlm.nih.gov/pubmed/29046265" } @Article{info:doi/10.2196/mededu.7730, author="Shah, H. Shikhar and Clark, D. Maureen and Hu, Kimberly and Shoener, A. Jalene and Fogel, Joshua and Kling, C. William and Ronayne, James", title="Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study", journal="JMIR Med Educ", year="2017", month="Oct", day="17", volume="3", number="2", pages="e18", keywords="health policy", keywords="education, public health professional", keywords="education, medical", keywords="legislation, medical", keywords="problem-based learning", keywords="knowledge management", keywords="interdisciplinary communication", abstract="Background: There is a dearth of advocacy training in graduate medical education in the United States. To address this void, the Legislative Education and Advocacy Development (LEAD) course was developed as an interprofessional experience, partnering a cohort of pediatrics residents, fourth-year medical students, and public health students to be trained in evidence-informed health policy making. Objective: The objective of our study was to evaluate the usefulness and acceptability of a service-based legislative advocacy course. Methods: We conducted a pilot study using a single-arm pre-post study design with 10 participants in the LEAD course. The course's didactic portion taught learners how to define policy problems, research the background of the situation, brainstorm solutions, determine evaluation criteria, develop communication strategies, and formulate policy recommendations for state legislators. Learners worked in teams to create and present policy briefs addressing issues submitted by participating Illinois State legislators. We compared knowledge and attitudes of learners from pre- and postcourse surveys. We obtained qualitative feedback from legislators and pediatric residency directors. Results: Self-reported understanding of the health care system increased (mean score from 4 to 3.3, P=.01), with answers scored from 1=highly agree to 5=completely disagree. Mean knowledge-based scores improved (6.8/15 to 12.0/15 correct). Pediatric residency program directors and state legislators provided positive feedback about the LEAD course. Conclusions: Promising results were demonstrated for the LEAD approach to incorporate advocacy training into graduate medical education. ", doi="10.2196/mededu.7730", url="http://mededu.jmir.org/2017/2/e18/", url="http://www.ncbi.nlm.nih.gov/pubmed/29042343" } @Article{info:doi/10.2196/jmir.7506, author="Micheel, M. Christine and Anderson, A. Ingrid and Lee, Patricia and Chen, Sheau-Chiann and Justiss, Katy and Giuse, B. Nunzia and Ye, Fei and Kusnoor, V. Sheila and Levy, A. Mia", title="Internet-Based Assessment of Oncology Health Care Professional Learning Style and Optimization of Materials for Web-Based Learning: Controlled Trial With Concealed Allocation", journal="J Med Internet Res", year="2017", month="Jul", day="25", volume="19", number="7", pages="e265", keywords="e-learning", keywords="Web-based Instruction", keywords="learning", keywords="teaching materials", keywords="information dissemination", keywords="online systems", keywords="education, distance", keywords="continuing education", keywords="medical oncology/education", abstract="Background: Precision medicine has resulted in increasing complexity in the treatment of cancer. Web-based educational materials can help address the needs of oncology health care professionals seeking to understand up-to-date treatment strategies. Objective: This study aimed to assess learning styles of oncology health care professionals and to determine whether learning style-tailored educational materials lead to enhanced learning. Methods: In all, 21,465 oncology health care professionals were invited by email to participate in the fully automated, parallel group study. Enrollment and follow-up occurred between July 13 and September 7, 2015. Self-enrolled participants took a learning style survey and were assigned to the intervention or control arm using concealed alternating allocation. Participants in the intervention group viewed educational materials consistent with their preferences for learning (reading, listening, and/or watching); participants in the control group viewed educational materials typical of the My Cancer Genome website. Educational materials covered the topic of treatment of metastatic estrogen receptor-positive (ER+) breast cancer using cyclin-dependent kinases 4/6 (CDK4/6) inhibitors. Participant knowledge was assessed immediately before (pretest), immediately after (posttest), and 2 weeks after (follow-up test) review of the educational materials. Study statisticians were blinded to group assignment. Results: A total of 751 participants enrolled in the study. Of these, 367 (48.9\%) were allocated to the intervention arm and 384 (51.1\%) were allocated to the control arm. Of those allocated to the intervention arm, 256 (69.8\%) completed all assessments. Of those allocated to the control arm, 296 (77.1\%) completed all assessments. An additional 12 participants were deemed ineligible and one withdrew. Of the 552 participants, 438 (79.3\%) self-identified as multimodal learners. The intervention arm showed greater improvement in posttest score compared to the control group (0.4 points or 4.0\% more improvement on average; P=.004) and a higher follow-up test score than the control group (0.3 points or 3.3\% more improvement on average; P=.02). Conclusions: Although the study demonstrated more learning with learning style-tailored educational materials, the magnitude of increased learning and the largely multimodal learning styles preferred