@Article{info:doi/10.2196/62838, author="Gashi, Andi and Brodmann Maeder, Monika and Hennel, K. Eva", title="Making Medical Education Courses Visible: Theory-Based Development of a National Database", journal="JMIR Med Educ", year="2025", month="Apr", day="16", volume="11", pages="e62838", keywords="curriculum mapping", keywords="faculty development", keywords="competencies", keywords="database", keywords="medical education", abstract="Background: Medical education has undergone professionalization during the last decades, and internationally, educators are trained in specific medical education courses also known as ``train the trainer'' courses. As these courses have developed organically based on local needs, the lack of a general structure and terminology can confuse and hinder educators' information and development. The first aim of this study was to conduct a national search, analyze the findings, and provide a presentation of medical education courses based on international theoretical frameworks to support Swiss course providers and educators searching for courses. The second aim was to provide a blueprint for such a procedure to be used by the international audience. Objective: In this study, we devised a scholarly approach to sorting and presenting medical education courses to make their content accessible to medical educators. This approach is presented in detailed steps and our openly available exemplary database to make it serve as a blueprint for other settings. Methods: Following our constructivist paradigm, we examined content from medical education courses using a theory-informed inductive data approach. Switzerland served as an example, covering 4 languages and different approaches to medical education. Data were gathered through an online search and a nationwide survey with course providers. The acquired data and a concurrently developed keyword system to standardize course terminology are presented using Obsidian, a software that shows data networks. Results: Our iterative search included several strategies (web search, survey, provider enquiry, and snowballing) and yielded 69 courses in 4 languages, with varying terminology, target audiences, and providers. The database of courses is interactive and openly accessible. An open-access template database structure is also available. Conclusions: This study proposes a novel method for sorting and visualizing medical education courses and the competencies they cover to provide an easy-to-use database, helping medical educators' practical and scholarly development. Notably, our analysis identified a specific emphasis on undergraduate teaching settings, potentially indicating a gap in postgraduate educational offerings. This aspect could be pivotal for future curriculum development and resource allocation. Our method might guide other countries and health care professions, offering a straightforward means of cataloging and making information about medical education courses widely available and promotable. ", doi="10.2196/62838", url="https://mededu.jmir.org/2025/1/e62838" } @Article{info:doi/10.2196/67419, author="Jourdi, Georges and Selmi, Mayssa and Gaussem, Pascale and Truchot, Jennifer and Margaill, Isabelle and Siguret, Virginie", title="Evaluation of the Inverted Classroom Approach in a Case-Study Course on Antithrombotic Drug Use in a PharmD Curriculum: French Monocentric Randomized Study", journal="JMIR Med Educ", year="2025", month="Apr", day="10", volume="11", pages="e67419", keywords="antithrombotic drugs", keywords="case-study course", keywords="inverted classroom", keywords="pharmacy students", keywords="traditional educational approach", keywords="medical education", abstract="Background: Appropriate antithrombotic drug use is crucial knowledge for pharmacy students. Objective: We sought to compare the inverted classroom (IC) approach to a traditional question-and-answer educational approach with the aim of enhancing pharmacy students' engagement with a case-study course on antithrombotic drug use. Methods: Third-year PharmD (Doctor of Pharmacy) students from Paris Cit{\'e} University were randomly assigned to control (n=171) and IC (n=175) groups. The latter were instructed to read and prepare the preprovided course material 1 week before the in-class session to assume the instructor role on the target day, whereas students of the control group attended a traditional case-study course carried out by the same instructor. All students completed pre- and posttest multiple-choice questions surveys assessing their knowledge levels as well as stress, empathy, and satisfaction questionnaires. Results: A significantly higher participation rate was observed in the control group (93/171, 54\%) compared to the IC group (65/175, 37\%; P=.002). Women (110/213, 52\%) participated more than men (48/133, 36\%; P=.002) whatever the group was. Students' knowledge scores from both groups had similar results with no difference neither in the prescore (1.17, SD 0.66 and 1.24, SD 0.72 of 5, respectively) nor in the short-term knowledge retention (2.45, SD 0.61 and 2.35, SD 0.73, respectively). The IC approach did not increase student stress or enhance their empathy for the instructor. It increased the preclass workload (P=.02) and was not well received among students. Conclusions: This study showed that the traditional educational approach remains an efficient method for case-study courses in the early stages (ie, third-year) of the 6-year PharmD curriculum, yet dynamic methods improving the active role of students in the learning process are still needed. ", doi="10.2196/67419", url="https://mededu.jmir.org/2025/1/e67419" } @Article{info:doi/10.2196/59326, author="Domann, Maximilian and Richters, Constanze and Stadler, Matthias", title="Student Acceptance of Digital Entrustable Professional Activities: Protocol for a Cohort Study", journal="JMIR Res Protoc", year="2025", month="Mar", day="25", volume="14", pages="e59326", keywords="medical education", keywords="entrustable professional activities", keywords="EPAs", keywords="digital EPAs", keywords="technology acceptance model", abstract="Background: Integrating digital entrustable professional activities (EPAs) and simulations in medical education represents a substantial shift toward competency-based learning. This approach focuses on developing specific skills through manageable units and enhancing proficiency in high-stakes environments. The technology acceptance model provides a framework to evaluate the adoption of these educational technologies, emphasizing the roles of perceived usefulness and ease of use. Objective: This cohort study aims to investigate the acceptance of digital EPAs among medical students within simulated training environments. It seeks to understand how perceived usefulness and ease of use influence this acceptance, guided by the principles of the technology acceptance model. Methods: The cohort study will involve medical students in the clinical phase of their education at Ludwig Maximilians University Munich. The survey, distributed through the Module-6 distributor, will capture their perceptions of digital EPAs. The data will be analyzed using regression analysis. Results: Data collection is anticipated to be complete by April 2025, with analysis concluded by May 2025. The results will provide insights into students' attitudes toward digital EPAs and their willingness to integrate these tools into their learning. Conclusions: This study will contribute to the understanding of digital EPAs' role in medical education, potentially guiding future design and implementation of these tools. While highlighting the importance of perceived usefulness and ease of use, the study also acknowledges limitations in sample size and recruitment methodology, indicating the need for further research with more diverse and larger groups. This research is poised to shape future medical training programs, aligning with the evolving landscape of medical education. International Registered Report Identifier (IRRID): PRR1-10.2196/59326 ", doi="10.2196/59326", url="https://www.researchprotocols.org/2025/1/e59326" } @Article{info:doi/10.2196/68309, author="Alreshaid, Lulwah and Alkattan, Rana", title="Feedback From Dental Students Using Two Alternate Coaching Methods: Qualitative Focus Group Study", journal="JMIR Med Educ", year="2025", month="Mar", day="18", volume="11", pages="e68309", keywords="student feedback", keywords="coaching", keywords="dental education", keywords="student evaluation", keywords="teaching methods", keywords="educational intervention", abstract="Background: Student feedback is crucial for evaluating the effectiveness of institutions. However, implementing feedback can be challenging due to practical difficulties. While student feedback on courses can improve teaching, there is a debate about its effectiveness if not well-written to provide helpful information to the receiver. Objective: This study aimed to evaluate the impact of coaching on proper feedback given by dental students in Saudi Arabia. Methods: A total of 47 first-year dental students from a public dental school in Riyadh, Saudi Arabia, completed 3 surveys throughout the academic year. The surveys assessed their feedback on a Dental Anatomy and Operative Dentistry course, including their feedback on the lectures, practical sessions, examinations, and overall experience. The surveys focused on assessing student feedback on the knowledge, understanding, and practical skills achieved during the course, as aligned with the defined course learning outcomes. The surveys were distributed without coaching, after handout coaching and after workshop coaching on how to provide feedback, designated as survey \#1, survey \#2, and survey \#3, respectively. The same group of students received all 3 surveys consecutively (repeated measures design). The responses were then rated as neutral, positive, negative, or constructive by 2 raters. The feedback was analyzed using McNemar test to compare the effectiveness of the different coaching approaches. Results: While no significant changes were found between the first 2 surveys, a significant increase in constructive feedback was observed in survey \#3 after workshop coaching compared with both other surveys (P<.001). The results also showed a higher proportion of desired changes in feedback, defined as any change from positive, negative, or neutral to constructive, after survey \#3 (P<.001). Overall, 20.2\% reported desired changes at survey \#2\% and 41.5\% at survey \#3 compared with survey \#1. Conclusions: This study suggests that workshops on feedback coaching can effectively improve the quality of feedback provided by dental students. Incorporating feedback coaching into dental school curricula could help students communicate their concerns more effectively, ultimately enhancing the learning experience. ", doi="10.2196/68309", url="https://mededu.jmir.org/2025/1/e68309" } @Article{info:doi/10.2196/64768, author="Zainal, Humairah and Xiao Hui, Xin and Thumboo, Julian and Kok Yong, Fong", title="Organizational Leaders' Views on Digital Health Competencies in Medical Education: Qualitative Semistructured Interview Study", journal="JMIR Med Educ", year="2025", month="Mar", day="7", volume="11", pages="e64768", keywords="technology", keywords="medical education", keywords="curriculum", keywords="clinical competence", keywords="digital competence", keywords="Singapore", keywords="digital health", keywords="qualitative study", keywords="medical school", keywords="risk", keywords="comprehensive framework", keywords="doctor", keywords="thematic analysis", keywords="information technology", keywords="evidence-based", keywords="undergraduate", keywords="healthcare systems", keywords="mobile phone", abstract="Background: Digital technologies (DTs) have profoundly impacted health care delivery globally and are increasingly used in clinical practice. Despite this, there is a scarcity of guidelines for implementing training in digital health competencies (DHC) in medical schools, especially for clinical practice. A lack of sustained integration of DHC risks creating knowledge gaps due to a limited understanding of how DT should be used in health care. Furthermore, few studies have explored reasons for this lag, both within and beyond the medical school curriculum. Current frameworks to address these barriers are often specific to individual countries or schools and focus primarily on curriculum design and delivery. A comprehensive framework is therefore required to ensure consistent implementation of DHC across various contexts and times. Objective: This study aims to use Singapore as a case study and examine the perspectives of doctors in organizational leadership positions to identify and analyze the barriers to DHC implementation in the undergraduate curriculum of Singapore's medical schools. It also seeks to apply the Normalization Process Theory (NPT) to address these barriers and bridge the gap between health care systems and digital health education (DHE) training. Methods: Individual semistructured interviews were conducted with doctors in executive and organizational leadership roles. Participants were recruited through purposive sampling, and the data were interpreted using qualitative thematic analysis. Results: A total of 33 doctors participated, 26 of whom are currently in organizational leadership roles and 7 of whom have previously held such positions. A total of 6 barriers were identified: bureaucratic inertia, lack of opportunities to pursue nontraditional career pathways, limited protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, insufficient integration between medical school education and clinical experience, and poor IT integration within the health care industry. Conclusions: These barriers are also present in other high-income countries experiencing health care digitalization, highlighting the need for a theoretical framework that broadens the generalizability of existing recommendations. Applying the NPT underscores the importance of addressing these barriers to effectively integrate DHC into the curriculum. The active involvement of multiple stakeholders and the incorporation of continuous feedback mechanisms are essential. Our proposed framework provides concrete, evidence-based, and step-by-step recommendations for implementation practice, supporting the introduction of DHC in undergraduate medical education. ", doi="10.2196/64768", url="https://mededu.jmir.org/2025/1/e64768", url="http://www.ncbi.nlm.nih.gov/pubmed/40053774" } @Article{info:doi/10.2196/53276, author="Bieler, Sandra and von D{\"u}ring, Stephan and Tagan, Damien and Grosgurin, Olivier and Fumeaux, Thierry", title="Impact of a Point-of-Care Ultrasound Training Program on the Management of Patients With Acute Respiratory or Circulatory Failure by In-Training Emergency Department Residents (IMPULSE): Before-and-After Implementation Study", journal="JMIRx Med", year="2025", month="Mar", day="3", volume="6", pages="e53276", keywords="point-of-care ultrasonography", keywords="training program", keywords="emergency department", keywords="acute respiratory failure", keywords="acute circulatory failure", abstract="Background: Due to its diagnostic accuracy, point-of-care ultrasound (POCUS) is becoming more frequently used in the emergency department (ED), but the feasibility of its use by in-training residents and the potential clinical impact have not been assessed. Objective: This study aimed to assess the feasibility of implementing a structured POCUS training program for in-training ED residents, as well as the clinical impact of their use of POCUS in the management of patients in the ED. Methods: IMPULSE (Impact of a Point-of Care Ultrasound Examination) is a before-and-after implementation study evaluating the impact of a structured POCUS training program for ED residents on the management of patients admitted with acute respiratory failure (ARF) and/or circulatory failure (ACF) in a Swiss regional hospital. The training curriculum was organized into 3 steps and consisted of a web-based training course; an 8-hour, practical, hands-on session; and 10 supervised POCUS examinations. ED residents who successfully completed the curriculum participated in the postimplementation phase of the study. Outcomes were time to ED diagnosis, rate and time to correct diagnosis in the ED, time to prescribe appropriate treatment, and in-hospital mortality. Standard statistical analyses were performed using chi-square and Mann-Whitney U tests as appropriate, supplemented by Bayesian analysis, with a Bayes factor (BF)>3 considered significant. Results: A total of 69 and 54 patients were included before and after implementation of the training program, respectively. The median time to ED diagnosis was 25 (IQR 15?60) minutes after implementation versus 30 (IQR 10?66) minutes before implementation, a difference that was significant in the Bayesian analysis (BF=9.6). The rate of correct diagnosis was higher after implementation (51/54, 94\% vs 36/69, 52\%; P<.001), with a significantly shorter time to correct