@Article{info:doi/10.2196/53133, author="Lee, Seonmi and Jeong, Jaehyun and Kim, Myungsung and Lee, Sangil and Kim, Sung-Phil and Jung, Dooyoung", title="Development of a Mobile Intervention for Procrastination Augmented With a Semigenerative Chatbot for University Students: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="10", volume="13", pages="e53133", keywords="procrastination", keywords="chatbot", keywords="generative model", keywords="semigenerative model", keywords="time management", keywords="cognitive behavioral therapy", keywords="psychological assessment", keywords="intervention engagement", keywords="emotional support", keywords="user experience", keywords="mobile intervention", keywords="artificial intelligence", keywords="AI", abstract="Background: Procrastination negatively affects university students' academics and mental health. Traditional time management apps lack therapeutic strategies like cognitive behavioral therapy to address procrastination's psychological aspects. Therefore, we developed and integrated a semigenerative chatbot named Moa into a to-do app. Objective: We intended to determine the benefits of the Moa-integrated to-do app over the app without Moa by verifying behavioral and cognitive changes, analyzing the influence of engagement patterns on the changes, and exploring the user experience. Methods: The developed chatbot Moa guided users over 30 days in terms of self-observation, strategy establishment, and reflection. The architecture comprised response-generating and procrastination factor--detection algorithms. A pilot randomized controlled trial was conducted with 85 participants (n=37, 44\% female; n=48, 56\% male) from a university in South Korea. The control group used a to-do app without Moa, whereas the treatment group used a fully automated Moa-integrated app. The Irrational Procrastination Scale, Pure Procrastination Scale, Time Management Behavior Scale, and the Perceived Stress Scale were examined using linear mixed models with repeated measurements obtained before (T0) and after (T1) 1-month use and after 2-month use (T2) to assess the changes in irrational procrastination, pure procrastination, time management and behavior, academic self-regulation, and stress. Intervention engagement, divided into ``high,'' ``middle'' and ``low'' clusters, was quantified using app access and use of the to-do list and grouped using k-means clustering. In addition, changes in the psychological scale scores between the control and treatment groups were analyzed within each cluster. User experience was quantified based on the usability, feasibility, and acceptability of and satisfaction with the app, whereas thematic analysis explored the users' subjective responses to app use. Results: In total, 75 participants completed the study. The interaction of time {\texttimes} procrastination was significant during the required use period (P=.01). The post hoc test indicated a significant improvement from T0 to T1 in the Time Management Behavior Scale and Perceived Stress Scale scores only in the treatment group (P<.001 and P=.009). The changes in Pure Procrastination Scale score after the required use period were significant in all clusters except for the low cluster of the control group. The high cluster in the treatment group exhibited a significant change in the Irrational Procrastination Scale after Bonferroni correction (P=.046). Usability was determined to be good in the treatment group (mean score 72.8, SD 16.0), and acceptability was higher than in the control group (P=.03). Evaluation of user experience indicated that only the participants in the treatment group achieved self-reflection and experienced an alliance with the app. Conclusions: The chatbot-integrated app demonstrated greater efficacy in influencing user behavior providing psychological support. It will serve as a valuable tool for managing procrastination and stress together. Trial Registration: Clinical Research Information Service (CRIS) KCT0009056; https://tinyurl.com/yc84tedk ", doi="10.2196/53133", url="https://mhealth.jmir.org/2025/1/e53133", url="http://www.ncbi.nlm.nih.gov/pubmed/40208664" } @Article{info:doi/10.2196/58897, author="Tseng, Liang-Wei and Lu, Yi-Chin and Tseng, Liang-Chi and Chen, Yu-Chun and Chen, Hsing-Yu", title="Performance of ChatGPT-4 on Taiwanese Traditional Chinese Medicine Licensing Examinations: Cross-Sectional Study", journal="JMIR Med Educ", year="2025", month="Mar", day="19", volume="11", pages="e58897", keywords="artificial intelligence", keywords="AI language understanding tools", keywords="ChatGPT", keywords="natural language processing", keywords="machine learning", keywords="Chinese medicine license exam", keywords="Chinese medical licensing examination", keywords="medical education", keywords="traditional Chinese medicine", keywords="large language model", abstract="Background: The integration of artificial intelligence (AI), notably ChatGPT, into medical education, has shown promising results in various medical fields. Nevertheless, its efficacy in traditional Chinese medicine (TCM) examinations remains understudied. Objective: This study aims to (1) assess the performance of ChatGPT on the TCM licensing examination in Taiwan and (2) evaluate the model's explainability in answering TCM-related questions to determine its suitability as a TCM learning tool. Methods: We used the GPT-4 model to respond to 480 questions from the 2022 TCM licensing examination. This study compared the performance of the model against that of licensed TCM doctors using 2 approaches, namely direct answer selection and provision of explanations before answer selection. The accuracy and consistency of AI-generated responses were analyzed. Moreover, a breakdown of question characteristics was performed based on the cognitive level, depth of knowledge, types of questions, vignette style, and polarity of questions. Results: ChatGPT achieved an overall accuracy of 43.9\%, which was lower than that of 2 human participants (70\% and 78.4\%). The analysis did not reveal a significant correlation between the accuracy of the model and the characteristics of the questions. An in-depth examination indicated that errors predominantly resulted from a misunderstanding of TCM concepts (55.3\%), emphasizing the limitations of the model with regard to its TCM knowledge base and reasoning capability. Conclusions: Although ChatGPT shows promise as an educational tool, its current performance on TCM licensing examinations is lacking. This highlights the need for enhancing AI models with specialized TCM training and suggests a cautious approach to utilizing AI for TCM education. Future research should focus on model improvement and the development of tailored educational applications to support TCM learning. ", doi="10.2196/58897", url="https://mededu.jmir.org/2025/1/e58897" } @Article{info:doi/10.2196/58100, author="Briggs, Blake and Mulekar, Madhuri and Morales, Hannah and Husain, Iltifat", title="Comparison of an Emergency Medicine Asynchronous Learning Platform Usage Before and During the COVID-19 Pandemic: Retrospective Analysis Study", journal="JMIR Med Educ", year="2025", month="Feb", day="21", volume="11", pages="e58100", keywords="asynchronous learning", keywords="medical education", keywords="podcast", keywords="COVID-19", keywords="emergency medicine", keywords="online learning", keywords="engagement", keywords="web-based", keywords="online study", keywords="online class", keywords="videoconferencing", keywords="assessment", keywords="effectiveness", keywords="challenges", keywords="knowledge retention", keywords="performance", keywords="virtual learning", keywords="pre-pandemic", keywords="post-pandemic", abstract="Background: The COVID-19 pandemic challenged medical educators due to social distancing. Podcasts and asynchronous learning platforms help distill medical education in a socially distanced environment. Medical educators interested in providing asynchronous teaching should know how these methods performed during the pandemic. Objective: The purpose of this study was to assess the level of engagement for an emergency medicine (EM) board review podcast and website platform, before and during the COVID-19 pandemic. We measured engagement via website traffic, including such metrics as visits, bounce rate, unique visitors, and page views. We also evaluated podcast analytics, which included total listeners, engaged listeners, and number of plays. Methods: Content was designed after the American Board of EM Model, covering only 1 review question per episode. Website traffic and podcast analytics were studied monthly from 2 time periods of 20 months each, before the pandemic (July 11, 2018, to February 31, 2020) and during the pandemic (May 1, 2020, to December 31, 2021). March and April 2020 data were omitted from the analysis due to variations in closure at various domestic and international locations. Results underwent statistical analysis in March 2022. Results: A total of 132 podcast episodes and 93 handouts were released from July 11, 2018, to December 31, 2021. The mean