by the study participants lead us to conclude that future content-creation efforts should focus on multimodal educational materials rather than learning style-tailored content. ", doi="10.2196/jmir.7506", url="http://www.jmir.org/2017/7/e265/", url="http://www.ncbi.nlm.nih.gov/pubmed/28743680" } @Article{info:doi/10.2196/mededu.6590, author="Ma, Zhenyu and Yang, Li and Yang, Lan and Huang, Kaiyong and Yu, Hongping and He, Huimin and Wang, Jiaji and Cai, Le and Wang, Jie and Fu, Hua and Quintiliani, Lisa and Friedman, H. Robert and Xiao, Jian and Abdullah, S. Abu", title="Developing a Curriculum for Information and Communications Technology Use in Global Health Research and Training: A Qualitative Study Among Chinese Health Sciences Graduate Students", journal="JMIR Med Educ", year="2017", month="Jun", day="12", volume="3", number="1", pages="e11", keywords="information and communication technology", keywords="ICT", keywords="global health", keywords="research", keywords="training", keywords="China", abstract="Background: Rapid development of information and communications technology (ICT) during the last decade has transformed biomedical and population-based research and has become an essential part of many types of research and educational programs. However, access to these ICT resources and the capacity to use them in global health research are often lacking in low- and middle-income country (LMIC) institutions. Objective: The aim of our study was to assess the practical issues (ie, perceptions and learning needs) of ICT use among health sciences graduate students at 6 major medical universities of southern China. Methods: Ten focus group discussions (FGDs) were conducted from December 2015 to March 2016, involving 74 health sciences graduate students studying at 6 major medical universities in southern China. The sampling method was opportunistic, accounting for the graduate program enrolled and the academic year. All FGDs were audio recorded and thematic content analysis was performed. Results: Researchers had different views and arguments about the use of ICT which are summarized under six themes: (1) ICT use in routine research, (2) ICT-related training experiences, (3) understanding about the pros and cons of Web-based training, (4) attitudes toward the design of ICT training curriculum, (5) potential challenges to promoting ICT courses, and (6) related marketing strategies for ICT training curriculum. Many graduate students used ICT on a daily basis in their research to stay up-to-date on current development in their area of research or study or practice. The participants were very willing to participate in ICT courses that were relevant to their academic majors and would count credits. Suggestion for an ICT curriculum included (1) both organized training course or short lecture series, depending on the background and specialty of the students, (2) a mixture of lecture and Web-based activities, and (3) inclusion of topics that are career focused. Conclusions: The findings of this study suggest that a need exists for a specialized curriculum related to ICT use in health research for health sciences graduate students in China. The results have important implications for the design and implementation of ICT-related educational program in China or other developing countries. ", doi="10.2196/mededu.6590", url="http://mededu.jmir.org/2017/1/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/28606894" } @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/jmir.6199, author="DelSignore, A. Lisa and Wolbrink, A. Traci and Zurakowski, David and Burns, P. Jeffrey", title="Test-Enhanced E-Learning Strategies in Postgraduate Medical Education: A Randomized Cohort Study", journal="J Med Internet Res", year="2016", month="Nov", day="21", volume="18", number="11", pages="e299", keywords="distance learning", keywords="computer-assisted instruction", keywords="medical education", keywords="educational measurement", keywords="retention", abstract="Background: The optimal design of pedagogical strategies for e-learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with initial research suggesting that taking short breaks while watching videos (independent of answering test questions) may improve learning by focusing attention on the content presented. Interspersed test questions may also improve knowledge acquisition and retention. Objective: To examine the effect of interspersed test questions and periodic breaks on immediate knowledge acquisition and retention at 6 months by pediatric residents engaged in video-based e-learning. Methods: First- and second-year pediatric residents were randomized to 1 of the following 3 groups: viewing the complete video uninterrupted (full video), viewing the video interrupted with unrelated logic puzzles (logic puzzles), or viewing the video interrupted with brief comprehension test questions (short answer questions). Residents answered pre- and post-tests before and after video viewing, followed by a retention test at 6 months. Primary outcome included comparison of the change in test scores between groups. Results: A total of 49 residents completed the initial testing session. All 3 learning groups had comparable mean increases in immediate knowledge gain, but with no significant differences between groups (F2,46=0.35, P=.71). Thirty-five residents completed retention testing with comparable degrees of knowledge retention in the full video and short answer test questions groups (P<.001), but no significant change in the logic puzzles group (F1,32=2.44, P=.13). Conclusions: Improved knowledge gain was not demonstrated among residents