diagnosis after implementation (25, IQR 15?60 min vs 43, IQR 11?70 min; BF=5.0). The median time to prescribe the appropriate therapy was shorter after implementation (47, IQR 25?101 min vs 70, IQR 20?120 min; BF=2.0). Finally, there was a significant difference in hospital mortality (9/69, 13\% vs 3/54, 6\%; BF=15.7). Conclusions: The IMPULSE study shows that the implementation of a short, structured POCUS training program for ED residents is not only feasible but also has a significant impact on their initial evaluation of patients with ARF and/or ACF, improving diagnostic accuracy, time to correct diagnosis, and rate of prescribing the appropriate therapy and possibly decreasing hospital mortality. These results should be replicated in other settings to provide further evidence that implementation of a short, structured POCUS training curriculum could significantly impact ED management of patients with ARF and/or ACF. ", doi="10.2196/53276", url="https://xmed.jmir.org/2025/1/e53276" } @Article{info:doi/10.2196/66157, author="Potter, Alison and Munsch, Chris and Watson, Elaine and Hopkins, Emily and Kitromili, Sofia and O'Neill, Cameron Iain and Larbie, Judy and Niittymaki, Essi and Ramsay, Catriona and Burke, Joshua and Ralph, Neil", title="Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e66157", keywords="digital education", keywords="health professions education", keywords="research priorities", keywords="umbrella review", keywords="Delphi", keywords="artificial intelligence", keywords="AI", abstract="Background: In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness. Objective: This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education. Methods: We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method. Results: A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals' education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions' digital education be defined and standardized? Conclusions: This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education. ", doi="10.2196/66157", url="https://www.jmir.org/2025/1/e66157", url="http://www.ncbi.nlm.nih.gov/pubmed/39969988" } @Article{info:doi/10.2196/64550, author="Rivera Garc{\'i}a, Esmeralda Guadalupe and Cervantes L{\'o}pez, Janet Miriam and Ram{\'i}rez V{\'a}zquez, Carlos Juan and Llanes Castillo, Arturo and Cruz Casados, Jaime", title="Reviewing Mobile Apps for Teaching Human Anatomy: Search and Quality Evaluation Study", journal="JMIR Med Educ", year="2025", month="Feb", day="14", volume="11", pages="e64550", keywords="anatomy", keywords="Google Play", keywords="mobile health", keywords="mHealth", keywords="Mobile App Rating Scale", keywords="MARS", abstract="Background: Mobile apps designed for teaching human anatomy offer a flexible, interactive, and personalized learning platform, enriching the educational experience for both students and health care professionals. Objective: This study aimed to conduct a systematic review of the human anatomy mobile apps available on Google Play, evaluate their quality, highlight the highest scoring apps, and determine the relationship between objective quality ratings and subjective star ratings. Methods: The Mobile App Rating Scale (MARS) was used to evaluate the apps. The intraclass correlation coefficient was calculated using a consistency-type 2-factor random model to measure the reliability of the evaluations made by the experts. In addition, Pearson correlations were used to analyze the relationship between MARS quality scores and subjective evaluations of MARS quality item 23. Results: The mobile apps with the highest overall quality scores according to the MARS (ie, sections A, B, C, and D) were Organos internos 3D (anatom{\'i}a) (version 4.34), Sistema {\'o}seo en 3D (Anatom{\'i}a) (version 4.32), and VOKA Anatomy Pro (version 4.29). To measure the reliability of the MARS quality evaluations (sections A, B, C, and D), the intraclass correlation coefficient was used, and the result was ``excellent.'' Finally, Pearson correlation results revealed a significant relationship (r=0.989; P<.001) between the quality assessments conducted by health care professionals and the subjective evaluations of item 23. Conclusions: The average evaluation results of the selected apps indicated a ``good'' level of quality, and those with the highest ratings could be recommended. However, the lack of scientific backing for these technological tools is evident. It is crucial that research centers and higher education institutions commit to the active development of new mobile health apps, ensuring their accessibility and validation for the general public. ", doi="10.2196/64550", url="https://mededu.jmir.org/2025/1/e64550" } @Article{info:doi/10.2196/55206, author="Hoyt, Garrik and Bakshi, Shekhar Chandra and Basu, Paramita", title="Integration of an Audiovisual Learning Resource in a Podiatric Medical Infectious Disease Course: Multiple Cohort Pilot Study", journal="JMIR Med Educ", year="2025", month="Feb", day="11", volume="11", pages="e55206", keywords="learning retention", keywords="preclinical education", keywords="podiatric medical education", keywords="audiovisual learning resources", keywords="multimedia-based learning resource", keywords="animation-supported learning tools", keywords="mnemonics", keywords="spaced repetition", abstract="Background: Improved long-term learning retention leads to higher exam scores and overall course grades, which is crucial for success in preclinical coursework in any podiatric medicine curriculum. Audiovisual mnemonics, in conjunction with text-based materials and an interactive user interface, have been shown to increase memory retention and higher order thinking. Objective: This pilot study aims to evaluate the effectiveness of integrating web-based multimedia learning resources for improving student engagement and increasing learning retention. Methods: A quasi-experimental study was conducted with 2 cohorts totaling 158 second-year podiatric medical students. The treatment group had access to Picmonic's audiovisual resources, while the control group followed traditional instruction methods. Exam scores, final course grades, and user interactions with Picmonic were analyzed. Logistic regression and correlation analyses were conducted to examine the relationships between Picmonic access, performance outcomes, and student engagement. Results: The treatment group (n=91) had significantly higher average exam scores (P<.001) and final course grades (P<.001) than the control group (n=67). Effect size for the average final grades (d=0.96) indicated the practical significance of these differences. Logistic regression analysis revealed a positive association between Picmonic access with an odds ratio of 2.72 with a 95\% confidence interval, indicating that it is positively associated with the likelihood of achieving high final grades. Correlation analysis revealed a positive relationship (r=0.25, P=.02) between the number of in-video questions answered and students' final grades. Survey responses reflected increased student engagement, comprehension, and higher user satisfaction (3.71 out of 5 average rating) with the multimedia-based resources compared to traditional instructional resources. Conclusions: This pilot study underscores the positive impact of animation-supported web-based instruction on preclinical medical education. The treatment group, equipped with Picmonic, exhibited improved learning outcomes, enhanced engagement, and high satisfaction. These results contribute to the discourse on innovative educational methods and highlight the potential of multimedia-based learning resources to enrich medical curricula. Despite certain limitations, this research suggests that animation-supported audiovisual instruction offers a valuable avenue for enhancing student learning experiences in medical education. ", doi="10.2196/55206", url="https://mededu.jmir.org/2025/1/e55206" } @Article{info:doi/10.2196/63708, author="Davoody, Nadia and Stathakarou, Natalia and Swain, Cara and Bonacina, Stefano", title="Exploring the Impact of the COVID-19 Pandemic on Learning Experience, Mental Health, Adaptability, and Resilience Among Health Informatics Master's Students: Focus Group Study", journal="JMIR Med Educ", year="2025", month="Feb", day="10", volume="11", pages="e63708", keywords="COVID-19 pandemic", keywords="eHealth", keywords="blended learning", keywords="health informatics", keywords="higher education adaptation", abstract="Background: The shift to online education due to the COVID-19 pandemic posed significant challenges and opportunities for students, affecting their academic performance, mental well-being, and engagement. Objective: This study aimed to explore the overall learning experience among health informatics master's students at Karolinska Institutet, Sweden, and the strategies they used to overcome learning challenges posed by the COVID-19 pandemic. Methods: Through 3 structured focus groups, this study explored health informatics master's students' experiences of shifting learning environments for classes that started in 2019, 2020, and 2021. All focus group sessions were recorded and transcribed verbatim. Inductive content analysis was used to analyze the data. Results: The results highlight the benefits of increased autonomy and flexibility and identify challenges such as technical difficulties, diminished social interactions, and psychological impacts. This study underscores the importance of effective online educational strategies, technological preparedness, and support systems to enhance student learning experiences during emergencies. The findings of this study highlight implications for educators, students, and higher education institutions to embrace adaptation and foster innovation. Implications for educators, students, and higher education institutions include the need for educators to stay current with the latest educational technologies and design teaching strategies and pedagogical approaches suited to both online and in-person settings to effectively foster student engagement. Students must be informed about the technological requirements for online learning and adequately prepared to meet them. Institutions play a critical role in ensuring equitable access to technology, guiding and supporting educators in adopting innovative tools and methods, and offering mental health resources to assist students in overcoming the challenges of evolving educational environments. Conclusions: This research contributes to understanding the complexities of transitioning to online learning in urgent circumstances and offers insights for better preparing educational institutions for future pandemics. ", doi="10.2196/63708", url="https://mededu.jmir.org/2025/1/e63708" } @Article{info:doi/10.2196/63241, author="Baetzner, Sabine Anke and Hill, Yannick and Roszipal, Benjamin and Gerwann, Sol{\`e}ne and Beutel, Matthias and Birrenbach, Tanja and Karlseder, Markus and Mohr, Stefan and Salg, Alexander Gabriel and Schrom-Feiertag, Helmut and Frenkel, Ottilie Marie and Wrzus, Cornelia", title="Mass Casualty Incident Training in Immersive Virtual Reality: Quasi-Experimental Evaluation of Multimethod Performance Indicators", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e63241", keywords="prehospital decision-making", keywords="disaster medicine", keywords="emergency medicine", keywords="mass casualty incident", keywords="medical education", keywords="eye tracking", keywords="emergency simulation", keywords="virtual reality", abstract="Background: Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. Objective: This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. Methods: A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59\% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking--based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51\% MFRs vs 37/76, 49\% non-MFRs) and a knowledge test with patient vignettes. Results: Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman $\rho$=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. Conclusions: iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers' feedback and provide trainees with guidance on evaluating and reflecting on their own performance. ", doi="10.2196/63241", url="https://www.jmir.org/2025/1/e63241" } @Article{info:doi/10.2196/57424, author="Brown, Joan and De-Oliveira, Sophia and Mitchell, Christopher and Cesar, Carmen Rachel and Ding, Li and Fix, Melissa and Stemen, Daniel and Yacharn, Krisda and Wong, Fum Se and Dhillon, Anahat", title="Barriers to and Facilitators of Implementing Team-Based Extracorporeal Membrane Oxygenation Simulation Study: Exploratory Analysis", journal="JMIR Med Educ", year="2025", month="Jan", day="24", volume="11", pages="e57424", keywords="intensive care unit", keywords="ICU", keywords="teamwork in the ICU", keywords="team dynamics", keywords="collaboration", keywords="interprofessional collaboration", keywords="simulation", keywords="simulation training", keywords="ECMO", keywords="extracorporeal membrane oxygenation", keywords="life support", keywords="cardiorespiratory dysfunction", keywords="cardiorespiratory", keywords="cardiology", keywords="respiratory", keywords="heart", keywords="lungs", abstract="Introduction: Extracorporeal membrane oxygenation (ECMO) is a critical tool in the care of severe cardiorespiratory dysfunction. Simulation training for ECMO has become standard practice. Therefore, Keck Medicine of the University of California (USC) holds simulation-training sessions to reinforce and improve providers knowledge. Objective: This study aimed to understand the impact of simulation training approaches on interprofessional collaboration. We believed simulation-based ECMO training would improve interprofessional collaboration through increased communication and enhance teamwork. Methods: This was a single-center, mixed methods study of the Cardiac and Vascular Institute Intensive Care Unit at Keck Medicine of USC conducted from September 2021 to April 2023. Simulation training was offered for 1 hour monthly to the clinical team focused on the collaboration and decision-making needed to evaluate the initiation of ECMO therapy. Electronic surveys were distributed before, after, and 3 months post training. The survey evaluated teamwork and the effectiveness of training, and focus groups were held to understand social environment factors. Additionally, trainee and peer evaluation focus groups were held to understand socioenvironmental factors. Results: In total, 37 trainees attended the training simulation from August 2021 to August 2022. Using 27 records for exploratory factor analysis, the standardized Cronbach $\alpha$ was 0.717. The survey results descriptively demonstrated a positive shift in teamwork ability. Qualitative themes identified improved confidence and decision-making. Conclusions: The study design was flawed, indicating improvement opportunities for future research on simulation training in the clinical setting. The paper outlines what to avoid when designing and implementing studies that assess an educational intervention in a complex clinical setting. The hypothesis deserves further exploration and is supported by the results of this study. ", doi="10.2196/57424", url="https://mededu.jmir.org/2025/1/e57424" } @Article{info:doi/10.2196/64970, author="Nijkamp, Nick and Calleja, Pauline and Sahay, Ashlyn and Jack, Leanne", title="Evaluation of the Transition-to-Practice Arrangements for Novice Perioperative Nurses: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="23", volume="14", pages="e64970", keywords="transition to practice", keywords="perioperative nursing", keywords="novice nurses", keywords="nurse educators", keywords="mixed methods research", keywords="protocol", keywords="document analysis", keywords="semistructured interviews", keywords="pedagogy", abstract="Background: Transitioning into the first year of clinical practice as a nurse or changing specialties in the nursing career presents a critical phase for novice nurses characterized by excitement, apprehension, and the phenomenon of ``transition shock.'' Within perioperative nursing, this transition phase takes on distinctive challenges. However, there is a lack of empirical evidence on transition programs and arrangements. Objective: This study aimed to evaluate the current transition-to-practice (TTP) arrangements available to new graduate and novice nurses within Australian perioperative nursing settings. Methods: This study uses an exploratory mixed-method, multilevel triangulation with a sequential phase design to address 4 research questions. Phases 1 to 3 will use document analysis, surveys, and semistructured interviews to establish the findings of the research questions. Phase 4 will use meta-inference and triangulation to aggregate and analyze the data from all preceding phases. These findings will be the foundation for developing a framework to inform future TTP arrangements. This robust framework will embed empirical evidence, existing literature, and sound learning and teaching pedagogy. Results emerging from this study will be