number of listeners per podcast increased significantly from 2.11 (SD 1.19) to 3.77 (SD 0.76; t test, P<.001), the mean number engaged per podcast increased from 1.72 (SD 1.00) to 3.09 (SD 0.62; t test, P<.001), and the mean number of plays per podcast increased from 42.54 (SD 40.66) to 69.23 (SD 17.54; t test, P=.012). Similarly, the mean number of visits per posting increased from 5.85 (SD 3.28) to 15.39 (SD 3.06; t test, P<.001), the mean number of unique visitors per posting increased from 3.74 (SD 1.83) to 10.41 (SD 2.33; t test, P<.001), and the mean number of page views per posting increased from 17.13 (SD 10.63) to 33.32 (SD 7.01; t test, P<.001). Note that, all measures showed a decrease from November 2021 to December 2021. Conclusions: During the COVID-19 pandemic, there was an increased engagement for our EM board review podcast and website platform over a long-term period, specifically through website visitors and the number of podcast plays. Medical educators should be aware of the increasing usage of web-based education tools, and that asynchronous learning is favorably viewed by learners. Limitations include the inability to view Spotify (Spotify Technology S.A.) analytics during the study period, and confounding factors like increased popularity of social media inadvertently promoting the podcast. ", doi="10.2196/58100", url="https://mededu.jmir.org/2025/1/e58100" } @Article{info:doi/10.2196/64780, author="Chang, Wen and Lin, Chun-Chih and Crilly, Julia and Lee, Hui-Ling and Chen, Li-Chin and Han, Chin-Yen", title="Virtual Reality Simulation for Undergraduate Nursing Students for Care of Patients With Infectious Diseases: Mixed Methods Study", journal="JMIR Med Educ", year="2025", month="Feb", day="11", volume="11", pages="e64780", keywords="virtual reality", keywords="infection control", keywords="learning motivation", keywords="learning attitudes", keywords="nursing education", abstract="Background: Virtual reality simulation (VRS) teaching offers nursing students a safe, immersive learning environment with immediate feedback, enhancing learning outcomes. Before the COVID-19 pandemic, nursing students had limited training and opportunities to care for patients in isolation units with infectious diseases. However, the pandemic highlighted the ongoing global priority of providing care for patients with infectious diseases. Objective: This study aims to (1) examine the effectiveness of VRS in preparing nursing students to care for patients with infectious diseases by assessing its impact on their theoretical knowledge, learning motivation, and attitudes; and (2) evaluate their experiences with VRS. Methods: This 2-phased mixed methods study recruited third-year undergraduate nursing students enrolled in the Integrated Emergency and Critical Care course at a university in Taiwan. Phase 1 used a quasi-experimental design to address objective 1 by comparing the learning outcomes of students in the VRS teaching program (experimental group) with those in the traditional teaching program (control group). Tools included an infection control written test, the Instructional Materials Motivation Survey, and a learning attitude questionnaire. The experimental group participated in a VRS lesson titled ``Caring for a Patient with COVID-19 in the Negative Pressure Unit'' as part of the infection control unit. In phase 2, semistructured interviews were conducted to address objective 2, exploring students' learning experiences. Results: A total of 107 students participated in phase 1, and 18 students participated in phase 2. Both the VRS and control groups showed significant improvements in theoretical knowledge scores (for the VRS group t46=--7.47; P<.001, for the control group t59=--4.04; P<.001). However, compared with the control group, the VRS group achieved significantly higher theoretical knowledge scores (t98.13=2.70; P=.008) and greater learning attention (t105=2.30; P=.02) at T1. Additionally, the VRS group demonstrated a statistically significant higher regression coefficient for learning confidence compared with the control group ($\beta$=.29; P=.03). The students' learning experiences in the VRS group were categorized into 4 themes: Applying Professional Knowledge to Patient Care, Enhancing Infection Control Skills, Demonstrating Patient Care Confidence, and Engaging in Real Clinical Cases. The core theme identified was Strengthening Clinical Patient Care Competencies. Conclusions: The findings suggest that VRS teaching significantly enhanced undergraduate nursing students' infection control knowledge, learning attention, and confidence. Qualitative insights reinforced the quantitative results, highlighting the holistic benefits of VRS teaching in nursing education, including improved learning outcomes. The positive impact on student motivation and attitudes indicates a potentially transformative approach to nursing education, particularly in the post--COVID-19 era, where digital and remote learning tools play an increasingly vital role. ", doi="10.2196/64780", url="https://mededu.jmir.org/2025/1/e64780" } @Article{info:doi/10.2196/57655, author="Zechner, Olivia and Schrom-Feiertag, Helmut and Wespi, Rafael and Pretolesi, Daniele and Nguyen, Quynh and Tscheligi, Manfred", title="Enhancing Mixed Reality Simulation Training Technology With Real-Time Performance Visualization: Mixed Methods Study With Medical First Responders", journal="JMIR XR Spatial Comput", year="2024", month="Dec", day="24", volume="1", pages="e57655", keywords="mixed reality", keywords="immersive technologies", keywords="simulation training", keywords="simulation", keywords="paramedic", keywords="medical first responders", keywords="human performance", keywords="stress", keywords="stress monitoring", keywords="human-centered design", abstract="Background: Mixed reality (MR) simulation training is emerging in paramedical education as a way to practice responding to stress-intensive scenarios like mass casualty incidents in a safe and controlled environment. Current training platforms, however, lack real-time stress and human performance monitoring tools. Objective: The study aims to enhance MR training for medical first responders through real-time evaluation of performance and stress levels, leveraging biosignal monitoring and advanced analytics to allow instructors to tailor feedback and maintain optimal challenge and safety levels. Methods: The study includes a structured, multiphase approach including initial requirement gathering (structured interviews and cocreation workshops), an online design survey, iterative prototype development, and a field trial (including training observations and interviews). Data were collected from 5 end user consortium members across Europe. Quantitative data from checklists were analyzed using frequencies and percentages to understand feature usage and event occurrences. Qualitative data from semistructured interviews and cocreation workshops were transcribed, coded, and subjected to thematic analysis to identify patterns and insights into the usability and effectiveness of the enhanced features in the MR training. Results: The study identified a number of requirements that medical first responders have for an MR training system, including requirements not included in currently available solutions. A total of 80 performance metrics were initially identified and refined to a set of 54 metrics, which were categorized into key performance indicator groups such as scene safety, triage performance, and communication. Requirements for smart wearables to monitor stress levels are provided and highlight the importance of a user-centered design process to provide users with effective tools that fit their needs. Stress visualization preferences are described in the form of a dashboard as well as in virtual environments surrounding the avatar. Using an iterative design process and user feedback, a training system was developed, integrating real-time performance tracking and stress monitoring. The field trial provided insights into the practical use of these features during a real training exercise, showed interaction preferences between trainer and trainees, and highlighted further improvement opportunities. Conclusions: This research enhances MR training for paramedics by integrating real-time performance metrics and stress indicators based on a human-centered design approach that aligns with end user needs, thereby laying the foundation for developing more effective and immersive training solutions for high-stress professions. ", doi="10.2196/57655", url="https://xr.jmir.org/2024/1/e57655" } @Article{info:doi/10.2196/64476, author="Bazie, Hiwot and Lemma, Bekele and Workneh, Anteneh and Estifanos, Ashebir", title="The Effect of Virtual Laboratories on the Academic Achievement of Undergraduate Chemistry Students: Quasi-Experimental Study", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e64476", keywords="virtual laboratory", keywords="practical chemistry", keywords="student achievement", keywords="undergraduate student", keywords="Dilla University", keywords="simulation", keywords="chemistry