answering interspersed questions or completing logic puzzles during interrupted online video viewing when compared with residents viewing uninterrupted video content. However, residents who either participated in uninterrupted video viewing or answered interspersed questions during interrupted video viewing demonstrated significant knowledge retention at 6 months. ", doi="10.2196/jmir.6199", url="http://www.jmir.org/2016/11/e299/", url="http://www.ncbi.nlm.nih.gov/pubmed/27872034" } @Article{info:doi/10.2196/jmir.6299, author="Liu, Chunfeng and Lim, L. Renee and McCabe, L. Kathryn and Taylor, Silas and Calvo, A. Rafael", title="A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study", journal="J Med Internet Res", year="2016", month="Sep", day="12", volume="18", number="9", pages="e246", keywords="nonverbal communication", keywords="nonverbal behavior", keywords="clinical consultation", keywords="medical education", keywords="communication skills", keywords="nonverbal behavior detection", keywords="automated feedback", keywords="affective computing", abstract="Background: In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students' awareness of their nonverbal communication. Objective: This study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students. Methods: We conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1--5 (group A) or to complete EQClinic training during weeks 8--11 (group B). EQClinic delivered an automated visual presentation of students' nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6--7 and 12--13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students' performance during face-to-face consultations pre- and postexposure to EQClinic. Results: We randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4--16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement. Conclusions: The EQClinic is a useful tool for medical students' clinical communication skills training that can be applied to university settings to improve students clinical communication skills development. ", doi="10.2196/jmir.6299", url="http://www.jmir.org/2016/9/e246/", url="http://www.ncbi.nlm.nih.gov/pubmed/27619564" } @Article{info:doi/10.2196/jmir.5534, author="Pathipati, S. Akhilesh and Azad, D. Tej and Jethwani, Kamal", title="Telemedical Education: Training Digital Natives in Telemedicine", journal="J Med Internet Res", year="2016", month="Jul", day="12", volume="18", number="7", pages="e193", keywords="telemedicine", keywords="medical education", keywords="medical school", keywords="curriculum reform", doi="10.2196/jmir.5534", url="http://www.jmir.org/2016/7/e193/", url="http://www.ncbi.nlm.nih.gov/pubmed/27405323" } @Article{info:doi/10.2196/mededu.5392, author="Bull, Preston Tyler and Dewar, Roxanne Alexis and Malvey, M. Donna and Szalma, Leo James", title="Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies", journal="JMIR Med Educ", year="2016", month="Jul", day="08", volume="2", number="2", pages="e11", keywords="telehealth systems", keywords="younger adults", keywords="telehealth advantages", keywords="telehealth disadvantages", keywords="thematic analysis", abstract="Background: While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. Objective: This study aims to examine the perceptions of telehealth systems within a large student sample. Methods: Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. Results: We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. Conclusion: By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems. ", doi="10.2196/mededu.5392", url="http://mededu.jmir.org/2016/2/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731865" } @Article{info:doi/10.2196/jmir.5612, author="Lefebvre, Cedric and Mesner, Jason and Stopyra, Jason and O'Neill, James and Husain, Iltifat and Geer, Carol and Gerancher, Karen and Atkinson, Hal and Harper, Erin and Huang, William and Cline, M. David", title="Social Media in Professional Medicine: New Resident Perceptions and Practices", journal="J Med Internet Res", year="2016", month="Jun", day="09", volume="18", number="6", pages="e119", keywords="social media", keywords="professionalism", keywords="physicians", keywords="education", abstract="Background: For younger generations, unconstrained online social activity is the norm. Little data are available about perceptions among young medical practitioners who enter the professional clinical arena, while the impact of existing social media policy on these perceptions is unclear. Objective: The objective of this study was to investigate the existing perceptions about social media and professionalism among new physicians entering in professional clinical practice; and to determine the effects of formal social media instruction and policy on young professionals' ability to navigate case-based scenarios about online behavior in the context of professional medicine. Methods: This was a prospective observational study involving the new resident physicians at a large academic medical center. Medical residents from 9 specialties were invited to participate and answer an anonymous questionnaire about social media in clinical medicine. Data were analyzed using SAS 9.4 (Cary, NC), chi-square or Fisher's exact test was used as appropriate, and the correct responses were compared between different groups using the Kruskal--Wallis analysis of variance. Results: Familiarity with current institutional policy was associated with an average of 2.2 more correct responses (P=.01). Instruction on social media use during medical school was related to correct responses for 2 additional questions (P=.03). On dividing the groups into no policy exposure, single