reported using the Good Reporting of Mixed Methods Study guidelines. Results: This project received approval in June 2023. Following this, Human Research Ethics Committee approval was sought for phases 1 and 2, and recruitment began. As of August 2024, phase 1 has collected 50 responses and phase 2 has collected 69 responses. Data collection for phase 3 is projected to commence in May 2025 once data from phases 1 and 2 have been analyzed. Phase 4 is projected to occur in 2026. Each phase is anticipated to have a results manuscript submitted for publication once data are analyzed and written up. Conclusions: The findings of this study will provide an in-depth exploration of TTP arrangements within perioperative nursing in Australia and provide a framework to guide the future development of TTP arrangements. Trial Registration: OSF Registries osf.io/zm432; https://osf.io/54s36 International Registered Report Identifier (IRRID): DERR1-10.2196/64970 ", doi="10.2196/64970", url="https://www.researchprotocols.org/2025/1/e64970", url="http://www.ncbi.nlm.nih.gov/pubmed/39847424" } @Article{info:doi/10.2196/54152, author="Dushyanthen, Sathana and Zamri, Izzati Nadia and Chapman, Wendy and Capurro, Daniel and Lyons, Kayley", title="Evaluation of an Interdisciplinary Educational Program to Foster Learning Health Systems: Education Evaluation", journal="JMIR Med Educ", year="2025", month="Jan", day="14", volume="11", pages="e54152", keywords="continuing professional development", keywords="learning health system", keywords="flipped classroom", keywords="digital health informatics", keywords="data science", keywords="health professions education", keywords="interdisciplinary education", keywords="foster", keywords="foster learning", keywords="health data", keywords="design", keywords="innovative", keywords="innovative solution", keywords="health care workforce", keywords="Australia", keywords="real time", keywords="teaching model", abstract="Background: Learning health systems (LHS) have the potential to use health data in real time through rapid and continuous cycles of data interrogation, implementing insights to practice, feedback, and practice change. However, there is a lack of an appropriately skilled interprofessional informatics workforce that can leverage knowledge to design innovative solutions. Therefore, there is a need to develop tailored professional development training in digital health, to foster skilled interprofessional learning communities in the health care workforce in Australia. Objective: This study aimed to explore participants' experiences and perspectives of participating in an interprofessional education program over 13 weeks. The evaluation also aimed to assess the benefits, barriers, and opportunities for improvements and identify future applications of the course materials. Methods: We developed a wholly online short course open to interdisciplinary professionals working in digital health in the health care sector. In a flipped classroom model, participants (n=400) undertook 2 hours of preclass learning online and then attended 2.5 hours of live synchronous learning in interactive weekly Zoom workshops for 13 weeks. Throughout the course, they collaborated in small, simulated learning communities (n=5 to 8), engaging in various activities and problem-solving exercises, contributing their unique perspectives and diverse expertise. The course covered a number of topics including background on LHS, establishing learning communities, the design thinking process, data preparation and machine learning analysis, process modeling, clinical decision support, remote patient monitoring, evaluation, implementation, and digital transformation. To evaluate the purpose of the program, we undertook a mixed methods evaluation consisting of pre- and postsurveys rating scales for usefulness, engagement, value, and applicability for various aspects of the course. Participants also completed identical measures of self-efficacy before and after (n=200), with scales mapped to specific skills and tasks that should have been achievable following each of the topics covered. Further, they undertook voluntary weekly surveys to provide feedback on which aspects to continue and recommendations for improvements, via free-text responses. Results: From the evaluation, it was evident that participants found the teaching model engaging, useful, valuable, and applicable to their work. In the self-efficacy component, we observed a significant increase (P<.001) in perceived confidence for all topics, when comparing pre- and postcourse ratings. Overall, it was evident that the program gave participants a framework to organize their knowledge and a common understanding and shared language to converse with other disciplines, changed the way they perceived their role and the possibilities of data and technologies, and provided a toolkit through the LHS framework that they could apply in their workplaces. Conclusions: We present a program to educate the health workforce on integrating the LHS model into standard practice. Interprofessional collaborative learning was a major component of the value of the program. This evaluation shed light on the multifaceted challenges and expectations of individuals embarking on a digital health program. Understanding the barriers and facilitators of the audience is crucial for creating an inclusive and supportive learning environment. Addressing these challenges will not only enhance participant engagement but also contribute to the overall success of the program and, by extension, the broader integration of digital health solutions into health care practice and, ultimately, patient outcomes. ", doi="10.2196/54152", url="https://mededu.jmir.org/2025/1/e54152" } @Article{info:doi/10.2196/62669, author="Rjoop, Anwar and Al-Qudah, Mohammad and Alkhasawneh, Raja and Bataineh, Nesreen and Abdaljaleel, Maram and Rjoub, A. Moayad and Alkhateeb, Mustafa and Abdelraheem, Mohammad and Al-Omari, Salem and Bani-Mari, Omar and Alkabalan, Anas and Altulaih, Saoud and Rjoub, Iyad and Alshimi, Rula", title="Awareness and Attitude Toward Artificial Intelligence Among Medical Students and Pathology Trainees: Survey Study", journal="JMIR Med Educ", year="2025", month="Jan", day="10", volume="11", pages="e62669", keywords="artificial intelligence", keywords="AI", keywords="deep learning", keywords="medical schools", keywords="pathology", keywords="Jordan", keywords="medical education", keywords="awareness", keywords="attitude", keywords="medical students", keywords="pathology trainees", keywords="national survey study", keywords="medical practice", keywords="training", keywords="web-based survey", keywords="survey", keywords="questionnaire", abstract="Background: Artificial intelligence (AI) is set to shape the future of medical practice. The perspective and understanding of medical students are critical for guiding the development of educational curricula and training. Objective: This study aims to assess and compare medical AI-related attitudes among medical students in general medicine and in one of the visually oriented fields (pathology), along with illuminating their anticipated role of AI in the rapidly evolving landscape of AI-enhanced health care. Methods: This was a cross-sectional study that used a web-based survey composed of a closed-ended questionnaire. The survey addressed medical students at all educational levels across the 5 public medical schools, along with pathology residents in 4 residency programs in Jordan. Results: A total of 394 respondents participated (328 medical students and 66 pathology residents). The majority of respondents (272/394, 69\%) were already aware of AI and deep learning in medicine, mainly relying on websites for information on AI, while only 14\% (56/394) were aware of AI through medical schools. There was a statistically significant difference in awareness among respondents who consider themselves tech experts compared with those who do not (P=.03). More than half of the respondents believed that AI could be used to diagnose diseases automatically (213/394, 54.1\% agreement), with medical students agreeing more than pathology residents (P=.04). However, more than one-third expressed fear about recent AI developments (167/394, 42.4\% agreed). Two-thirds of respondents disagreed that their medical schools had educated them about AI and its potential use (261/394, 66.2\% disagreed), while 46.2\% (182/394) expressed interest in learning about AI in medicine. In terms of pathology-specific questions, 75.4\% (297/394) agreed that AI could be used to identify pathologies in slide examinations automatically. There was a significant difference between medical students and pathology residents in their agreement (P=.001). Overall, medical students and pathology trainees had similar responses. Conclusions: AI education should be introduced into medical school curricula to improve medical students' understanding and attitudes. Students agreed that they need to learn about AI's applications, potential hazards, and legal and ethical implications. This is the first study to analyze medical students' views and awareness of AI in Jordan, as well as the first to include pathology residents' perspectives. The findings are consistent with earlier research internationally. In comparison with prior research, these attitudes are similar in low-income and industrialized countries, highlighting the need for a global strategy to introduce AI instruction to medical students everywhere in this era of rapidly expanding technology. ", doi="10.2196/62669", url="https://mededu.jmir.org/2025/1/e62669" } @Article{info:doi/10.2196/49895, author="Zucca, Alison and Bryant, Jamie and Purse, Jeffrey and Szwec, Stuart and Sanson-Fisher, Robert and Leigh, Lucy and Richer, Mike and Morrison, Alan", title="Evaluation of the Effectiveness of Advanced Technology Clinical Simulation Manikins in Improving the Capability of Australian Paramedics to Deliver High-Quality Cardiopulmonary Resuscitation: Pre- and Postintervention Study", journal="JMIR Cardio", year="2024", month="Dec", day="24", volume="8", pages="e49895", keywords="paramedicine", keywords="cardiopulmonary resuscitation", keywords="clinical simulation", keywords="professional development", keywords="manikins", keywords="effectiveness", keywords="technology", keywords="paramedics", keywords="patient care", keywords="simulation-based training", keywords="deployment", abstract="Background: Emergency medical services attend out-of-hospital cardiac arrests all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. Consequently, for paramedics working in areas with low out-of-hospital cardiac arrest case volumes, ambulance services and professional bodies recognize the importance of alternative ways to maintain resuscitation skills. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills. Objective: The aim of the study is to examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high-quality patient care, as measured by external cardiac compression (ECC) performance. Methods: A pre- and postintervention study design without a control group was used. Data were collected at the start of the manikin training forum (baseline), immediately following the training forum (time 2), and 6 to 11 months after the training forum (time 3). The study was conducted with paramedics from 95 NSW Ambulance locations (75 regional locations and 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (N=106; 100\% consent rate). As part of the intervention, paramedics attended a training session on the use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measure was an overall compression score that was automatically recorded and calculated by the simulator manikin in 2-minute cycles. This score was derived from compressions that were fully released and with the correct hand position, adequate depth, and adequate rate. Results: A total of 106 (100\% consent rate) paramedics participated, primarily representing regional ambulance locations (n= 75, 78.9\%). ECC compression scores were on average 95\% or above at all time points, suggesting high performance. No significant differences over time (P>.05) were identified for the overall ECC performance score, compressions fully released, compressions with adequate depth, or compressions with the correct hand position. However, paramedics had significantly lower odds (odds ratio 0.30, 95\% CI 0.12-0.78) of achieving compressions with adequate rate at time 3 compared to time 2 (P=.01). Compressions were of a slower rate, with an average difference of 2.1 fewer compressions every minute. Conclusions: Despite this difference in compression rate over time, this did not cause significant detriment to overall ECC performance. Training and deployment of simulator manikins did not significantly change paramedics' overall ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance. ", doi="10.2196/49895", url="https://cardio.jmir.org/2024/1/e49895" } @Article{info:doi/10.2196/56132, author="Mehyar, Nimer and Awawdeh, Mohammed and Omair, Aamir and Aldawsari, Adi and Alshudukhi, Abdullah and Alzeer, Ahmed and Almutairi, Khaled and Alsultan, Sultan", title="Long-Term Knowledge Retention of Biochemistry Among Medical Students in Riyadh, Saudi Arabia: Cross-Sectional Survey", journal="JMIR Med Educ", year="2024", month="Dec", day="16", volume="10", pages="e56132", keywords="biochemistry", keywords="knowledge", keywords="retention", keywords="medical students", keywords="retention interval", keywords="Saudi Arabia", abstract="Background: Biochemistry is a cornerstone of medical education. Its knowledge is integral to the understanding of complex biological processes and how they are applied in several areas in health care. Also, its significance is reflected in the way it informs the practice of medicine, which can guide and help in both diagnosis and treatment. However, the retention of biochemistry knowledge over time remains a dilemma. Long-term retention of such crucial information is extremely important, as it forms the foundation upon which clinical skills are developed and refined. The effectiveness of biochemistry education, and consequently its long-term retention, is influenced by several factors. Educational methods play a critical role; interactional and integrative teaching approaches have been suggested to enhance retention compared with traditional didactic methods. The frequency and context in which biochemistry knowledge is applied in clinical settings can significantly impact its retention. Practical application reinforces theoretical understanding, making the knowledge more accessible in the long term. Prior knowledge (familiarity) of information suggests that it is stored in long-term memory, which makes its retention in the long term easier to recall. Objectives: This investigation was conducted at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. The aim of the study is to understand the dynamics of long-term retention of biochemistry among medical students. Specifically, it looks for the association between students' familiarity with biochemistry content and actual knowledge retention levels. Methods: A cross-sectional correlational survey involving 240 students from King Saud bin Abdulaziz University for Health Sciences was conducted. Participants were recruited via nonprobability convenience sampling. A validated biochemistry assessment tool with 20 questions was used to gauge students' retention in biomolecules, catalysis, bioenergetics, and metabolism. To assess students' familiarity with the knowledge content of test questions, each question is accompanied by options that indicate students' prior knowledge of the content of the question. Statistical analyses tests such as Mann-Whitney U test, Kruskal-Wallis test, and chi-square tests were used. Results: Our findings revealed a significant correlation between students' familiarity of the content with their knowledge retention in the biomolecules (r=0.491; P<.001), catalysis (r=0.500; P<.001), bioenergetics (r=0.528; P<.001), and metabolism (r=0.564; P<.001) biochemistry knowledge domains. Conclusions: This study highlights the significance of familiarity (prior knowledge) in evaluating the retention of biochemistry knowledge. Although limited in terms of generalizability and inherent biases, the research highlights the crucial significance of student's familiarity in actual knowledge retention of several biochemistry domains. These results might be used by educators to customize instructional methods in order to improve students' long-term retention of biochemistry information and boost their clinical performance. ", doi="10.2196/56132", url="https://mededu.jmir.org/2024/1/e56132" } @Article{info:doi/10.2196/52068, author="Yokokawa, Daiki and Shikino, Kiyoshi and Nishizaki, Yuji and Fukui, Sho and Tokuda, Yasuharu", title="Evaluation of a Computer-Based Morphological Analysis Method for Free-Text Responses in the General Medicine In-Training Examination: Algorithm Validation Study", journal="JMIR Med Educ", year="2024", month="Dec", day="5", volume="10", pages="e52068", keywords="General