education", abstract="Background: Experimentation is crucial in chemistry education as it links practical experience with theoretical concepts. However, practical chemistry courses typically rely on real laboratory experiments and often face challenges such as limited resources, equipment shortages, and logistical constraints in university settings. To address these challenges, computer-based laboratories have been introduced as a potential solution, offering electronic simulations that replicate real laboratory experiences. Objective: This study examines the effect of virtual laboratories on the academic achievement of undergraduate chemistry students and evaluates their potential as a viable alternative or complement to traditional laboratory-based instruction. Methods: A quasi-experimental design was implemented to examine the cause-and-effect relationship between instructional methods and student outcomes. The study involved 60 fourth-year BSc chemistry students from Dilla University, divided into 3 groups: a real laboratory group (n=20), which performed real laboratory experiments; a virtual group (n=20), which used virtual laboratory simulations; and a lecture group (n=20), which received lecture-based instruction. Quantitative data were collected through tests administered before and after the intervention to assess academic performance. The data analysis used descriptive and inferential statistics, such as means and SDs, 1-way ANOVA, the Tukey honestly significant difference test, and independent-sample t tests (2-tailed), with a P value of .05 set for determining statistical significance. Results: Before the intervention, the results indicated no significant differences in academic achievement among the 3 groups (P=.99). However, after the intervention, notable differences were observed in student performance across the methods. The real laboratory group had the highest mean posttest score (mean 62.6, SD 10.7), followed by the virtual laboratory group (mean 55.5, SD 6.8) and the lecture-only group, which had the lowest mean score (mean 43.7, SD 11.5). ANOVA results confirmed significant differences between the groups (F2,57=18.429; P<.001). The Tukey post hoc test further revealed that the real laboratory group significantly outperformed the lecture-only group (mean difference 18.88; P<.001), while the virtual laboratory group also performed significantly better than the lecture-only group (mean difference 11.7; P=.001). However, no statistically significant difference was found between the real laboratory and virtual laboratory groups (mean difference 7.12; P=.07). In addition, gender did not significantly influence performance in the virtual laboratory group (P=.21), with no substantial difference in posttest scores between male and female students. Conclusions: These findings suggest that computer-based laboratories are a viable and effective alternative when real laboratories are unavailable, enhancing learning outcomes when compared with traditional lecture-based methods. Therefore, universities should consider integrating computer-based laboratories into their practical chemistry curricula to provide students with interactive and engaging learning experiences, especially when physical laboratories are inaccessible. ", doi="10.2196/64476", url="https://formative.jmir.org/2024/1/e64476" } @Article{info:doi/10.2196/59133, author="Takahashi, Hiromizu and Shikino, Kiyoshi and Kondo, Takeshi and Komori, Akira and Yamada, Yuji and Saita, Mizue and Naito, Toshio", title="Educational Utility of Clinical Vignettes Generated in Japanese by ChatGPT-4: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Aug", day="13", volume="10", pages="e59133", keywords="generative AI", keywords="ChatGPT-4", keywords="medical case generation", keywords="medical education", keywords="clinical vignettes", keywords="AI", keywords="artificial intelligence", keywords="Japanese", keywords="Japan", abstract="Background: Evaluating the accuracy and educational utility of artificial intelligence--generated medical cases, especially those produced by large language models such as ChatGPT-4 (developed by OpenAI), is crucial yet underexplored. Objective: This study aimed to assess the educational utility of ChatGPT-4--generated clinical vignettes and their applicability in educational settings. Methods: Using a convergent mixed methods design, a web-based survey was conducted from January 8 to 28, 2024, to evaluate 18 medical cases generated by ChatGPT-4 in Japanese. In the survey, 6 main question items were used to evaluate the quality of the generated clinical vignettes and their educational utility, which are information quality, information accuracy, educational usefulness, clinical match, terminology accuracy (TA), and diagnosis difficulty. Feedback was solicited from physicians specializing in general internal medicine or general medicine and experienced in medical education. Chi-square and Mann-Whitney U tests were performed to identify differences among cases, and linear regression was used to examine trends associated with physicians' experience. Thematic analysis of qualitative feedback was performed to identify areas for improvement and confirm the educational utility of the cases. Results: Of the 73 invited participants, 71 (97\%) responded. The respondents, primarily male (64/71, 90\%), spanned a broad range of practice years (from 1976 to 2017) and represented diverse hospital sizes throughout Japan. The majority deemed the information quality (mean 0.77, 95\% CI 0.75-0.79) and information accuracy (mean 0.68, 95\% CI 0.65-0.71) to be satisfactory, with these responses being based on binary data. The average scores assigned were 3.55 (95\% CI 3.49-3.60) for educational usefulness, 3.70 (95\% CI 3.65-3.75) for clinical match, 3.49 (95\% CI 3.44-3.55) for TA, and 2.34 (95\% CI 2.28-2.40) for diagnosis difficulty, based on a 5-point Likert scale. Statistical analysis showed significant variability in content quality and relevance across the cases (P<.001 after Bonferroni correction). Participants suggested improvements in generating physical findings, using natural language, and enhancing medical TA. The thematic analysis highlighted the need for clearer documentation, clinical information consistency, content relevance, and patient-centered case presentations. Conclusions: ChatGPT-4--generated medical cases written in Japanese possess considerable potential as resources in medical education, with recognized adequacy in quality and accuracy. Nevertheless, there is a notable need for enhancements in the precision and realism of case details. This study emphasizes ChatGPT-4's value as an adjunctive educational tool in the medical field, requiring expert oversight for optimal application. ", doi="10.2196/59133", url="https://mededu.jmir.org/2024/1/e59133", url="http://www.ncbi.nlm.nih.gov/pubmed/39137031" } @Article{info:doi/10.2196/51740, author="Srinivasa, Komal and Charlton, Amanda and Moir, Fiona and Goodyear-Smith, Felicity", title="How to Develop an Online Video for Teaching Health Procedural Skills: Tutorial for Health Educators New to Video Production", journal="JMIR Med Educ", year="2024", month="Aug", day="7", volume="10", pages="e51740", keywords="online video", keywords="developing video", keywords="procedural video", keywords="medical education", keywords="clinician educator", keywords="health education", abstract="Background: Clinician educators are experts in procedural skills that students need to learn. Some clinician educators are interested in creating their own procedural videos but are typically not experts in video production, and there is limited information on this topic in the clinical education literature. Therefore, we present a tutorial for clinician educators to develop a procedural video. Objective: We describe the steps needed to develop a medical procedural video from the perspective of a clinician educator new to creating videos, informed by best practices as evidenced by the literature. We also produce a checklist of elements that ensure a quality video. Finally, we identify the barriers and facilitators to making such a video. Methods: We used the example of processing a piece of skeletal muscle in a pathology laboratory to make a video. We developed the video by dividing it into 3 phases: preproduction, production, and postproduction. After writing the learning outcomes, we created a storyboard and script, which were validated by subject matter and audiovisual experts. Photos and videos were captured on a digital camera mounted on a monopod. Video editing software was used to sequence the video clips and photos, insert text and audio narration, and generate closed captions. The finished video was uploaded to YouTube (Google) and then inserted into open-source authoring software to enable an interactive quiz. Results: The final video was 4 minutes and 4 seconds long and took 70 hours to create. The final video included audio narration, closed captioning, bookmarks, and an interactive quiz. We identified that an effective video has six key factors: (1) clear