policy exposure, or both exposures, the mean differences were found to be statistically significant (3.5, 7.5, and 9.4, respectively) (P=.03). Conclusions: In this study, a number of young physicians demonstrated a casual approach to social media activity in the context of professional medical practice. Several areas of potential educational opportunity and focus were identified: (1) online privacy, (2) maintaining digital professionalism, (3) safeguarding the protected health information of patients, and (4) the impact of existing social media policies. Prior social media instruction and/or familiarity with a social media policy are associated with an improved performance on case-based questions regarding online professionalism. This suggests a correlation between an instruction about online professionalism and more cautious online behavior. Improving the content and delivery of social media policy may assist in preserving institutional priorities, protecting patient information, and safeguarding young professionals from online misadventure. ", doi="10.2196/jmir.5612", url="http://www.jmir.org/2016/6/e119/", url="http://www.ncbi.nlm.nih.gov/pubmed/27283846" } @Article{info:doi/10.2196/publichealth.5018, author="Kunkle, Sarah and Christie, Gillian and Yach, Derek and El-Sayed, M. Abdulrahman", title="The Importance of Computer Science for Public Health Training: An Opportunity and Call to Action", journal="JMIR Public Health Surveill", year="2016", month="Mar", day="14", volume="2", number="1", pages="e10", keywords="digital health", keywords="public health", keywords="machine learning", keywords="computer science", keywords="health technology", keywords="chronic disease", doi="10.2196/publichealth.5018", url="http://publichealth.jmir.org/2016/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/27227145" } @Article{info:doi/10.2196/mededu.4580, author="Torous, John and O'Connor, Ryan and Franzen, Jamie and Snow, Caitlin and Boland, Robert and Kitts, Robert", title="Creating a Pilot Educational Psychiatry Website: Opportunities, Barriers, and NextSteps", journal="JMIR Medical Education", year="2015", month="Nov", day="05", volume="1", number="2", pages="e14", keywords="Psychiatry", keywords="Internet", keywords="Online", keywords="Education", keywords="Website", abstract="Background: While medical students and residents may be utilizing websites as online learning resources, medical trainees and educators now have the opportunity to create such educational websites and digital tools on their own. However, the process and theory of building educational websites for medical education have not yet been fully explored. Objective: To understand the opportunities, barriers, and process of creating a novel medical educational website. Methods: We created a pilot psychiatric educational website to better understand the options, opportunities, challenges, and processes involved in the creation of a psychiatric educational website. We sought to integrate visual and interactive Web design elements to underscore the potential of such Web technology. Results: A pilot website (PsychOnCall) was created to demonstrate the potential of Web technology in medical and psychiatric education. Conclusions: Creating an educational website is now technically easier than ever before, and the primary challenge no longer is technology but rather the creation, validation, and maintenance of information for such websites as well as translating text-based didactics into visual and interactive tools. Medical educators can influence the design and implementation of online educational resources through creating their own websites and engaging medical students and residents in the process. ", doi="10.2196/mededu.4580", url="http://mededu.jmir.org/2015/2/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731837" } @Article{info:doi/10.2196/resprot.4016, author="Janssen, Anna and Shaw, Tim and Goodyear, Peter", title="Using Video Games to Enhance Motivation States in Online Education: Protocol for a Team-Based Digital Game", journal="JMIR Res Protoc", year="2015", month="Sep", day="28", volume="4", number="3", pages="e114", keywords="digital games", keywords="medical education", keywords="online learning", abstract="Background: Video and computer games for education have been of interest to researchers for several decades. Over the last half decade, researchers in the health sector have also begun exploring the value of this medium. However, there are still many gaps in the literature regarding the effective use of video and computer games in medical education, particularly in relation to how learners interact with the platform, and how the games can be used to enhance collaboration. Objective: The objective of the study is to evaluate a team-based digital game as an educational tool for engaging learners and supporting knowledge consolidation in postgraduate medical education. Methods: A mixed methodology will be used in order to establish efficacy and level of motivation provided by a team-based digital game. Second-year medical students will be recruited as participants to complete 3 matches of the game at spaced intervals, in 2 evenly distributed teams. Prior to playing the game, participants will complete an Internet survey to establish baseline data. After playing the game, participants will voluntarily complete a semistructured interview to establish motivation and player engagement. Additionally, metrics collected from the game platform will be analyzed to determine efficacy. Results: The research is in the preliminary stages, but thus far a total of 54 participants have been recruited into the