Medicine In-Training Examination", keywords="free-text response", keywords="morphological analysis", keywords="Situation, Background, Assessment, and Recommendation", keywords="video-based question", abstract="Background: The General Medicine In-Training Examination (GM-ITE) tests clinical knowledge in a 2-year postgraduate residency program in Japan. In the academic year 2021, as a domain of medical safety, the GM-ITE included questions regarding the diagnosis from medical history and physical findings through video viewing and the skills in presenting a case. Examinees watched a video or audio recording of a patient examination and provided free-text responses. However, the human cost of scoring free-text answers may limit the implementation of GM-ITE. A simple morphological analysis and word-matching model, thus, can be used to score free-text responses. Objective: This study aimed to compare human versus computer scoring of free-text responses and qualitatively evaluate the discrepancies between human- and machine-generated scores to assess the efficacy of machine scoring. Methods: After obtaining consent for participation in the study, the authors used text data from residents who voluntarily answered the GM-ITE patient reproduction video-based questions involving simulated patients. The GM-ITE used video-based questions to simulate a patient's consultation in the emergency room with a diagnosis of pulmonary embolism following a fracture. Residents provided statements for the case presentation. We obtained human-generated scores by collating the results of 2 independent scorers and machine-generated scores by converting the free-text responses into a word sequence through segmentation and morphological analysis and matching them with a prepared list of correct answers in 2022. Results: Of the 104 responses collected---63 for postgraduate year 1 and 41 for postgraduate year 2---39 cases remained for final analysis after excluding invalid responses. The authors found discrepancies between human and machine scoring in 14 questions (7.2\%); some were due to shortcomings in machine scoring that could be resolved by maintaining a list of correct words and dictionaries, whereas others were due to human error. Conclusions: Machine scoring is comparable to human scoring. It requires a simple program and calibration but can potentially reduce the cost of scoring free-text responses. ", doi="10.2196/52068", url="https://mededu.jmir.org/2024/1/e52068" } @Article{info:doi/10.2196/54176, author="Bonnin, Gabriel and Kr{\"o}ber, Svea and Schneider, Silvia and Margraf, J{\"u}rgen and Pflug, Verena and Gerlach, L. Alexander and Slotta, Timo and Christiansen, Hanna and Albrecht, Bj{\"o}rn and Chavanon, Mira-Lynn and Hirschfeld, Gerrit and In-Albon, Tina and Thielsch, T. Meinald and von Brachel, Ruth", title="A Blended Learning Course on the Diagnostics of Mental Disorders: Multicenter Cluster Randomized Noninferiority Trial", journal="J Med Internet Res", year="2024", month="Nov", day="27", volume="26", pages="e54176", keywords="diagnosis", keywords="structured clinical interviews", keywords="blended learning", keywords="dissemination", keywords="therapist training", keywords="clinical interview", keywords="clinical diagnosis", keywords="clinical practice", keywords="psychology students", keywords="diagnostic test", keywords="health personnel", keywords="mental health services", keywords="mental health", abstract="Background: Clinical diagnoses determine if and how therapists treat their patients. As misdiagnoses can have severe adverse effects, disseminating evidence-based diagnostic skills into clinical practice is highly important. Objective: This study aimed to develop and evaluate a blended learning course in a multicenter cluster randomized controlled trial. Methods: Undergraduate psychology students (N=350) enrolled in 18 university courses at 3 universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants' performances in a clinical diagnostic interview after the courses. The secondary outcomes were diagnostic knowledge and participants' reactions to the courses. All outcomes were analyzed on the individual participant level using noninferiority testing. Results: Compared with the synchronous course (74.6\% pass rate), participation in the blended learning course (89\% pass rate) increased the likelihood of successfully passing the behavioral test (odds ratio 2.77, 95\% CI 1.55-5.13), indicating not only noninferiority but superiority of the blended learning course. Furthermore, superiority of the blended learning over the synchronous course could be found regarding diagnostic knowledge ($\beta$=.13, 95\% CI 0.01-0.26), course clarity ($\beta$=.40, 95\% CI 0.27-0.53), course structure ($\beta$=.18, 95\% CI 0.04-0.32), and informativeness ($\beta$=.19, 95\% CI 0.06-0.32). Conclusions: Blended learning can help to improve the diagnostic skills and knowledge of (future) clinicians and thus make an important contribution to improving mental health care. Trial Registration: ClinicalTrials.gov NCT05294094; https://clinicaltrials.gov/study/NCT05294094 ", doi="10.2196/54176", url="https://www.jmir.org/2024/1/e54176" } @Article{info:doi/10.2196/59047, author="Lee, Allison and Goodman, Stephanie and Chen, Miao Chen and Landau, Ruth and Chatterji, Madhabi", title="Electronic Feedback Alone Versus Electronic Feedback Plus in-Person Debriefing for a Serious Game Designed to Teach Novice Anesthesiology Residents to Perform General Anesthesia for Cesarean Delivery: Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Nov", day="19", volume="12", pages="e59047", keywords="general anesthesia", keywords="cesarean delivery", keywords="multiple choice questions", keywords="serious game", keywords="debriefing", keywords="feedback", keywords="anesthesia", keywords="anesthesiology", keywords="anesthesiologist", keywords="anesthetist", keywords="cesarean", keywords="EmergenCSim", keywords="randomized controlled trial", abstract="Background: EmergenCSim is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia for emergent cesarean delivery for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared with using electronic feedback alone. Objective: We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. Methods: Novice first-year anesthesiology residents (CA-1; n=51) (1) watched a recorded lecture on general anesthesia for emergent cesarean delivery, (2) took a 26-item multiple-choice question pretest, and (3) played EmergenCSim (maximum score of 196.5). They were randomized to either the control group that experienced the electronic feedback alone (group EF, n=26) or the intervention group that experienced the SG-embedded electronic feedback and an in-person debriefing (group IPD+EF, n=25). All participants played the SG a second time, with instructions to try to increase their score, and then they took a 26-item multiple-choice question posttest. Pre- and posttests (maximum score of 26 points each) were validated parallel forms. Results: For groups EF and IPD+EF, respectively, mean pretest scores were 18.6 (SD 2.5) and 19.4 (SD 2.3), and mean posttest scores were 22.6 (SD 2.2) and 22.1 (SD 1.6; F1,49=1.8, P=.19). SG scores for groups EF and IPD+EF, respectively, were---mean first play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean second play SG scores of 163.1 (SE 2.9) and 173.3 (SE 2.9; F1,49=137.7, P<.001). Conclusions: Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools. ", doi="10.2196/59047", url="https://games.jmir.org/2024/1/e59047" } @Article{info:doi/10.2196/56844, author="M{\o}rk, Gry and Bonsaksen, Tore and Larsen, S{\o}nnik Ole and Kunnikoff, Martin Hans and Lie, Stangeland Silje", title="Virtual Reality Simulation in Undergraduate Health Care Education Programs: Usability Study", journal="JMIR Med Educ", year="2024", month="Nov", day="19", volume="10", pages="e56844", keywords="360{\textdegree} videos", keywords="health professions education", keywords="virtual reality", keywords="usability study", keywords="undergraduates", keywords="university", keywords="students", keywords="simulation", abstract="Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360{\textdegree} videos in VR headsets, followed by peer debrief and group discussions, may strengthen students' social and emotional learning. Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway. Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions. Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60\%), while occupational therapy students less often had prior experience (37\%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers. Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking. ", doi="10.2196/56844", url="https://mededu.jmir.org/2024/1/e56844" } @Article{info:doi/10.2196/60940, author="Hertel, Kay Amanda and Ajlan, S. Radwan", title="Impact of Ophthalmic Knowledge Assessment Program Scores and Surgical Volume on Subspecialty Fellowship Application in Ophthalmology Residency: Retrospective Cohort Study", journal="JMIR Med Educ", year="2024", month="Nov", day="13", volume="10", pages="e60940", keywords="residency", keywords="fellowship", keywords="ophthalmology", keywords="OKAP", keywords="surgical training", keywords="ophthalmology resident", keywords="ophthalmology residency program", keywords="examination", keywords="surgical volume exposure", keywords="fellowship training", keywords="surgical volume", keywords="exposure", keywords="Ophthalmic Knowledge Assessment Program", abstract="Background: Ophthalmology residents take the Ophthalmic Knowledge Assessment Program (OKAP) exam annually, which provides percentile rank for multiple categories and the total score. In addition, ophthalmology residency training programs have multiple subspecialty rotations with defined minimum procedure requirements. However, residents' surgical volumes vary, with some residents exceeding their peers in specific subspecialty rotations. Objective: This study aims to identify if there is a difference in OKAP examination scores and surgical volume exposure during ophthalmology residency training between nonfellowship and fellowship applicants and among various subspecialties. Methods: A retrospective review of OKAP scores and surgical procedure numbers of graduating residents in an accredited academic ophthalmology residency program in the Midwest United States was conducted. Data were collected from 2012 to 2022. Results: A total of 31 residents were identified. Most residents decided to pursue fellowship training upon graduation (20/31, 65\% residents), and the rest chose to practice comprehensive ophthalmology (11/31, 35\% residents). A total of 18/31 residents had OKAP score reports available. The fellowship group outperformed the nonfellowship group in multiple subsections and the total exam (P=.04). Those pursuing fellowship training in glaucoma performed higher on the Glaucoma section (P=.004) and the total exam (P=.005). Residents pursuing cornea performed higher on nearly all subsections, including External Disease and Cornea (P=.02) and the total exam (P=.007). The majority of the surgical volume exposure was identical between fellowship and nonfellowship groups. Those who pursued glaucoma fellowship performed more glaucoma filtering and shunting procedures (P=.03). Residents going into pediatrics fellowship were primary surgeons in more strabismus cases (P=.01), assisted in fewer strabismus cases (P<.001), and had no difference in the total number of strabismus surgeries. Conclusions: In our program, residents pursuing fellowship training had higher OKAP scores on multiple sections and the total exam. There was no significant difference in the overall surgical volume averages between fellowship and nonfellowship groups, but few differences existed in subspecialty procedures among fellowship applicants. Larger multicenter studies are needed to clarify the relationship between OKAP scores and ophthalmology fellowship decisions nationwide. ", doi="10.2196/60940", url="https://mededu.jmir.org/2024/1/e60940" } @Article{info:doi/10.2196/50389, author="Pang, MengWei and Lu, WeiYu and Huang, Chuling and Lin, Meixiu and Ran, Jiangsheng and Tang, Xiaomei and Huang, YuanDing and Yang, Sheng and Song, Jinlin", title="Development of an Interprofessional Education Project in Dentistry Based on the Positive Behavior Support Theory: Pilot Curriculum Development and Validation Study", journal="JMIR Form Res", year="2024", month="Nov", day="11", volume="8", pages="e50389", keywords="innovative interprofessional education", keywords="dentistry", keywords="dental technology", keywords="positive behavior support", keywords="IPE", keywords="positive behavior", keywords="training system", keywords="dental education", keywords="", abstract="Background: Effective interprofessional education (IPE) can facilitate teamwork between dentists and dental technicians, thereby enabling the efficient provision of high-quality dental care. Objective: This study aimed to design and assess an IPE module named Project 35, which was offered to dental and dental technology students early in their undergraduate training as a precursor to a more comprehensive IPE curriculum in dentistry and dental technology. Methods: Leveraging positive behavior support (PBS) theory, Project 35 was devised as an innovation and entrepreneurship educational training framework. It used project-based learning to cultivate teamwork skills and to promote the professional development of dental and dental technology students. The pilot study was designed to present the IPE module and preliminarily assess its validity. In survey 1, which was conducted immediately after the course, the dental and dental technology students' self-reported skill acquisition and attitudes were assessed and compared. Survey 2, conducted 1 year after the course, focused on the comparative benefits of Project 35 training for dental technology students versus an untrained group. Results: A total of 66 students, including 36 dental students and 30 dental technology students who had undertaken the training, were recruited. Project 35 training improved teamwork skills for students in both disciplines comparably, and the students recognized the training as highly valuable and effective. The mean values for all items indicating skills improvement of students ranged from 4.13 (SD 0.797) to 4.63 (SD 0.495) for dental students and from 4.13 (SD 0.869) to 4.74 (SD 0.619) for dental technology students. Among the dental technology students, the trained group showed greater independent and innovative approaches and was more optimistic about the future of the profession than the nontrained group (P<.05). Conclusions: Despite the small sample size, the validity of the Project 35 training system was evident, and the success of our pilot study provides a sound basis for the future development of IPE in clinical dental and dental technology education programs. ", doi="10.2196/50389", url="https://formative.jmir.org/2024/1/e50389" } @Article{info:doi/10.2196/53337, author="Bhavaraju, L. Vasudha and Panchanathan, Sarada and Willis, C. Brigham and Garcia-Filion, Pamela", title="Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study", journal="JMIR Med Educ", year="2024", month="Nov", day="6", volume="10", pages="e53337", keywords="clinical informatics", keywords="electronic health record", keywords="pediatric resident", keywords="COVID-19", keywords="competence-based medical education", keywords="pediatric", keywords="children", keywords="SARS-CoV-2", keywords="clinic", keywords="urban", keywords="diagnosis", keywords="health informatics", keywords="EHR", keywords="individualized learning plan", abstract="Background: Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. Objective: This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. Methods: This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020?2022) were compared with class and graduated resident (classes of 2016?2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Results: Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. Conclusions: This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education. ", doi="10.2196/53337", url="https://mededu.jmir.org/2024/1/e53337" } @Article{info:doi/10.2196/54280, author="Enich, Michael and Morton, Cory and Jermyn, Richard", title="Naloxone Coprescribing and the Prevention of Opioid Overdoses: Quasi-Experimental Metacognitive Assessment of a Novel Education Initiative", journal="JMIR Med Educ", year="2024", month="Oct", day="28", volume="10", pages="e54280", keywords="naloxone", keywords="coprescribing", keywords="prescription", keywords="academic detailing", keywords="metacognition", keywords="metacognitive evaluation", keywords="pharmacotherapy", keywords="pharmaceutic", keywords="pharmaceutical", keywords="education", keywords="educational intervention", keywords="opioid", keywords="opioid overdose", keywords="harm reduction", abstract="Background: Critical evaluation of naloxone coprescription academic detailing programs has been positive, but little research has focused on how participant thinking changes during