learning outcomes, (2) being engaging, (3) being learner-centric, (4) incorporating principles of multimedia learning, (5) incorporating adult learning theories, and (6) being of high audiovisual quality. To ensure educational quality, we developed a checklist of elements that educators can use to develop a video. One of the barriers to creating procedural videos for a clinician educator who is new to making videos is the significant time commitment to build videography and editing skills. The facilitators for developing an online video include creating a community of practice and repeated skill-building rehearsals using simulations. Conclusions: We outlined the steps in procedural video production and developed a checklist of quality elements. These steps and the checklist can guide a clinician educator in creating a quality video while recognizing the time, technical, and cognitive requirements. ", doi="10.2196/51740", url="https://mededu.jmir.org/2024/1/e51740", url="http://www.ncbi.nlm.nih.gov/pubmed/39110488" } @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/10.2196/55678, author="Ferrer Costa, Jose and Moran, Nuria and Garcia Marti, Carlos and Colmenares Hernandez, Javier Leomar and Radu Ciorba Ciorba, Florin and Ciudad, Jose Maria", title="Immediate Impact of an 8-Week Virtual Reality Educational Program on Burnout and Work Engagement Among Health Care Professionals: Pre-Post Pilot Study", journal="JMIR XR Spatial Comput", year="2024", month="Apr", day="25", volume="1", pages="e55678", keywords="virtual reality", keywords="burnout", keywords="mindfulness", keywords="health care professionals", keywords="mental health", keywords="health promotion", keywords="educational intervention", abstract="Background: Health care professionals globally face increasing levels of burnout characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment, and it has been notably exacerbated during the COVID-19 pandemic. This condition not only impacts the well-being of health care workers but also affects patient care and contributes to significant economic burden. Traditional approaches to mitigating burnout have included various psychosocial interventions, with mindfulness being recognized for its effectiveness in enhancing mental health and stress management. The emergence of virtual reality (VR) technology offers a novel immersive platform for delivering mindfulness and emotional management training. Objective: This study aimed to evaluate the immediate impact of an 8-week VR educational program on burnout and work engagement among health care professionals. Methods: This nonrandomized pre-post intervention study enrolled 90 health care professionals, including nurses, physicians, and allied health staff, from 3 different centers. Of these 90 professionals, 83 (92\%) completed the program. The intervention consisted of 8 weekly VR sessions of 10-13 minutes each, using Meta Quest 2 headsets. The sessions focused on mindfulness and emotional management. The Maslach Burnout Inventory (MBI) and Utrecht Work Engagement Scale (UWES) were used for assessments. Data analysis involved inferential statistical techniques for evaluating the impact on the scales, including paired t tests for normally distributed variables and Wilcoxon signed rank tests for nonnormally distributed variables. The significance of changes was indicated by P values <.05, with effect sizes measured using Cohen d for t tests and Cohen r for Wilcoxon tests for quantifying the magnitude of the intervention's effect. Results: The statistical analysis revealed significant improvements in the MBI and UWES indices after the intervention (P<.05). Specifically, the MBI showed reductions in emotional exhaustion (t82=5.58; P<.001; Cohen d=0.61) and depersonalization (t82=4.67; P<.001; Cohen d=0.51), and an increase in personal accomplishment (t82=?3.62; P<.001; Cohen d=0.4). The UWES revealed enhancements in vigor (t82=?3.77; P<.001; Cohen d=0.41), dedication (Z=?3.63; P<.001; Cohen r=0.41), and absorption (Z=?3.52; P<.001; Cohen r=0.4). Conclusions: The study provides initial data supporting the effectiveness of VR-based educational programs for reducing burnout and enhancing work engagement among health care professionals. While limitations, such as the absence of a control group, are acknowledged, the significant improvements in burnout and engagement indices coupled with high participant adherence and minimal VR discomfort underline the potential of VR interventions in health care settings. These encouraging findings pave the way for more comprehensive studies, including randomized controlled trials, to further validate and expand upon these results. ", doi="10.2196/55678", url="https://xr.jmir.org/2024/1/e55678" } @Article{info:doi/10.2196/54067, author="Hudon, Alexandre and Kiepura, Barnab{\'e} and Pelletier, Myriam and Phan, V{\'e}ronique", title="Using ChatGPT in Psychiatry to Design Script Concordance Tests in Undergraduate Medical Education: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Apr", day="4", volume="10", pages="e54067", keywords="psychiatry", keywords="artificial intelligence", keywords="medical education", keywords="concordance scripts", keywords="machine learning", keywords="ChatGPT", keywords="evaluation", keywords="education", keywords="medical learners", keywords="learning", keywords="teaching", keywords="design", keywords="support", keywords="tool", keywords="validation", keywords="educational", keywords="accuracy", keywords="clinical questions", keywords="educators", abstract="Background: Undergraduate medical studies represent a wide range of learning opportunities served in the form of various teaching-learning modalities for medical learners. A clinical scenario is frequently used as a modality, followed by multiple-choice and open-ended questions among other learning and teaching methods. As such, script concordance tests (SCTs) can be used to promote a higher level of clinical reasoning. Recent technological developments have made generative artificial intelligence (AI)--based systems such as ChatGPT (OpenAI) available to assist clinician-educators in creating instructional materials. Objective: The main objective of this project is to explore how SCTs generated by ChatGPT compared to SCTs produced by clinical experts on 3 major elements: the scenario (stem), clinical questions, and expert opinion. Methods: This mixed method study evaluated 3 ChatGPT-generated SCTs with 3 expert-created SCTs using a predefined framework. Clinician-educators as well as resident doctors in psychiatry involved in undergraduate medical education in Quebec, Canada, evaluated via a web-based survey the 6 SCTs on 3 criteria: the scenario, clinical questions, and expert opinion. They were also asked to describe the strengths and weaknesses of the SCTs. Results: A total of 102 respondents assessed the SCTs. There were no significant distinctions between the 2 types of SCTs concerning the scenario (P=.84), clinical questions (P=.99), and expert opinion (P=.07), as interpretated by the respondents. Indeed, respondents struggled to differentiate between ChatGPT- and expert-generated SCTs. ChatGPT showcased promise in expediting SCT design, aligning well with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, albeit with a tendency toward caricatured scenarios and simplistic content. Conclusions: This study is the first to concentrate on the design of SCTs supported by AI in a period where medicine is changing swiftly and where technologies generated from AI are expanding much faster. This study suggests that ChatGPT can be a valuable tool in creating educational materials, and further validation is essential to ensure educational efficacy and accuracy. ", doi="10.2196/54067", url="https://mededu.jmir.org/2024/1/e54067" } @Article{info:doi/10.2196/45177, author="Richardson, X. Matt and Aytar, Osman and Hess-Wiktor, Katarzyna and Wamala-Andersson, Sarah", title="Digital Microlearning for Training and Competency Development of Older Adult Care Personnel: Mixed Methods Intervention Study to Assess Needs, Effectiveness, and Areas of Application", journal="JMIR Med Educ", year="2023", month="Dec", day="4", volume="9", pages="e45177", keywords="digital microlearning", keywords="elderly care", keywords="older adult care", keywords="competency development", keywords="implementation research", keywords="dementia", keywords="COVID-19", abstract="Background: Older adult care organizations face challenges today due to high personnel turnover and pandemic-related obstacles in conducting training and competence development programs in a time-sensitive and fit-for-purpose manner. Digital microlearning is a method that attempts to meet these challenges by more quickly adapting to the educational needs of organizations and individual employees in terms of time, place, urgency, and retention capacity more than the traditional competency development methods. Objective: This study aimed to determine if and how an app-based digital microlearning intervention can meet older adult care organizations' personnel competency development needs in terms of