study. Additionally, a content development group has been convened to develop appropriate content for the platform. Conclusions: Video and computer games have been demonstrated to have value for educational purposes. Significantly less research has addressed how the medium can be effectively utilized in the health sector. Preliminary data from this study would suggest there is an interest in games for learning in the medical student body. As such, it is beneficial to undertake further research into how these games teach and engage learners in order to evaluate their role in tertiary and postgraduate medical education in the future. ", doi="10.2196/resprot.4016", url="http://www.researchprotocols.org/2002/3/e114/", url="http://www.ncbi.nlm.nih.gov/pubmed/26416522" } @Article{info:doi/10.2196/mededu.4267, author="O'Carroll, Marie Aoife and Westby, Patricia Erin and Dooley, Joseph and Gordon, E. Kevin", title="Information-Seeking Behaviors of Medical Students: A Cross-Sectional Web-Based Survey", journal="JMIR Medical Education", year="2015", month="Jun", day="29", volume="1", number="1", pages="e4", keywords="information-seeking behavior", keywords="information retrieval", keywords="Internet", keywords="medical education", keywords="medical students", abstract="Background: Medical students face an information-rich environment in which retrieval and appraisal strategies are increasingly important. Objective: To describe medical students' current pattern of health information resource use and characterize their experience of instruction on information search and appraisal. Methods: We conducted a cross-sectional web-based survey of students registered in the four-year MD Program at Dalhousie University (Halifax, Nova Scotia, and Saint John, New Brunswick, sites), Canada. We collected self-reported data on information-seeking behavior, instruction, and evaluation of resources in the context of their medical education. Data were analyzed using descriptive statistics. Results: Surveys were returned by 213 of 462 eligible students (46.1\%). Most respondents (165/204, 80.9\%) recalled receiving formal instruction regarding information searches, but this seldom included nontraditional tools such as Google (23/107, 11.1\%), Wikipedia, or social media. In their daily practice, however, they reported heavy use of these tools, as well as EBM summaries. Accessibility, understandability, and overall usefulness were common features of highly used resources. Students identified challenges managing information and/or resource overload and source accessibility. Conclusions: Medical students receive instruction primarily on searching and assessing primary medical literature. In their daily practice, however, they rely heavily on nontraditional tools as well as EBM summaries. Attention to appropriate use and appraisal of nontraditional sources might enhance the current EBM curriculum. ", doi="10.2196/mededu.4267", url="http://mededu.jmir.org/2015/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731842" } @Article{info:doi/10.2196/ijmr.3495, author="Brochhausen, Christoph and Winther, B. Hinrich and Hundt, Christian and Schmitt, H. Volker and Sch{\"o}mer, Elmar and Kirkpatrick, James C.", title="A Virtual Microscope for Academic Medical Education: The Pate Project", journal="Interact J Med Res", year="2015", month="May", day="11", volume="4", number="2", pages="e11", keywords="whole-slide imaging", keywords="WSI", keywords="virtual microscopy", keywords="telepathology", keywords="e-learning", keywords="databases", keywords="Internet", keywords="microscopy", abstract="Background: Whole-slide imaging (WSI) has become more prominent and continues to gain in importance in student teaching. Applications with different scope have been developed. Many of these applications have either technical or design shortcomings. Objective: To design a survey to determine student expectations of WSI applications for teaching histological and pathological diagnosis. To develop a new WSI application based on the findings of the survey. Methods: A total of 216 students were questioned about their experiences and expectations of WSI applications, as well as favorable and undesired features. The survey included 14 multiple choice and two essay questions. Based on the survey, we developed a new WSI application called Pate utilizing open source technologies. Results: The survey sample included 216 students---62.0\% (134) women and 36.1\% (78) men. Out of 216 students, 4 (1.9\%) did not disclose their gender. The best-known preexisting WSI applications included Mainzer Histo Maps (199/216, 92.1\%), Histoweb T{\"u}bingen (16/216, 7.4\%), and Histonet Ulm (8/216, 3.7\%). Desired features for the students were latitude in the slides (190/216, 88.0\%), histological (191/216, 88.4\%) and pathological (186/216, 86.1\%) annotations, points of interest (181/216, 83.8\%), background information (146/216, 67.6\%), and auxiliary informational texts (113/216, 52.3\%). By contrast, a discussion forum was far less important (9/216, 4.2\%) for the students. Conclusions: The survey revealed that the students appreciate a rich feature set, including WSI functionality, points of interest, auxiliary informational texts, and annotations. The development of Pate was significantly influenced by the findings of the survey. Although Pate currently has some issues with the Zoomify file format, it could be shown that Web technologies are capable of providing a high-performance WSI experience, as well as a rich feature set. ", doi="10.2196/ijmr.3495", url="http://www.i-jmr.org/2015/2/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/25963527" }