academic detailing. Objective: The dual purposes of this study were to (1) present a metacognitive evaluation of a naloxone coprescription academic detailing intervention and (2) describe the application of a metacognitive evaluation for future medical education interventions. Methods: Data were obtained from a pre-post knowledge assessment of a web-based, self-paced intervention designed to increase knowledge of clinical and organizational best practices for the coprescription of naloxone. To assess metacognition, items were designed with confidence-weighted true-false scoring. Multiple metacognitive scores were calculated: 3 content knowledge scores and 5 confidence-weighted true-false scores. Statistical analysis examined whether there were significant differences in scores before and after intervention. Analysis of overall content knowledge showed significant improvement at posttest. Results: There was a significant positive increase in absolute accuracy of participant confidence judgments, confidence in correct probability, and confidence in incorrect probability (all P values were <.05). Overall, results suggest an improvement in content knowledge scores after intervention and, metacognitively, suggest that individuals were more confident in their answer choices, regardless of correctness. Conclusions: Implications include the potential application of metacognitive evaluations to assess nuances in learner performance during academic detailing interventions and as a feedback mechanism to reinforce learning and guide curricular design. ", doi="10.2196/54280", url="https://mededu.jmir.org/2024/1/e54280" } @Article{info:doi/10.2196/53462, author="Saig{\'i}-Rubi{\'o}, Francesc and Romeu, Teresa and Hern{\'a}ndez Encuentra, Eul{\`a}lia and Guitert, Montse and Andr{\'e}s, Erik and Reixach, Elisenda", title="Design, Implementation, and Analysis of an Assessment and Accreditation Model to Evaluate a Digital Competence Framework for Health Professionals: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Oct", day="17", volume="10", pages="e53462", keywords="eHealth literacy", keywords="eHealth competencies", keywords="digital health", keywords="competencies", keywords="eHealth", keywords="health literacy", keywords="digital technology", keywords="health care professionals", keywords="health care workers", abstract="Background: Although digital health is essential for improving health care, its adoption remains slow due to the lack of literacy in this area. Therefore, it is crucial for health professionals to acquire digital skills and for a digital competence assessment and accreditation model to be implemented to make advances in this field. Objective: This study had two objectives: (1) to create a specific map of digital competences for health professionals and (2) to define and test a digital competence assessment and accreditation model for health professionals. Methods: We took an iterative mixed methods approach, which included a review of the gray literature and consultation with local experts. We used the arithmetic mean and SD in descriptive statistics, P values in hypothesis testing and subgroup comparisons, the greatest lower bound in test diagnosis, and the discrimination index in study instrument analysis. Results: The assessment model designed in accordance with the competence content defined in the map of digital competences and based on scenarios had excellent internal consistency overall (greatest lower bound=0.91). Although most study participants (110/122, 90.2\%) reported an intermediate self-perceived digital competence level, we found that the vast majority would not attain a level-2 Accreditation of Competence in Information and Communication Technologies. Conclusions: Knowing the digital competence level of health professionals based on a defined competence framework should enable such professionals to be trained and updated to meet real needs in their specific professional contexts and, consequently, take full advantage of the potential of digital technologies. These results have informed the Health Plan for Catalonia 2021-2025, thus laying the foundations for creating and offering specific training to assess and certify the digital competence of such professionals. ", doi="10.2196/53462", url="https://mededu.jmir.org/2024/1/e53462", url="http://www.ncbi.nlm.nih.gov/pubmed/39418092" } @Article{info:doi/10.2196/59009, author="Khamisy-Farah, Rola and Biras, Eden and Shehadeh, Rabie and Tuma, Ruba and Atwan, Hisham and Siri, Anna and Converti, Manlio and Chirico, Francesco and Szarpak, ?ukasz and Biz, Carlo and Farah, Raymond and Bragazzi, Nicola", title="Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Oct", day="8", volume="10", pages="e59009", keywords="gender medicine", keywords="medical education", keywords="clinical practice", keywords="gender-sensitive care", keywords="gender awareness", keywords="sexuality awareness", keywords="awareness", keywords="medical education and practice", keywords="healthcare", keywords="patient outcomes", keywords="patient", keywords="patients", keywords="medical professionals", keywords="training", keywords="educational interventions", keywords="status-based", keywords="survey", keywords="effectiveness", keywords="medical workforce", abstract="Background: The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery. Objective: The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel. Methods: This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants' replies. Results: The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions. Conclusions: The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce. ", doi="10.2196/59009", url="https://mededu.jmir.org/2024/1/e59009", url="http://www.ncbi.nlm.nih.gov/pubmed/39152652" } @Article{info:doi/10.2196/64125, author="Carrillo, Irene and Skoumalov{\'a}, Ivana and Bruus, Ireen and Klemm, Victoria and Guerra-Paiva, Sofia and Kne?evi{\'c}, Bojana and Jankauskiene, Augustina and Jocic, Dragana and Tella, Susanna and Buttigieg, C. Sandra and Srulovici, Einav and Madarasov{\'a} Geckov{\'a}, Andrea and P{\~o}lluste, Kaja and Strametz, Reinhard and Sousa, Paulo and Odalovic, Marina and Mira, Joaqu{\'i}n Jos{\'e}", title="Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study", journal="JMIR Med Educ", year="2024", month="Oct", day="7", volume="10", pages="e64125", keywords="psychological safety", keywords="speaking up", keywords="professional competence", keywords="patient safety", keywords="education", keywords="adverse event", abstract="Background: In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce. Objective: This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning. Methods: A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined. Results: In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6\%), of which 63 (36.4\%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned. Conclusions: This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context. ", doi="10.2196/64125", url="https://mededu.jmir.org/2024/1/e64125", url="http://www.ncbi.nlm.nih.gov/pubmed/39374073" } @Article{info:doi/10.2196/57772, author="Ba, Hongjun and Zhang, Lili and He, Xiufang and Li, Shujuan", title="Knowledge Mapping and Global Trends in the Field of the Objective Structured Clinical Examination: Bibliometric and Visual Analysis (2004-2023)", journal="JMIR Med Educ", year="2024", month="Sep", day="30", volume="10", pages="e57772", keywords="Objective Structured Clinical Examination", keywords="OSCE", keywords="medical education assessment", keywords="bibliometric analysis", keywords="academic collaboration", keywords="health care professional training", keywords="medical education", keywords="medical knowledge", keywords="medical training", keywords="medical student", abstract="Background: The Objective Structured Clinical Examination (OSCE) is a pivotal tool for assessing health care professionals and plays an integral role in medical education. Objective: This study aims to map the bibliometric landscape of OSCE research, highlighting trends and key influencers. Methods: A comprehensive literature search was conducted for materials related to OSCE from January 2004 to December 2023, using the Web of Science Core Collection database. Bibliometric analysis and visualization were performed with VOSviewer and CiteSpace software tools. Results: Our analysis indicates a consistent increase in OSCE-related publications over the study period, with a notable surge after 2019, culminating in a peak of activity in 2021. The United States emerged as a significant contributor, responsible for 30.86\% (1626/5268) of total publications and amassing 44,051 citations. Coauthorship network analysis highlighted robust collaborations, particularly between the United States and the United Kingdom. Leading journals in this domain---BMC Medical Education, Medical Education, Academic Medicine, and Medical Teacher---featured the highest volume of papers, while The Lancet garnered substantial citations, reflecting its high impact factor (to be verified for accuracy). Prominent authors in the field include Sondra Zabar, Debra Pugh, Timothy J Wood, and Susan Humphrey-Murto, with Ronaldo M Harden, Brian D Hodges, and George E Miller being the most cited. The analysis of key research terms revealed a focus on ``education,'' ``performance,'' ``competence,'' and ``skills,'' indicating these are central themes in OSCE research. Conclusions: The study underscores a dynamic expansion in OSCE research and international collaboration, spotlighting influential countries, institutions, authors, and journals. These elements are instrumental in steering the evolution of medical education assessment practices and suggest a trajectory for future research endeavors. Future work should consider the implications of these findings for medical education and the potential areas for further investigation, particularly in underrepresented regions or emerging competencies in health care training. ", doi="10.2196/57772", url="https://mededu.jmir.org/2024/1/e57772" } @Article{info:doi/10.2196/56787, author="Mielitz, Annabelle and Kulau, Ulf and Bublitz, Lucas and Bittner, Anja and Friederichs, Hendrik and Albrecht, Urs-Vito", title="Teaching Digital Medicine to Undergraduate Medical Students With an Interprofessional and Interdisciplinary Approach: Development and Usability Study", journal="JMIR Med Educ", year="2024", month="Sep", day="30", volume="10", pages="e56787", keywords="medical education", keywords="digital medicine", keywords="digital health", abstract="Background: An integration of digital medicine into medical education can help future physicians shape the digital transformation of medicine. Objective: We aim to describe and evaluate a newly developed course for teaching digital medicine (the Bielefeld model) for the first time. Methods: The course was held with undergraduate medical students at Medical School Ostwestfalen-Lippe at Bielefeld University, Germany, in 2023 and evaluated via pretest-posttest surveys. The subjective and objective achievement of superordinate learning objectives and the objective achievement of subordinate learning objectives of the course, course design, and course importance were evaluated using 5-point Likert scales (1=strongly disagree; 5=strongly agree); reasons for absences were assessed using a multiple-choice format, and comments were collected. The superordinate objectives comprised (1) the understanding of factors driving the implementation of digital medical products and processes, (2) the application of this knowledge to a project, and (3) the empowerment to design such solutions in the future. The subordinate objectives comprised competencies related to the first superordinate objective. Results: In total, 10 undergraduate medical students (male: n=4, 40\%; female: n=6, 60\%; mean age 21.7, SD 2.1 years) evaluated the course. The superordinate objectives were achieved well to very well---the medians for the objective achievement were 4 (IQR 4-5), 4 (IQR 3-5), and 4 (IQR 4-4) scale units for the first, second, and third objectives, respectively, and the medians for the subjective achievement of the first, second, and third objectives were 4 (IQR 3-4), 4.5 (IQR 3-5), and 4 (IQR 3-5) scale units, respectively. Participants mastered the subordinate objectives, on average, better after the course than before (presurvey median 2.5, IQR 2-3 scale units; postsurvey median 4, IQR 3-4 scale units). The course concept was rated as highly suitable for achieving the superordinate objectives (median 5, IQR 4-5 scale units for the first, second, and third objectives). On average, the students strongly liked the course (median 5, IQR 4-5 scale units) and gained a benefit from it (median 4.5, IQR 4-5 scale units). All students fully agreed that the teaching staff was a strength of the course. The category positive feedback on the course or positive personal experience with the course received the most comments. Conclusions: The course framework shows promise in attaining learning objectives within the realm of digital medicine, notwithstanding the constraint of limited interpretability arising from a small sample size and further limitations. The course concept aligns with insights derived from teaching and learning research and the domain of digital medicine, albeit with identifiable areas for enhancement. A literature review indicates a dearth of publications pertaining to analogous courses in Germany. Future investigations should entail a more exhaustive evaluation of the course. In summary, this course constitutes a valuable contribution to incorporating digital medicine into medical education. ", doi="10.2196/56787", url="https://mededu.jmir.org/2024/1/e56787", url="http://www.ncbi.nlm.nih.gov/pubmed/39189929" } @Article{info:doi/10.2196/54105, author="Livesay, Karen and Walter, Ruby and Petersen, Sacha and Abdolkhani, Robab and Zhao, Lin and Butler-Henderson, Kerryn", title="Challenges and Needs in Digital Health Practice and Nursing Education Curricula: Gap Analysis Study", journal="JMIR Med Educ", year="2024", month="Sep", day="13", volume="10", pages="e54105", keywords="nursing", keywords="digital health", keywords="capability", keywords="workforce", keywords="framework", keywords="nursing education", keywords="education", keywords="digital health practice", keywords="clinicians", keywords="nurse", keywords="nurse graduates", keywords="clinical nurses", keywords="nurses", keywords="nurse educators", keywords="teach", keywords="teaching", keywords="learning", keywords="nursing students", keywords="student", keywords="students", abstract="Background: Australian nursing programs aim to introduce students to digital health requirements for practice. However, innovation in digital health is more dynamic than education providers' ability to respond. It is uncertain whether what is taught and demonstrated in nursing programs meets the needs and expectations of clinicians with regard to the capability of the nurse graduates. Objective: This study aims to identify gaps in the National Nursing and Midwifery Digital Health Capability Framework , based on the perspectives of clinical nurses, and in nurse educators' confidence and knowledge to teach. The findings will direct a future co-design process. Methods: This study triangulated the findings from 2 studies of the Digital Awareness in Simulated Health project and the National Nursing and Midwifery Digital Capability Framework. The first was a qualitative study that considered the experiences of nurses with digital health technologies during the COVID-19 pandemic, and the second was a survey of nurse educators who identified their confidence and knowledge to teach and demonstrate digital health concepts. Results: The results were categorized by and presented from the perspectives of nurse clinicians, nurse graduates, and nurse educators. Findings were listed against each of the framework capabilities, and omissions from the framework were identified. A series of statements and questions were formulated from the gap analysis to direct a future co-design process with nursing stakeholders to develop a digital health capability curriculum for nurse educators. Conclusions: Further work to evaluate nursing digital health opportunities for nurse educators is indicated by the gaps identified in this study. ", doi="10.2196/54105", url="https://mededu.jmir.org/2024/1/e54105" } @Article{info:doi/10.2196/57187, author="Byon, Do Ha and Park, Sunbok and Quatrara, A. Beth and Taggart, Jessica and Wheeler, Buford Lindsay", title="Examining the Evidence on the Statistics Prerequisite for Admission to Doctor of Nursing Practice Programs: Retrospective Cohort Study", journal="Asian Pac Isl Nurs J", year="2024", month="Sep", day="9", volume="8", pages="e57187", keywords="Doctor of Nursing Practice", keywords="admission prerequisite", keywords="statistics requirement", keywords="biostatistics", keywords="nursing education", abstract="Background: Doctor of Nursing Practice (DNP) programs in the United States confer the highest practice degree in nursing. The proportion of racial and ethnic