knowledge retention and work performance. Methods: This study assessed the use of a digital microlearning app, which was at the testing stage in the design thinking model among managerial (n=4) and operational (n=22) employees within 3 older adult care organizations. The app was used to conduct predetermined competency development courses for the staff. Baseline measurements included participants' previous training and competency development methods and participation, as well as perceived needs in terms of time, design, and channel. They then were introduced to and used a digital microlearning app to conduct 2 courses on one or more digital devices, schedules, and locations of their own choice during a period of {\textasciitilde}1 month. The digital app and course content, perceived knowledge retention, and work performance and satisfaction were individually assessed via survey upon completion. The survey was complemented with 4 semistructured focus group interviews, which allowed participants (in total 16 individuals: 6 managerial-administrative employees and 10 operational employees) to describe their experiences with the app and its potential usefulness within their organizations. Results: The proposed advantages of the digital microlearning app were largely confirmed by the participants' perceptions, particularly regarding the ease of use and accessibility, and efficiency and timeliness of knowledge delivery. Assessments were more positive among younger or less experienced employees with more diverse backgrounds. Participants expressed a positive inclination toward using the app, and suggestions provided regarding its potential development and broader use suggested a positive view of digitalization in general. Conclusions: Our results show that app-based digital microlearning appears to be an appropriate new method for providing personnel competency development within the older adult care setting. Its implementation in a larger sample can potentially provide more detailed insights regarding its intended effects. ", doi="10.2196/45177", url="https://mededu.jmir.org/2023/1/e45177", url="http://www.ncbi.nlm.nih.gov/pubmed/38048152" } @Article{info:doi/10.2196/45340, author="Sonawane, Urvi and Kasetti, Pragna", title="How Valid Are Cortisol and Galvanic Skin Responses in Measuring Student Stress During Training? Comment on the Psychological Effects of Simulation Training", journal="JMIR Med Educ", year="2023", month="Aug", day="18", volume="9", pages="e45340", keywords="augmented reality", keywords="AR", keywords="salivary cortisol", keywords="galvanic skin conductance", keywords="medical simulation", keywords="medical education", doi="10.2196/45340", url="https://mededu.jmir.org/2023/1/e45340", url="http://www.ncbi.nlm.nih.gov/pubmed/37594784" } @Article{info:doi/10.2196/47394, author="Kumwichar, Ponlagrit", title="Enhancing Learning About Epidemiological Data Analysis Using R for Graduate Students in Medical Fields With Jupyter Notebook: Classroom Action Research", journal="JMIR Med Educ", year="2023", month="May", day="29", volume="9", pages="e47394", keywords="learning", keywords="Jupyter", keywords="R", keywords="epidemiology", keywords="data analysis", keywords="medical education", keywords="graduate student", keywords="longitudinal data analysis", keywords="graduate education", keywords="implementation", abstract="Background: Graduate students in medical fields must learn about epidemiology and data analysis to conduct their research. R is a software environment used to develop and run packages for statistical analysis; it can be challenging for students to learn because of compatibility with their computers and problems with package installations. Jupyter Notebook was used to run R, which enhanced the graduate students' ability to learn epidemiological data analysis by providing an interactive and collaborative environment that allows for more efficient and effective learning. Objective: This study collected class reflections from students and their lecturer in the class ``Longitudinal Data Analysis Using R,'' identified problems that occurred, and illustrated how Jupyter Notebook can solve those problems. Methods: The researcher analyzed issues encountered in the previous class and devised solutions using Jupyter Notebook. These solutions were then implemented and applied to a new group of students. Reflections from the students were regularly collected and documented in an electronic form. The comments were then thematically analyzed and compared to those of the prior cohort. Results: Improvements that were identified included the ease of using Jupyter R for data analysis without needing to install packages, increased student questioning due to curiosity, and students having the ability to immediately use all code functions. After using Jupyter Notebook, the lecturer could stimulate interest more effectively and challenge students. Furthermore, they highlighted that students responded to questions. The student feedback shows that learning R with Jupyter Notebook was effective in stimulating their interest. Based on the feedback received, it can be inferred that using Jupyter Notebook to learn R is an effective approach for equipping students with an all-encompassing comprehension of longitudinal data analysis. Conclusions: The use of Jupyter Notebook can improve graduate students' learning experience for epidemiological data analysis by providing an interactive and collaborative environment that is not affected by compatibility issues with different operating systems and computers. ", doi="10.2196/47394", url="https://mededu.jmir.org/2023/1/e47394", url="http://www.ncbi.nlm.nih.gov/pubmed/37247206" } @Article{info:doi/10.2196/43916, author="Preiksaitis, Carl and Dayton, R. John and Kabeer, Rana and Bunney, Gabrielle and Boukhman, Milana", title="Teaching Principles of Medical Innovation and Entrepreneurship Through Hackathons: Case Study and Qualitative Analysis", journal="JMIR Med Educ", year="2023", month="Feb", day="24", volume="9", pages="e43916", keywords="hackathon", keywords="innovation", keywords="entrepreneurship", keywords="medical education", keywords="gamification", keywords="curriculum", keywords="biodesign", keywords="emergency medicine", keywords="health care innovation", keywords="medical innovation", keywords="training", keywords="design", keywords="implementation", keywords="development", keywords="physician", keywords="educational", abstract="Background: Innovation and entrepreneurship training are increasingly recognized as being important in medical education. However, the lack of faculty comfort with the instruction of these concepts as well as limited scholarly recognition for this work has limited the implementation of curricula focused on these skills. Furthermore, this lack of familiarity limits the inclusion of practicing physicians in health care innovation, where their experience is valuable. Hackathons are intense innovation competitions that use gamification principles to increase comfort with creative thinking, problem-solving, and interpersonal collaboration, but they require further exploration in medical innovation. Objective: To address this, we aimed to design, implement, and evaluate a health care hackathon with 2 main goals: to improve emergency physician familiarity with the principles of health care innovation and entrepreneurship and to develop innovative solutions to 3 discrete problems facing emergency medicine physicians and patients. Methods: We used previously described practices for conducting hackathons to develop and implement our hackathon (HackED!). We partnered with the American College of Emergency Physicians, the Stanford School of Biodesign, and the Institute of Design at Stanford (d.school) to lend institutional support and expertise in health care innovation to our event. We determined a location, time frame, and logistics for the competition and settled on 3 use cases for teams to work on. We planned to explore the learning experience of participants within a pragmatic paradigm and complete an abductive thematic analysis using data from a variety of sources. Results: HackED! took place from October 1-3, 2022. In all, 3 teams developed novel solutions to each of the use cases. Our investigation into the educational experience of participants suggested that the event was valuable and uncovered themes suggesting that the learning experience could be understood within a framework from entrepreneurship education not previously described in relation to hackathons. Conclusions: Health care hackathons appear to be a viable method of increasing physician experience with innovation and entrepreneurship principles and addressing complex problems in health care. Hackathons should be considered as part of educational programs that focus on these concepts. ", doi="10.2196/43916", url="https://mededu.jmir.org/2023/1/e43916", url="http://www.ncbi.nlm.nih.gov/pubmed/36826988" } @Article{info:doi/10.2196/40758, 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="Effects of Practicing With and Obtaining Crowdsourced Feedback From the