minority DNP students, including those of Asian descent, keeps increasing in the United States. Statistics is commonly required for DNP programs. However, there is insufficient evidence regarding the number of years within which statistics should be taken and the minimum grade required for admission to the program. Objective: This study aimed to examine the associations of statistics prerequisite durations and grades for admission with the course performances within the DNP program. We also explored whether a postadmission statistics overview course can prepare students for a DNP statistics course as well as a required statistics prerequisite course. Methods: A retrospective cohort study was conducted with a sample of 31 DNP students at a large university in the Mid-Atlantic region. Statistical analysis of data collected over 5 years, between 2018 and 2022, was performed to examine the associations, using Spearman rank correlation analysis and Mann-Whitney U test (U). Results: The performance of students in a DNP statistics course was not associated with prerequisite duration. There was no significant association between the duration and the DNP statistics course letter grades ($\rho$=0.12; P=.66), neither with exam 1 ($\rho$=0.03; P=.91) nor with exam 2 scores ($\rho$=0.01; P=.97). Prerequisite grades were positively associated with exam 1 grades ($\rho$=0.59; P=.02), but not exam 2 ($\rho$=0.35; P=.19) or course grades ($\rho$=0.40; P=.12). In addition, no difference was found in the performance of students whether meeting the prerequisite requirements or taking a 1-month, self-paced overview course (exam 1: U=159, P=.13; exam 2: U=102, P=.50; course letter grade: U=117, P=.92). Conclusions: No evidence was found to support the need for limits on when prerequisites are completed or grade requirements. Opting for a statistics overview course after admission can serve as a viable alternative to the statistics prerequisite, effectively preparing students for advanced quantitative data analysis in a DNP program. ", doi="10.2196/57187", url="https://apinj.jmir.org/2024/1/e57187", url="http://www.ncbi.nlm.nih.gov/pubmed/39250220" } @Article{info:doi/10.2196/56727, author="Costa, Silva Carlos Dario da and Silva, Gouvea Gabriela and Santos, dos Emerson Roberto and Engel, Carvalho Ana Maria Rita Pedroso Vilela Torres de and Costa, Santos Ana Caroline dos and da Silva, Morete Taisa and da Concei{\c{c}}{\~a}o, Henrique Washington and Crist{\'o}v{\~a}o, Helena and Lima, Abreu Alba Regina de and Brienze, MS V{\^a}nia and Bizotto, Gastardelo Tha{\'i}s Santana and Oliani, H{\'e}lio Antonio and Andr{\'e}, C{\'e}sar J{\'u}lio", title="Surgical Residents' Perception of Feedback on Their Education: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Aug", day="19", volume="13", pages="e56727", keywords="medical education", keywords="occupational training", keywords="surgical residents", keywords="feedback", keywords="perception", abstract="Background: Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner's perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. Objective: The aim of this study is to identify and map out data from studies that report surgical residents' perception of the feedback received during their education. Methods: The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies' titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. Results: The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. Conclusions: Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents' learning progress. Trial Registration: Open Science Framework yexb; https://osf.io/yexkb. International Registered Report Identifier (IRRID): PRR1-10.2196/56727 ", doi="10.2196/56727", url="https://www.researchprotocols.org/2024/1/e56727", url="http://www.ncbi.nlm.nih.gov/pubmed/39158942" } @Article{info:doi/10.2196/52533, author="Vallabhajosyula, Ranganath and Perumal, Vivek and Chandrasekaran, Ramya and Mogali, Reddy Sreenivasulu", title="Preuniversity Students' Perceptions and Attitudes About an Anatomy and Physiology Outreach Program: Survey Study and Inductive Thematic Analysis", journal="JMIR Form Res", year="2024", month="Aug", day="12", volume="8", pages="e52533", keywords="anatomy", keywords="physiology", keywords="educational outreach", keywords="preuniversity outreach", keywords="team-based learning", keywords="anatomy workshop", keywords="medical education", keywords="health profession education", keywords="health professions", keywords="health care careers", keywords="student", keywords="students", keywords="outreach activity", keywords="physiological", keywords="school", keywords="university", keywords="Singapore", keywords="thematic analysis", keywords="learning", keywords="education", keywords="motivation", keywords="health care", keywords="health profession", keywords="medical school", abstract="Background: Science and health outreach activities are aimed at motivating and sparking interest among prospective students to pursue careers in these fields; however, research studies supporting this hypothesis are limited. Objective: The aim of our study was to organize an integrated Anatomy and Physiology outreach to examine preuniversity students' learning experiences (learning tools, activities, and facilitators) and motivation to pursue a career in health care and to gather evidence on their attitudes and perceptions of such activities. Methods: A 2-day course on cardiorespiratory and gastrointestinal anatomical systems was presented at the Lee Kong Chian School of Medicine in Singapore using its key pedagogies, that is, multimodal practical and team-based learning. Ninety preuniversity students from 21 preuniversity institutions in Singapore participated in this 2-day course, and their experiences were evaluated using a 4-point Likert scale and open-ended survey questions. Free-text comments were analyzed using inductive thematic analysis. Results: The survey using the 4-point Likert scale was completed by 81 (92\%) of the 88 participants. Most students felt that the course materials were adequate (mean 3.57, SD 0.57) and met the learning objectives (mean 3.73, SD 0.52). The students felt that the instructors were clear (mean 3.73, SD 0.52) and effective (mean 3.70, SD 0.53). They liked the organization of the outreach session (mean 3.64, SD 0.48) and were highly motivated to study medicine or allied/biomedical sciences (mean 3.69, SD 0.54). Practical and team-based learning were regarded as exceedingly satisfactory (mean 3.63, SD 0.53 and mean 3.58, SD 0.54, respectively). All the respondents said that they would recommend this course to peers. Thematic analysis revealed that the participants gained a new perspective of the human body structure and function, they liked the unique learning settings, they were motivated to pursue a career in health care, they were satisfied with the sessions, and interactions with the facilitators increased their understanding of the human anatomy and physiology. Conclusions: Structured health outreach activities provide students with unique opportunities to experience a preclinical learning environment in a medical school, deepen their understanding of human body structure and function, and increase their motivation and interest in science. Further, outreach programs may lay the foundations for potential students aiming to pursue health profession education. ", doi="10.2196/52533", url="https://formative.jmir.org/2024/1/e52533" } @Article{info:doi/10.2196/54473, author="Mikkonen, Kasperi and Helminen, Eeva-Eerika and Saarni, I. Samuli and Saarni, E. Suoma", title="Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review", journal="J Med Internet Res", year="2024", month="Jul", day="29", volume="26", pages="e54473", keywords="mental health", keywords="psychotherapy", keywords="digital learning", keywords="Kirkpatrick model", keywords="e-learning", keywords="online health", keywords="psychotherapy training", keywords="learning outcome", keywords="learning outcomes", keywords="systematic review", keywords="training methods", keywords="mental disorders", keywords="mental disorder", keywords="accessibility", keywords="evidence-based", keywords="scalability", keywords="cost-effectiveness", keywords="internet", keywords="education", abstract="Background: Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. Objective: This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. Results: The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. Conclusions: e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings. ", doi="10.2196/54473", url="https://www.jmir.org/2024/1/e54473", url="http://www.ncbi.nlm.nih.gov/pubmed/39073862" } @Article{info:doi/10.2196/55155, author="Ferreira, Tomas and Collins, M. Alexander and French, Benjamin and Fortescue, Amelia and Handscomb, Arthur and Plumb, Ella and Bolton, Emily and Feng, Oliver", title="Factors Affecting Specialty Training Preference Among UK Medical Students (FAST): Protocol for a National Cross-Sectional Survey", journal="JMIR Res Protoc", year="2024", month="Jul", day="26", volume="13", pages="e55155", keywords="medical students", keywords="NHS", keywords="specialty preferences", keywords="workforce planning", keywords="medical education", keywords="National Health Service", abstract="Background: The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students' specialty choices, against a backdrop of increasing challenges in health care workforce planning. Objective: The primary objectives of the FAST study are to explore UK medical students' preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students' confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools. Methods: A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis. Results: The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024. Conclusions: The FAST study represents an important step in understanding the factors influencing UK medical students' career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system. International Registered Report Identifier (IRRID): DERR1-10.2196/55155 ", doi="10.2196/55155", url="https://www.researchprotocols.org/2024/1/e55155" } @Article{info:doi/10.2196/47560, author="Syed, Ahmed Toufeeq and Thompson, L. Erika and Latif, Zainab and Johnson, Jay and Javier, Damaris and Stinson, Katie and Saleh, Gabrielle and Vishwanatha, K. Jamboor", title="Diverse Mentoring Connections Across Institutional Boundaries in the Biomedical Sciences: Innovative Graph Database Analysis", journal="J Med Internet Res", year="2024", month="Jun", day="17", volume="26", pages="e47560", keywords="online platform", keywords="mentorship", keywords="diversity", keywords="network analysis", keywords="graph database", keywords="online communities", abstract="Background: With an overarching goal of increasing diversity and inclusion in biomedical sciences, the National Research Mentoring Network (NRMN) developed a web-based national mentoring platform (MyNRMN) that seeks to connect mentors and mentees to support the persistence of underrepresented minorities in the biomedical sciences. As of May 15, 2024, the MyNRMN platform, which provides mentoring, networking, and professional development tools, has facilitated more than 12,100 unique mentoring connections between faculty, students, and researchers in the biomedical domain. Objective: This study aimed to examine the large-scale mentoring connections facilitated by our web-based platform between students (mentees) and faculty (mentors) across institutional and geographic boundaries. Using an innovative graph database, we analyzed diverse mentoring connections between mentors and mentees across demographic characteristics in the biomedical sciences. Methods: Through the MyNRMN platform, we observed profile data and analyzed mentoring connections made between students and faculty across institutional boundaries by race, ethnicity, gender, institution type, and educational attainment between July 1, 2016, and May 31, 2021. Results: In total, there were 15,024 connections with 2222 mentees and 1652 mentors across 1625 institutions contributing data. Female mentees participated in the highest number of connections (3996/6108, 65\%), whereas female mentors participated in 58\% (5206/8916) of the connections. Black mentees made up 38\% (2297/6108) of the connections, whereas White mentors participated in 56\% (5036/8916) of the connections. Mentees were predominately from institutions classified as Research 1 (R1; doctoral universities---very high research activity) and historically Black colleges and universities (556/2222, 25\% and 307/2222, 14\%, respectively), whereas 31\% (504/1652) of mentors were from R1 institutions. Conclusions: To date, the utility of mentoring connections across institutions throughout the United States and how mentors and mentees are connected is unknown. This study examined these connections and the diversity of these connections using an extensive web-based mentoring network. ", doi="10.2196/47560", url="https://www.jmir.org/2024/1/e47560", url="http://www.ncbi.nlm.nih.gov/pubmed/38885013" } @Article{info:doi/10.2196/52207, author="Kataoka, Koshi and Nishizaki, Yuji and Shimizu, Taro and Yamamoto, Yu and Shikino, Kiyoshi and Nojima, Masanori and Nagasaki, Kazuya and Fukui, Sho and Nishiguchi, Sho and Katayama, Kohta and Kurihara, Masaru and Ueda, Rieko and Kobayashi, Hiroyuki and Tokuda, Yasuharu", title="Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study", journal="JMIR Med Educ", year="2024", month="May", day="30", volume="10", pages="e52207", keywords="clinical knowledge support system", keywords="GM-ITE", keywords="postgraduate clinical resident", keywords="in-training examination performance", keywords="exam", keywords="exams", keywords="examination", keywords="examinations", keywords="resident", keywords="residents", keywords="cross-sectional", keywords="national", keywords="nationwide", keywords="postgraduate", keywords="decision support", keywords="point-of-care", keywords="UpToDate", keywords="DynaMed", keywords="knowledge support", keywords="medical education", keywords="performance", keywords="information behavior", keywords="information behaviour", keywords="information seeking", keywords="teaching", keywords="pedagogy", keywords="pedagogical", keywords="log", keywords="logs", keywords="usage", keywords="evidence-based medicine", keywords="EBM", keywords="educational", keywords="decision support system", keywords="clinical decision support", keywords="Japan", keywords="General Medicine In-Training Examination", abstract="Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year--1 and --2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95\% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95\% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes. ", doi="10.2196/52207", url="https://mededu.jmir.org/2024/1/e52207" } @Article{info:doi/10.2196/52230, author="Chien, Cheng-Yu and Tsai, Shang-Li and Huang, Chien-Hsiung and Wang, Ming-Fang and Lin, Chi-Chun and Chen, Chen-Bin and Tsai, Li-Heng and Tseng, Hsiao-Jung and Huang, Yan-Bo and Ng, Chip-Jin", title="Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study", journal="JMIR Med Educ", year="2024", month="Apr", day="29", volume="10", pages="e52230", keywords="cardiopulmonary resuscitation", keywords="blended method", keywords="blended", keywords="hybrid", keywords="refresher", keywords="refreshers", keywords="teaching", keywords="instruction", keywords="observational", keywords="training", keywords="professional development", keywords="continuing education", keywords="retraining", keywords="traditional method", keywords="self-directed learning", keywords="resuscitation", keywords="CPR", keywords="emergency", keywords="rescue", keywords="life support", keywords="cardiac", keywords="cardiopulmonary", abstract="Background: Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method. Objective: This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators. Methods: This study recruited participants aged ?18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators. Results: This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3\% female), with 332 (28.5\%), 270 (23.2\%), 258 (22.2\%), and 303 (26.1\%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80\%); however, a higher proportion (98/303, 32.3\%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training. Conclusions: Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach. Trial Registration: IGOGO NCT05659108; https://www.cgmh-igogo.tw ", doi="10.2196/52230", url="https://mededu.jmir.org/2024/1/e52230", url="http://www.ncbi.nlm.nih.gov/pubmed/38683663" } @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/10.2196/56037, author="Fija{\v c}ko, Nino and Masterson Creber, Ruth and Metli{\v c}ar, {\vS}pela and Strnad, Matej and Greif, Robert and {\vS}tiglic, Gregor and Skok, Pavel", title="Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List--Controlled Trial", journal="JMIR Serious Games", year="2024", month="Apr", day="5", volume="12", pages="e56037", keywords="serious smartphone game", keywords="adult basic life support", keywords="teaching", keywords="game", keywords="games", keywords="gaming", keywords="education", keywords="nurse", keywords="nursing", keywords="nurses", keywords="educational", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="smartphone", keywords="smartphones", keywords="RCT", keywords="randomized controlled trial", keywords="controlled trial", keywords="technology-enhanced learning", keywords="TEL", keywords="life support", keywords="knowledge retention", keywords="theoretical knowledge", keywords="practice", keywords="practical", keywords="resuscitation", abstract="Background: Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education. Objective: The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS. Methods: This study used a randomized wait list--controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist. Results: In total, 43 nursing students participated in the study, 22 (51\%) in MOBICPR-IG and 21 (49\%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator. Conclusions: Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training. Trial Registration: ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675 ", doi="10.2196/56037", url="https://games.jmir.org/2024/1/e56037", url="http://www.ncbi.nlm.nih.gov/pubmed/38578690" } @Article{info:doi/10.2196/48135, author="Koester, MacKenzie and Motz, Rosemary and Porto, Ariel and Reyes Nieves, Nikita and Ashley, Karen", title="Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study", journal="JMIR Med Educ", year="2024", month="Apr", day="1", volume="10", pages="e48135", keywords="continuing medical education", keywords="telementoring", keywords="substance use disorder treatment", keywords="substance use disorder", keywords="SUD", keywords="primary care", keywords="Extension for Community Healthcare Outcomes", keywords="Project ECHO", abstract="Background: Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio's growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care. Objective: The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants' change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health. Methods: We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants' self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants' knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries. Results: The results of the content analysis indicated that 3 learning objective themes---team-based care, harm reduction, and social determinants of health---resulted in the highest frequencies and dose, appearing in 100\% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81\% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03). Conclusions: These findings indicate that the ECHO program's content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care. ", doi="10.2196/48135", url="https://mededu.jmir.org/2024/1/e48135", url="http://www.ncbi.nlm.nih.gov/pubmed/38557477" } @Article{info:doi/10.2196/54401, author="Shikino, Kiyoshi and Nishizaki, Yuji and Fukui, Sho and Yokokawa, Daiki and Yamamoto, Yu and Kobayashi, Hiroyuki and Shimizu, Taro and Tokuda, Yasuharu", title="Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study", journal="JMIR Med Educ", year="2024", month="Feb", day="29", volume="10", pages="e54401", keywords="discrimination index", keywords="General Medicine In-Training Examination", keywords="clinical simulation video", keywords="postgraduate medical education", keywords="video", keywords="videos", keywords="training", keywords="examination", keywords="examinations", keywords="medical education", keywords="resident", keywords="residents", keywords="postgraduate", keywords="postgraduates", keywords="simulation", keywords="simulations", keywords="diagnosis", keywords="diagnoses", keywords="diagnose", keywords="general medicine", keywords="general practice", keywords="general practitioner", keywords="skill", keywords="skills", abstract="Background: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. Objective: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. Methods: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ?0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. Results: Of the 56 participants, 6 (11\%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52\%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78\%) affirmed the realism of the video simulation, and 17 (74\%) indicated that the experience increased their motivation to learn. Conclusions: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education. ", doi="10.2196/54401", url="https://mededu.jmir.org/2024/1/e54401", url="http://www.ncbi.nlm.nih.gov/pubmed/38421691" } @Article{info:doi/10.2196/48672, author="Stevens, Kathleen and Moralejo, Donna and Crossman, Renee", title="Evaluation of Incremental Validity of Casper in Predicting Program and National Licensure Performance of Undergraduate Nursing Students: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Oct", day="18", volume="12", pages="e48672", keywords="communication", keywords="empathy", keywords="incremental validity", keywords="mixed methods", keywords="nursing school admissions", keywords="problem-solving", keywords="professionalism", keywords="situational judgement testing", keywords="undergraduate nursing students", abstract="Background: Academic success has been the primary criterion for admission to many nursing programs. However, academic success as an admission criterion may have limited predictive value for success in noncognitive skills. Adding situational judgment tests, such as Casper, to admissions procedures may be one strategy to strengthen decisions and address the limited predictive value of academic admission criteria. In 2021, admissions processes were modified to include Casper based on concerns identified with noncognitive skills. Objective: This study aims to (1) assess the incremental validity of Casper scores in predicting nursing student performance at years 1, 2, 3, and 4 and on the National Council Licensing Examination (NCLEX) performance; and (2) examine faculty members' perceptions of student performance and influences related to communication, professionalism, empathy, and problem-solving. Methods: We will use a multistage evaluation mixed methods design with 5 phases. At the end of each year, students will complete questionnaires related to empathy and professionalism and have their performance assessed for communication and problem-solving in psychomotor laboratory sessions. The final phase will assess graduate performance on the NCLEX. Each phase also includes qualitative data collection (ie, focus groups with faculty members). The goal of the focus groups is to help explain the quantitative findings (explanatory phase) as well as inform data collection (eg, focus group questions) in the subsequent phase (exploratory sequence). All students enrolled in the first year of the nursing program in 2021 were asked to participate (n=290). Faculty will be asked to participate in the focus groups at the end of each year of the program. Hierarchical multiple regression will be conducted for each outcome of interest (eg, communication, professionalism, empathy, and problem-solving) to determine the extent to which scores on Casper with admission grades, compared to admission grades alone, predict nursing student performance at years 1-4 of the program and success on the national exam. Thematic analysis of focus group transcripts will be conducted using interpretive description. The quantitative and qualitative data will be integrated after each phase is complete and at the end of the study. Results: This study was funded in September 2021, and data collection began in March 2022. Year 1 data collection and analysis are complete. Year 2 data collection is complete, and data analysis is in progress. Conclusions: At the end of the study, we will provide the results of a comprehensive analysis to determine the extent to which the addition of scores on Casper compared to admission grades alone predicts nursing student performance at years 1-4 of the program and on the NCLEX exam. International Registered Report Identifier (IRRID): RR1-10.2196/48672 ", doi="10.2196/48672", url="https://www.researchprotocols.org/2023/1/e48672", url="http://www.ncbi.nlm.nih.gov/pubmed/37851504" } @Article{info:doi/10.2196/48586, author="Lucero, Stringer Katie and Larkin, Amy and Zakharkin, Stanislav and Wysham, Carol and Anderson, John", title="The Impact of Web-Based Continuing Medical Education Using Patient Simulation on Real-World Treatment Selection in Type 2 Diabetes: Retrospective Case-Control Analysis", journal="JMIR Med Educ", year="2023", month="Aug", day="29", volume="9", pages="e48586", keywords="continuing medical education", keywords="virtual patient simulation", keywords="real-world evidence", keywords="evaluation", keywords="outcomes", keywords="diabetes education", keywords="medical education", keywords="type 2 diabetes", keywords="web-based learning", keywords="web-based education", abstract="Background: Despite guidelines recommending the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in certain patients with type 2 diabetes (T2D), they are not being prescribed for many of these patients. Web-based continuing medical education (CME) patient simulations have been used to identify clinicians' practice gaps and improve clinical decision-making as measured within a simulation, but the impact of this format on real-world treatment has not been researched. Objective: This study aimed to evaluate the effect of a simulation-based CME intervention on real-world use of GLP-1 RAs by endocrinologists and primary care physicians. Methods: Two evaluation phases of the CME simulation were conducted: phase I, the CME simulation phase, was a paired, pre-post study of 435 physician learners in the United States; and phase II, the real-world phase, was a retrospective, matched case-control study of 157 of the 435 physicians who had claims data available for the study period. Results: Phase I CME results showed a 29 percentage point increase in correct decisions from pre- to postfeedback (178/435, 40.9\% to 304/435, 69.9\%; P<.001) in selecting treatment that addresses both glycemic control and cardiovascular event protection. Phase II results showed that 39 of 157 (24.8\%) physicians in the intervention group increased use of GLP-1 RAs, compared to 20 of 157 (12.7\%) in the comparison group. Being in the intervention group predicted GLP-1 RA use after education (odds ratio 4.49; 95\% CI 1.45-13.97; P=.001). Conclusions: A web-based CME simulation focused on secondary prevention of cardiovascular events in a patient with T2D was associated with increased use of evidence-based treatment selection in the real world. ", doi="10.2196/48586", url="https://mededu.jmir.org/2023/1/e48586", url="http://www.ncbi.nlm.nih.gov/pubmed/37642994" } @Article{info:doi/10.2196/50902, author="Toohey, Shannon and Wray, Alisa and Hunter, John and Saadat, Soheil and Boysen-Osborn, Megan and Smart, Jonathan and Wiechmann, Warren and Pressman, D. Sarah", title="Authors' Response to the Validity of Cortisol and Galvanic Skin Responses for Measuring Student Stress During Training", journal="JMIR Med Educ", year="2023", month="Aug", day="18", volume="9", pages="e50902", keywords="augmented reality", keywords="AR", keywords="salivary cortisol", keywords="galvanic skin conductance", keywords="medical simulation", keywords="medical education", doi="10.2196/50902", url="https://mededu.jmir.org/2023/1/e50902", url="http://www.ncbi.nlm.nih.gov/pubmed/37594800" } @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/10.2196/44361, author="Deutsch, E. Judith and Palmieri, L. John and Gorin, Holly and Wendell, Augustus and Wohn, Yvette Donghee and Damodaran, Harish", title="Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study", journal="JMIR Med Educ", year="2023", month="Aug", day="10", volume="9", pages="e44361", keywords="physical therapy", keywords="education", keywords="teaching tool", keywords="simulation-based learning", keywords="computer-aided instruction", keywords="standardized assessment", keywords="clinical reasoning", keywords="sensors", abstract="Background: The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale. Objective: This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability. Methods: A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education. Results: The faculty members' and students' positive useful comments ranged from 83\% (10/12) to 100\%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50\%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43\%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability. Conclusions: The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption. ", doi="10.2196/44361", url="https://mededu.jmir.org/2023/1/e44361", url="http://www.ncbi.nlm.nih.gov/pubmed/37561552" } @Article{info:doi/10.2196/46841, author="Zhao, Yusui and Xu, Shuiyang and Zhang, Xuehai and Wang, Lei and Huang, Yu and Wu, Shuxian and Wu, Qingqing", title="The Effectiveness of Improving Infectious Disease--Specific Health Literacy Among Residents: WeChat-Based Health Education Intervention Program", journal="JMIR Form Res", year="2023", month="Aug", day="9", volume="7", pages="e46841", keywords="effectiveness", keywords="health education", keywords="infectious disease-specific health literacy", keywords="intervention", keywords="WeChat", abstract="Background: Infectious disease--specific health literacy (IDSHL) has become an important determinant of infectious disease incidence. It can not only reduce the incidence of re-emerging infectious diseases, but also effectively prevent the emergence of new infectious diseases such as COVID-19. WeChat, as a new media, has been proven to greatly reduce the chance of infectious diseases spreading from person to person, especially in case of respiratory infections. However, there is currently no concrete health education invention program to improve IDSHL using a WeChat public account. Objective: The aims of this study were as follows: (1) to determine the IDSHL of the population in Zhejiang, China; (2) to develop a health education program for the improvement of IDSHL using a WeChat public account; and (3) to evaluate the effectiveness of the health education program that was implemented in the prevention of infectious disease outbreaks. Methods: We used a standardized questionnaire, which consisted of 28 closed-ended questions, to measure the level and score of IDSHL before and after intervention. A multiple-stage stratified random sampling technique was used to select study participants from Zhejiang province in China, who were further divided randomly into 2 groups: the intervention and control groups. From July 2014 to January 2015, a WeChat-based health education intervention program was carried out on the intervention group. Standard descriptive statistics and chi-square and t tests were conducted to analyze the data. Results: A total of 3001 residents participated in the baseline survey of this study. At baseline, participant IDSHL rates were 73.29\% and 72.12\% for the intervention and control groups, respectively ($\Chi$21=0.5; P=.50). After 7 months of intervention, 9.90\% (297/3001) of participants dropped out of the study. Of the lost participants, 119 were from the intervention group and 178 were from the control group. There were significant differences between follow-up and lost participants with respect to age (P=.04), marital status (P=.02) and occupations (P=.002). After intervention, the intervention group scores in the different domains were higher than those in the control group (infectious disease--related knowledge, prevention, management, or treatment, identification of pathogens and infection sources, and cognitive ability). There were significant improvements in the IDSHL of participants in both the intervention and control groups ($\Chi$21=135.9; P<.001 vs $\Chi$21=9.1; P=.003), and there was a greater change in the IDSHL among the intervention group participants than among the control group participants (1230/1359, 90.51\% vs 1038/1359, 77.17\%). Conclusions: The health education intervention program using a WeChat public account proved to be an effective, feasible, and well-accepted means to improve the IDSHL of the general population. In the future, this health education intervention program can be used as a reference for prevention and treatment of infectious diseases. ", doi="10.2196/46841", url="https://formative.jmir.org/2023/1/e46841", url="http://www.ncbi.nlm.nih.gov/pubmed/37556189" } @Article{info:doi/10.2196/47748, author="Liaw, Ying Sok and Tan, Zhi Jian and Bin Rusli, Dzakirin Khairul and Ratan, Rabindra and Zhou, Wentao and Lim, Siriwan and Lau, Ching Tang and Seah, Betsy and Chua, Ling Wei", title="Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training: Randomized Controlled Study", journal="J Med Internet Res", year="2023", month="Jul", day="26", volume="25", pages="e47748", keywords="artificial intelligence", keywords="interprofessional education", keywords="interprofessional communication", keywords="sepsis care", keywords="team training", keywords="virtual