Video-Based Communication Assessment App on Resident Physicians' Adverse Event Communication Skills: Pre-post Trial", journal="JMIR Med Educ", year="2022", month="Oct", day="3", volume="8", number="4", pages="e40758", keywords="medical error disclosure", keywords="simulation studies", keywords="communication assessment", keywords="graduate medical education", keywords="crowdsourcing", keywords="patient-centered care", keywords="medical education", keywords="virtual education", keywords="virtual communication", keywords="physician communication", keywords="resident", keywords="virtual learning", keywords="digital learning", keywords="video communication", keywords="medical error", keywords="digital response", abstract="Background: US residents require practice and feedback to meet Accreditation Council for Graduate Medical Education mandates and patient expectations for effective communication after harmful errors. Current instructional approaches rely heavily on lectures, rarely provide individualized feedback to residents about communication skills, and may not assure that residents acquire the skills desired by patients. The Video-based Communication Assessment (VCA) app is a novel tool for simulating communication scenarios for practice and obtaining crowdsourced assessments and feedback on physicians' communication skills. We previously established that crowdsourced laypeople can reliably assess residents' error disclosure skills with the VCA app. However, its efficacy for error disclosure training has not been tested. Objective: We aimed to evaluate the efficacy of using VCA practice and feedback as a stand-alone intervention for the development of residents' error disclosure skills. Methods: We conducted a pre-post study in 2020 with pathology, obstetrics and gynecology, and internal medicine residents at an academic medical center in the United States. At baseline, residents each completed 2 specialty-specific VCA cases depicting medical errors. Audio responses were rated by at least 8 crowdsourced laypeople using 6 items on a 5-point scale. At 4 weeks, residents received numerical and written feedback derived from layperson ratings and then completed 2 additional cases. Residents were randomly assigned cases at baseline and after feedback assessments to avoid ordinal effects. Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2{\texttimes}3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings. Results: In total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents' communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents' communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44\%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6\%). Conclusions: Residents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum. ", doi="10.2196/40758", url="https://mededu.jmir.org/2022/4/e40758", url="http://www.ncbi.nlm.nih.gov/pubmed/36190751" } @Article{info:doi/10.2196/36447, author="Toohey, Shannon and Wray, Alisa and Hunter, John and Waldrop, Ian and Saadat, Soheil and Boysen-Osborn, Megan and Sudario, Gabriel and Smart, Jonathan and Wiechmann, Warren and Pressman, D. Sarah", title="Comparing the Psychological Effects of Manikin-Based and Augmented Reality--Based Simulation Training: Within-Subjects Crossover Study", journal="JMIR Med Educ", year="2022", month="Aug", day="1", volume="8", number="3", pages="e36447", keywords="augmented reality", keywords="AR", keywords="salivary cortisol", keywords="galvanic skin conductance", keywords="medical simulation", keywords="medical education", abstract="Background: Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators. Objective: The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations. Methods: A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use. Results: Of the total 86 medical students who participated, 37 (43\%) were male and 49 (57\%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: --0.11, 95\% CI --0.18 to --0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95\% CI --0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95\% CI --2.35 to 3.42; P=.71) or simulation stress (AR-manikin: --2.17, 95\% CI --6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: --4.0, 95\% CI --0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: --0.33, 95\% CI --1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95\% CI --0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95\% CI --0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR. Conclusions: AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm. ", doi="10.2196/36447", url="https://mededu.jmir.org/2022/3/e36447", url="http://www.ncbi.nlm.nih.gov/pubmed/35916706" } @Article{info:doi/10.2196/36960, author="Chidambaram, Swathi and Palumbo, Chiara Maria and Stifano, Vito and McKenna, John and Redaelli, Alberto and Olivi, Alessandro and Apuzzo, Michael and Pannullo, Susan", title="The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study", journal="JMIR Neurotech", year="2022", month="Jun", day="1", volume="1", number="1", pages="e36960", keywords="mixed reality", keywords="augmented reality", keywords="extended reality", keywords="HoloLens", keywords="interdisciplinary teams", keywords="virtual reality", keywords="brain tumour", keywords="tumor", keywords="radiosurgery", keywords="surgery", abstract="Background: Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement. Objective: We describe a novel visualization application, titled ``NeuroVis'' by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient's neuroanatomy in stereotactic surgery (SRS) case planning discussions. Methods: We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs. Results: The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs. Conclusions: The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care. ", doi="10.2196/36960", url="https://neuro.jmir.org/2022/1/e36960" } @Article{info:doi/10.2196/33565, author="Ajab, Shereen and Pearson, Emma and Dumont, Steven and Mitchell, Alicia and Kastelik, Jack and Balaji, Packianathaswamy and Hepburn, David", title="An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study", journal="JMIR Med Educ", year="2022", month="May", day="9", volume="8", number="2", pages="e33565", keywords="simulation", keywords="high fidelity", keywords="low fidelity", keywords="COVID-19", keywords="bedside teaching", keywords="undergraduate medical education", keywords="fidelity", keywords="medical education", keywords="medical student", keywords="review", keywords="innovation", keywords="risk", keywords="design", keywords="implementation", abstract="Background: Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students' confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods. Objective: To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19--safe environment using SimMan 3G. Methods: Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session. Results: In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90\% (n=9) felt more confident in their clinical examination skills following the teaching; 100\% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature. Conclusions: Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally. ", doi="10.2196/33565", url="https://mededu.jmir.org/2022/2/e33565", url="http://www.ncbi.nlm.nih.gov/pubmed/35404828" } @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/10.2196/31464, 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/10.2196/33630, 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/10.2196/37401, author="Balaji, Aanika and Clever, Lou Sarah", title="Authors' Reply to: Techniques to Teach Students Effectively Using Telemedicine. Comment on ``Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial''", journal="JMIR Med Educ", year="2022", month="Mar", day="11", volume="8", number="1", pages="e37401", keywords="medical student", keywords="education", keywords="primary care", keywords="telehealth", keywords="video visits", keywords="internal medicine", keywords="medical education", keywords="teleconsultation", keywords="digital health", keywords="COVID-19", keywords="teaching", keywords="telemedicine", keywords="clerkships", doi="10.2196/37401", url="https://mededu.jmir.org/2022/1/e37401", url="http://www.ncbi.nlm.nih.gov/pubmed/35191840" } @Article{info:doi/10.2196/30703, author="Kandola, Hardeep and Minhas, Sonica", title="Techniques to Teach Students Effectively Using Telemedicine. Comment on ``Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial''", journal="JMIR Med Educ", year="2022", month="Mar", day="11", volume="8", number="1", pages="e30703", keywords="medical student", keywords="education", keywords="primary care", keywords="telehealth", keywords="video visits", keywords="internal medicine", keywords="medical education", keywords="teleconsultation", keywords="digital health", keywords="COVID-19", keywords="teaching", keywords="telemedicine", keywords="clerkships", doi="10.2196/30703", url="https://mededu.jmir.org/2022/1/e30703", url="http://www.ncbi.nlm.nih.gov/pubmed/35191846" } @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/10.2196/34751, author="Schnieders, Elena and R{\"o}hr, Freda and Mbewe, Misho and Shanzi, Aubrey and Berner-Rodoreda, Astrid and Barteit, Sandra and Louis, R. Val{\'e}rie and Andreadis, Petros and Syakantu, Gardner and Neuhann, Florian", title="Real-life Evaluation of an Interactive Versus Noninteractive e-Learning Module on Chronic Obstructive Pulmonary Disease for Medical Licentiate Students in Zambia: Web-Based, Mixed Methods Randomized Controlled Trial", journal="JMIR Med Educ", year="2022", month="Feb", day="24", volume="8", number="1", pages="e34751", keywords="distance education", keywords="randomized controlled trial", keywords="personal satisfaction", keywords="knowledge", keywords="user-centered design", keywords="chronic obstructive pulmonary disease", keywords="interactive", keywords="noninteractive", keywords="low- and middle-income country", keywords="LMIC", keywords="mobile phone", abstract="Background: e-Learning for health professionals in many low- and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive (user-influenceable content) and noninteractive (static material) e-learning. Studies conducted in high-income countries suggest that interactive e-learning is more effective than noninteractive e-learning in increasing learner satisfaction and knowledge; however, there is a gap in our understanding of whether this also holds true in LMICs. Objective: This study aims to validate the hypothesis above in a resource-constrained and real-life setting to understand e-learning quality and delivery by comparing interactive and noninteractive e-learning user satisfaction, usability, and knowledge gain in a new medical university in Zambia. Methods: We conducted a web-based, mixed methods randomized controlled trial at the Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited medical licentiate students (second, third, and fourth study years) via email. Participants were randomized to undergo asynchronous e-learning with an interactive or noninteractive module for chronic obstructive pulmonary disease and informally blinded to their group allocation. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the noninteractive module consisted of PowerPoint slides. Both modules covered the same content scope. The primary outcome was learner satisfaction. The secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights into quantitative findings, which were evaluated through web-based questionnaires. Results: Initially, 94 participants were enrolled in the study, of whom 41 (44\%; 18 intervention participants and 23 control participants) remained in the study and were analyzed. There were no significant differences in satisfaction (intervention: median 33.5, first quartile 31.3, second quartile 35; control: median 33, first quartile 30, second quartile 37.5; P=.66), usability, or knowledge gain between the intervention and control groups. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested that the content of the interactive module was more challenging to access because of technical difficulties and individual factors (eg, limited experience with interactive e-learning). Conclusions: We did not observe an increase in user satisfaction with interactive e-learning. However, this finding may not be generalizable to other low-resource settings because the post hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, technical and individual barriers to accessing e-learning may have affected the results, mainly because the interactive module was considered more difficult to access and use. Nevertheless, qualitative data showed high motivation and interest in e-learning. Future studies should minimize technical barriers to e-learning to further evaluate interactive e-learning in LMICs. ", doi="10.2196/34751", url="https://mededu.jmir.org/2022/1/e34751", url="http://www.ncbi.nlm.nih.gov/pubmed/35200149" } @Article{info:doi/10.2196/34171, author="Jung, Dukyoo and De Gagne, C. Jennie and Choi, Eunju and Lee, Kyuri", title="An Online International Collaborative Learning Program During the COVID-19 Pandemic for Nursing Students: Mixed Methods Study", journal="JMIR Med Educ", year="2022", month="Jan", day="24", volume="8", number="1", pages="e34171", keywords="COVID-19", keywords="distance education", keywords="global competencies", keywords="nursing students", keywords="program evaluation", keywords="synchronous virtual classroom", keywords="video conferencing", abstract="Background: Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments. Objective: We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students' international and global competencies in South Korea. Methods: We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants' global leadership competencies, and the focus group interviews were used to evaluate the program's effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods. Results: Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative. Conclusions: The online international collaborative learning program had a positive impact on the development of students' international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era. ", doi="10.2196/34171", url="https://mededu.jmir.org/2022/1/e34171", url="http://www.ncbi.nlm.nih.gov/pubmed/34982035" } @Article{info:doi/10.2196/32017, author="Dederichs, Melina and Nitsch, Jan Felix and Apolin{\'a}rio-Hagen, Jennifer", title="Piloting an Innovative Concept of e--Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study", journal="JMIR Med Educ", year="2022", month="Jan", day="10", volume="8", number="1", pages="e32017", keywords="participatory design", keywords="co-design", keywords="mHealth", keywords="medical student", keywords="eHealth", keywords="medical education", keywords="mental health", keywords="mobile phone", abstract="Background: Medical students show low levels of e--mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students' well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students' preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. Objective: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students' preferences and ideas for mHealth apps through the design of a hypothetical prototype. Methods: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e--mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students' permission. Results: The participants' feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. Conclusions: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education. ", doi="10.2196/32017", url="https://mededu.jmir.org/2022/1/e32017", url="http://www.ncbi.nlm.nih.gov/pubmed/35006085" } @Article{info:doi/10.2196/33861, author="Karabacak, Mert and Ozkara, Berksu Burak and Ozcan, Zeynep", title="Adjusting to the Reign of Webinars: Viewpoint", journal="JMIR Med Educ", year="2021", month="Nov", day="12", volume="7", number="4", pages="e33861", keywords="virtual conference", keywords="student-based organization", keywords="neuroscience conference", keywords="COVID-19", keywords="medical education", keywords="webinars", keywords="web-based education", abstract="Background: With the integration of COVID-19 into our lives, the way events are organized has changed. The Cerrahpa?a Neuroscience Days held on May 8-9, 2021, was one of the conferences that was affected. The annual conference of the student-based Cerrahpa?a Neuroscience Society transitioned to the internet for the first time and had the premise of going international. Objective: With this study, we aim to both discuss how a virtual conference is organized and perceived, and where our conference stands within the literature as a completely student-organized event. Methods: The conference was planned in accordance with virtual standards and promoted to primarily medical schools. During the execution, there were no major issues. The feedback was collected via a form developed with Google Forms. Results: Out of 2195 registrations, 299 qualified to receive a certificate. The feedback forms revealed a general satisfaction; the overall quality of the event was rated an average of 4.6 out of 5, and the ratings of various Likert scale--based questions were statistically analyzed. Open-ended questions provided improvement suggestions for future events. Conclusions: The virtual Cerrahpa?a Neuroscience Days was a success in organization and received positive feedback from the participants. We aim to ground future events on this experience. ", doi="10.2196/33861", url="https://mededu.jmir.org/2021/4/e33861", url="http://www.ncbi.nlm.nih.gov/pubmed/34766916" } @Article{info:doi/10.2196/24418, author="Clark, Justin and McFarlane, Catherine and Cleo, Gina and Ishikawa Ramos, Christiane and Marshall, Skye", title="The Impact of Systematic Review Automation Tools on Methodological Quality and Time Taken to Complete Systematic Review Tasks: Case Study", journal="JMIR Med Educ", year="2021", month="May", day="31", volume="7", number="2", pages="e24418", keywords="systematic reviews", keywords="automation", keywords="technology assessment", keywords="methods evaluation", keywords="case study", keywords="comparison study", abstract="Background: Systematic reviews (SRs) are considered the highest level of evidence to answer research questions; however, they are time and resource intensive. Objective: When comparing SR tasks done manually, using standard methods, versus those same SR tasks done using automated tools, (1) what is the difference in time to complete the SR task and (2) what is the impact on the error rate of the SR task? Methods: A case study compared specific tasks done during the conduct of an SR on prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease. Two participants (manual team) conducted the SR using current methods, comprising a total of 16 tasks. Another two participants (automation team) conducted the tasks where a systematic review automation (SRA) tool was available, comprising of a total of six tasks. The time taken and error rate of the six tasks that were completed by both teams were compared. Results: The approximate time for the manual team to produce a draft of the background, methods, and results sections of the SR was 126 hours. For the six tasks in which times were compared, the manual team spent 2493 minutes (42 hours) on the tasks, compared to 708 minutes (12 hours) spent by the automation team. The manual team had a higher error rate in two of the six tasks---regarding Task 5: Run the systematic search, the manual team made eight errors versus three errors made by the automation team; regarding Task 12: Assess the risk of bias, 25 assessments differed from a reference standard for the manual team compared to 20 differences for the automation team. The manual team had a lower error rate in one of the six tasks---regarding Task 6: Deduplicate search results, the manual team removed one unique study and missed zero duplicates versus the automation team who removed two unique studies and missed seven duplicates. Error rates were similar for the two remaining compared tasks---regarding Task 7: Screen the titles and abstracts and Task 9: Screen the full text, zero relevant studies were excluded by both teams. One task could not be compared between groups---Task 8: Find the full text. Conclusions: For the majority of SR tasks where an SRA tool was used, the time required to complete that task was reduced for novice researchers while methodological quality was maintained. ", doi="10.2196/24418", url="https://mededu.jmir.org/2021/2/e24418", url="http://www.ncbi.nlm.nih.gov/pubmed/34057072" } @Article{info:doi/10.2196/24300, author="Balaji, Aanika and Clever, Lou Sarah", title="Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial", journal="JMIR Med Educ", year="2021", month="May", day="28", volume="7", number="2", pages="e24300", keywords="medical student", keywords="education", keywords="primary care", keywords="telehealth", keywords="video visits", keywords="internal medicine", keywords="medical education", keywords="teleconsultation", keywords="digital health", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has brought about sweeping change in health care delivery, which has shifted from in-person consultations to a web-based format. Few medical schools provide web-based medicine or telemedicine training to their learners, though this is likely to be important for future medical practice. Objective: This tutorial communicates a framework for incorporating medical students into primary care telemedicine clinics. Methods: A third-year medical student and internal medicine attending physician from the Johns Hopkins University completed telemedicine clinic visits in April 2020 by using a variety of video platforms and via telephone calls. Results: Nine telemedicine visits were completed over 4 clinic days. Our patients were, on average, aged 68 years. The majority of patients were female (6/9, 67\%), and most appointments were completed via a video platform (6/9, 67\%). Additionally, our experience is summarized and describe (1) practical tips for how to prepare for a telehealth visit; (2) technology considerations; (3) recommendations for participation during a telehealth visit; (4) debriefing and feedback; (5) challenges to care; and (6) student, care provider, and patient reactions to telemedicine visits. Conclusions: Telemedicine clinics have been successfully used for managing patients with chronic conditions, those who have attended low-risk urgent care visits, and those with mental health concerns. Patients have reported high patient satisfaction scores for telemedicine visits, and the majority of patients are comfortable with having medical students as part of their care team. Moving forward, telemedicine will remain a popular method for receiving health care. This study has highlighted that medical students can successfully be integrated into telemedicine clinics and that they should be exposed to telehealth whenever possible prior to residency. ", doi="10.2196/24300", url="https://mededu.jmir.org/2021/2/e24300", url="http://www.ncbi.nlm.nih.gov/pubmed/33974552" } @Article{info:doi/10.2196/mededu.5159, author="Chaballout, Basil and Molloy, Margory and Vaughn, Jacqueline and Brisson III, Raymond and Shaw, Ryan", title="Feasibility of Augmented Reality in Clinical Simulations: Using Google Glass With Manikins", journal="JMIR Medical Education", year="2016", month="Mar", day="07", volume="2", number="1", pages="e2", keywords="clinical simulation", keywords="augmented reality", keywords="feasibility", keywords="student learning", keywords="Google Glass", abstract="Background: Studies show that students who use fidelity-based simulation technology perform better and have higher retention rates than peers who learn in traditional paper-based training. Augmented reality is increasingly being used as a teaching and learning tool in a continual effort to make simulations more realistic for students. Objective: The aim of this project was to assess the feasibility and acceptability of using augmented reality via Google Glass during clinical simulation scenarios for training health science students. Methods: Students performed a clinical simulation while watching a video through Google Glass of a patient actor simulating respiratory distress. Following participation in the scenarios students completed two surveys and were questioned if they would recommend continued use of this technology in clinical simulation experiences. Results: We were able to have students watch a video in their field of vision of a patient who mimicked the simulated manikin. Students were overall positive about the implications for being able to view a patient during the simulations, and most students recommended using the technology in the future. Overall, students reported perceived realism with augmented reality using Google Glass. However, there were technical and usability challenges with the device. Conclusions: As newer portable and consumer-focused technologies become available, augmented reality is increasingly being used as a teaching and learning tool to make clinical simulations more realistic for health science students. We found Google Glass feasible and acceptable as a tool for augmented reality in clinical simulations. ", doi="10.2196/mededu.5159", url="http://mededu.jmir.org/2016/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731862" } @Article{info:doi/10.2196/jmir.3650, author="Antoniades, Athos and Nicolaidou, Iolie and Spachos, Dimitris and Myll{\"a}ri, Jarkko and Giordano, Daniela and Dafli, Eleni and Mitsopoulou, Evangelia and Schizas, N. Christos and Pattichis, Constantinos and Nikolaidou, Maria and Bamidis, Panagiotis", title="Medical Content Searching, Retrieving, and Sharing Over the Internet: Lessons Learned From the mEducator Through a Scenario-Based Evaluation", journal="J Med Internet Res", year="2015", month="Oct", day="09", volume="17", number="10", pages="e229", keywords="searching and sharing of medical educational content", keywords="repurposing", keywords="metadata", keywords="evaluation", abstract="Background: The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users' performance, was designed and utilized for the evaluation of these solutions. Objective: The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - ``MEdical Education LINnked Arena'' MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. Methods: A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. Results: The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end-user perspective, users faced difficulties in achieving a shared understanding of the meaning of some metadata fields and in correctly managing the intellectual property rights of repurposed content. Conclusions: The results of this evaluation impact researchers, medical professionals, and designers interested in using similar systems for educational content sharing in medical and other domains. Recommendations on how to improve the search, retrieval, identification, and obtaining of medical resources are provided, by addressing issues of content description metadata, content description procedures, and intellectual property rights for re-purposed content. ", doi="10.2196/jmir.3650", url="http://www.jmir.org/2015/10/e229/", url="http://www.ncbi.nlm.nih.gov/pubmed/26453250" }