reality", keywords="simulation", keywords="AI", keywords="health care education", keywords="nursing student", keywords="nursing education", keywords="medical education", abstract="Background: Interprofessional communication is needed to enhance the early recognition and management of patients with sepsis. Preparing medical and nursing students using virtual reality simulation has been shown to be an effective learning approach for sepsis team training. However, its scalability is constrained by unequal cohort sizes between medical and nursing students. An artificial intelligence (AI) medical team member can be implemented in a virtual reality simulation to engage nursing students in sepsis team training. Objective: This study aimed to evaluate the effectiveness of an AI-powered doctor versus a human-controlled doctor in training nursing students for sepsis care and interprofessional communication. Methods: A randomized controlled trial study was conducted with 64 nursing students who were randomly assigned to undertake sepsis team training with an AI-powered doctor (AI-powered group) or with medical students using virtual reality simulation (human-controlled group). Participants from both groups were tested on their sepsis and communication performance through simulation-based assessments (posttest). Participants' sepsis knowledge and self-efficacy in interprofessional communication were also evaluated before and after the study interventions. Results: A total of 32 nursing students from each group completed the simulation-based assessment, sepsis and communication knowledge test, and self-efficacy questionnaire. Compared with the baseline scores, both the AI-powered and human-controlled groups demonstrated significant improvements in communication knowledge (P=.001) and self-efficacy in interprofessional communication (P<.001) in posttest scores. For sepsis care knowledge, a significant improvement in sepsis care knowledge from the baseline was observed in the AI-powered group (P<.001) but not in the human-controlled group (P=.16). Although no significant differences were found in sepsis care performance between the groups (AI-powered group: mean 13.63, SD 4.23, vs human-controlled group: mean 12.75, SD 3.85, P=.39), the AI-powered group (mean 9.06, SD 1.78) had statistically significantly higher sepsis posttest knowledge scores (P=.009) than the human-controlled group (mean 7.75, SD 2.08). No significant differences were found in interprofessional communication performance between the 2 groups (AI-powered group: mean 29.34, SD 8.37, vs human-controlled group: mean 27.06, SD 5.69, P=.21). However, the human-controlled group (mean 69.6, SD 14.4) reported a significantly higher level of self-efficacy in interprofessional communication (P=.008) than the AI-powered group (mean 60.1, SD 13.3). Conclusions: Our study suggested that AI-powered doctors are not inferior to human-controlled virtual reality simulations with respect to sepsis care and interprofessional communication performance, which supports the viability of implementing AI-powered doctors to achieve scalability in sepsis team training. Our findings also suggested that future innovations should focus on the sociability of AI-powered doctors to enhance users' interprofessional communication training. Perhaps in the nearer term, future studies should examine how to best blend AI-powered training with human-controlled virtual reality simulation to optimize clinical performance in sepsis care and interprofessional communication. Trial Registration: ClinicalTrials.gov NCT05953441; https://clinicaltrials.gov/study/NCT05953441 ", doi="10.2196/47748", url="https://www.jmir.org/2023/1/e47748", url="http://www.ncbi.nlm.nih.gov/pubmed/37494112" } @Article{info:doi/10.2196/40545, author="Babiker, Samar and Ogunmwonyi, Innocent and Georgi, W. Maria and Tan, Lawrence and Haque, Sharmi and Mullins, William and Singh, Prisca and Ang, Nadya and Fu, Howell and Patel, Krunal and Khera, Jevan and Fricker, Monty and Fleming, Simon and Giwa-Brown, Lolade and A Brennan, Peter and Irune, Ekpemi and Vig, Stella and Nathan, Arjun", title="Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="16", volume="12", pages="e40545", keywords="diversity in surgery", keywords="Black and Minority Ethnic", keywords="BME in surgery", keywords="differential attainment", keywords="diversity", keywords="surgery", keywords="health care system", keywords="surgical training", keywords="disparity", keywords="ethnic disparity", keywords="ethnicity", keywords="medical student", keywords="doctor", keywords="training experience", keywords="surgical placements", keywords="physician", keywords="health care provider", keywords="experience", keywords="perception", keywords="cross-sectional", keywords="doctor in training", keywords="resident", keywords="fellow", keywords="fellowship", keywords="questionnaire", keywords="survey", keywords="Everyday Discrimination Scale", keywords="Maslach Burnout Inventory", keywords="Higher Education", keywords="ethnicities", abstract="Background: The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom.BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10\% less likely to be considered suitable for core surgical training.Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors.The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. Objective: The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. Methods: This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. Results: Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. Conclusions: Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. International Registered Report Identifier (IRRID): DERR1-10.2196/40545 ", doi="10.2196/40545", url="https://www.researchprotocols.org/2023/1/e40545", url="http://www.ncbi.nlm.nih.gov/pubmed/37327055" } @Article{info:doi/10.2196/43190, author="Bajra, Rika and Frazier, Winfred and Graves, Lisa and Jacobson, Katherine and Rodriguez, Andres and Theobald, Mary and Lin, Steven", title="Feasibility and Acceptability of a US National Telemedicine Curriculum for Medical Students and Residents: Multi-institutional Cross-sectional Study", journal="JMIR Med Educ", year="2023", month="May", day="8", volume="9", pages="e43190", keywords="curriculum", keywords="distance education", keywords="graduate medical education", keywords="telemedicine", keywords="undergraduate medical education", abstract="Background: Telemedicine use increased as a response to health care delivery changes necessitated by the COVID-19 pandemic. However, lack of standardized curricular content creates gaps and inconsistencies in effectively integrating telemedicine training at both the undergraduate medical education and graduate medical education levels. Objective: This study evaluated the feasibility and acceptability of a web-based national telemedicine curriculum developed by the Society of Teachers of Family Medicine for medical students and family medicine (FM) residents. Based on the Association of American Medical Colleges telehealth competencies, the asynchronous curriculum featured 5 self-paced modules; covered topics include evidence-based telehealth uses, best practices in communication and remote physical examinations, technology requirements and documentation, access and equity in telehealth delivery, and the promise and potential perils of emerging technologies. Methods: A total of 17 medical schools and 17 FM residency programs implemented the curriculum between September 1 and December 31, 2021. Participating sites represented 25 states in all 4 US census regions with balanced urban, suburban, and rural settings. A total of 1203 learners, including 844 (70\%) medical students and 359 (30\%) FM residents, participated. Outcomes were measured through self-reported 5-point Likert scale responses. Results: A total of 92\% (1101/1203) of learners completed the entire curriculum. Across the modules, 78\% (SD 3\%) of participants agreed or strongly agreed that they gained new knowledge, skills, or attitudes that will help them in their training or career; 87\% (SD 4\%) reported that the information presented was at the right level for them; 80\% (SD 2\%) reported that the structure of the modules was effective; and 78\% (SD 3\%) agreed or strongly agreed that they were satisfied. Overall experience using the national telemedicine curriculum did not differ significantly between medical students and FM residents on binary analysis. No consistent statistically significant relationships were found between participants' responses and their institution's geographic region, setting, or previous experience with a telemedicine curriculum. Conclusions: Both undergraduate medical education and graduate medical education learners, represented by diverse geographic regions and institutions, indicated that the curriculum was broadly acceptable and effective. ", doi="10.2196/43190", url="https://mededu.jmir.org/2023/1/e43190", url="http://www.ncbi.nlm.nih.gov/pubmed/37155241" } @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/10.2196/41591, author="Fang, Heping and Lv, Yuxin and Chen, Lin and Zhang, Xuan and Hu, Yan", title="The Current Knowledge, Attitudes, and Practices of the Neglected Methodology of Web-Based Questionnaires Among Chinese Health Workers: Web-Based Questionnaire Study", journal="J Med Internet Res", year="2023", month="Jan", day="27", volume="25", pages="e41591", keywords="epidemiological survey", keywords="knowledge, attitudes, and practices (KAP)", keywords="medical education", keywords="methodology", keywords="web-based questionnaire (WBQ)", abstract="Background: Web-based questionnaire (WBQ) surveys are popular, but the quality of reporting WBQ survey research is uneven and unsatisfactory worldwide. Education and training on WBQ methodology may be necessary. However, the current knowledge, attitudes, and practices (KAP) of its methodology remain unknown. Objective: We investigated the KAP of WBQ methodology among Chinese health workers for the first time to clarify the possible reasons for the unsatisfactory reporting quality of WBQ survey research from China's experience, aiming to provide a basis for improvement. Methods: We developed a structured WBQ based on the current recommendations and knowledge and investigated 458 health workers from June 7 to July 6, 2022. A total of 381 valid questionnaires were analyzed after data processing. We defined 50\% and 75\% as ``qualified'' and ``satisfactory'' in knowledge and practice topics to describe the results and analyzed the basic characteristics of the participants who had difficulties in conducting WBQ survey research. Results: A total of 215 (56.4\%) participants had used WBQs for investigation, mostly more than 2 times (88.3\%), but only 95 (44.2\%) of them had ever received methodological training. A total of 134 (62.3\%) users believed that WBQs were practical, but 126 (58.6\%) had doubts about the reliability of the results. Most of the knowledge and practice topics did not reach a satisfactory level, and some even did not reach a qualified level. A total of 95 (44.2\%)-136 (63.3\%) of the users had reported difficulties in conducting WBQ survey research, and different participants could have different difficulties according to their characteristics. In addition, 191 (88.8\%) users believed training was necessary. Conclusions: We found that Chinese health workers seriously underestimated and neglected the importance of the WBQ methodology, which may be an important reason for the reduced reporting quality of WBQ survey research. Medical educators need to strengthen methodological training on WBQs, which may help to improve the quality of WBQ survey research. ", doi="10.2196/41591", url="https://www.jmir.org/2023/1/e41591", url="http://www.ncbi.nlm.nih.gov/pubmed/36533302" } @Article{info:doi/10.2196/40082, author="Zeng, Minrui and Cai, Yiyuan and Cao, Jin and He, Qianyu and Wang, Xiaohui and Lu, Yun and Liang, Huijuan and Xu, Dong and Liao, Jing", title="The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China", journal="J Med Internet Res", year="2022", month="Dec", day="2", volume="24", number="12", pages="e40082", keywords="virtual patient", keywords="unannounced standardized patient", keywords="primary health care", keywords="primary care", keywords="quality assessment", keywords="quality improvement", keywords="scenario", keywords="simulation", keywords="simulate", keywords="medical education", keywords="cross-sectional", keywords="digital health", keywords="eHealth", abstract="Background: The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. Objective: This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Methods: Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted $\kappa$ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Results: Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95\% CI 0.24-0.49); for physical examination, 0.27 (95\% CI 0.12-0.42); for laboratory and imaging tests, --0.03 (95\% CI --0.20 to 0.14); and for treatment, 0.22 (95\% CI 0.07-0.37). The weighted $\kappa$ for diagnosis was 0.32 (95\% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. Conclusions: There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the ``know-do'' gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study. ", doi="10.2196/40082", url="https://www.jmir.org/2022/12/e40082", url="http://www.ncbi.nlm.nih.gov/pubmed/36459416" } @Article{info:doi/10.2196/39794, author="Chartash, David and Rosenman, Marc and Wang, Karen and Chen, Elizabeth", title="Informatics in Undergraduate Medical Education: Analysis of Competency Frameworks and Practices Across North America", journal="JMIR Med Educ", year="2022", month="Sep", day="13", volume="8", number="3", pages="e39794", keywords="undergraduate medical education", keywords="medical informatics", keywords="curriculum", keywords="medical education", keywords="education", keywords="North America", keywords="framework", keywords="clinical", keywords="informatics", keywords="Canada", keywords="United States", keywords="US", keywords="teaching", keywords="management", keywords="cognitive", abstract="Background: With the advent of competency-based medical education, as well as Canadian efforts to include clinical informatics within undergraduate medical education, competency frameworks in the United States have not emphasized the skills associated with clinical informatics pertinent to the broader practice of medicine. Objective: By examining the competency frameworks with which undergraduate medical education in clinical informatics has been developed in Canada and the United States, we hypothesized that there is a gap: the lack of a unified competency set and frame for clinical informatics education across North America. Methods: We performed directional competency mapping between Canadian and American graduate clinical informatics competencies and general graduate medical education competencies. Directional competency mapping was performed between Canadian roles and American common program requirements using keyword matching at the subcompetency and enabling competency levels. In addition, for general graduate medical education competencies, the Physician Competency Reference Set developed for the Liaison Committee on Medical Education was used as a direct means of computing the ontological overlap between competency frameworks. Results: Upon mapping Canadian roles to American competencies via both undergraduate and graduate medical education competency frameworks, the difference in focus between the 2 countries can be thematically described as a difference between the concepts of clinical and management reasoning. Conclusions: We suggest that the development or deployment of informatics competencies in undergraduate medical education should focus on 3 items: the teaching of diagnostic reasoning, such that the information tasks that comprise both clinical and management reasoning can be discussed; precision medical education, where informatics can provide for more fine-grained evaluation; and assessment methods to support traditional pedagogical efforts (both at the bedside and beyond). Assessment using cases or structured assessments (eg, Objective Structured Clinical Examinations) would help students draw parallels between clinical informatics and fundamental clinical subjects and would better emphasize the cognitive techniques taught through informatics. ", doi="10.2196/39794", url="https://mededu.jmir.org/2022/3/e39794", url="http://www.ncbi.nlm.nih.gov/pubmed/36099007" } @Article{info:doi/10.2196/38209, author="Kennedy, Blair Ann and Riyad, Youssef Cindy Nessim and Ellis, Ryan and Fleming, R. Perry and Gainey, Mallorie and Templeton, Kara and Nourse, Anna and Hardaway, Virginia and Brown, April and Evans, Pam and Natafgi, Nabil", title="Evaluating a Global Assessment Measure Created by Standardized Patients for the Multiple Mini Interview in Medical School Admissions: Mixed Methods Study", journal="J Particip Med", year="2022", month="Aug", day="30", volume="14", number="1", pages="e38209", keywords="co-design", keywords="participatory design", keywords="medical schools", keywords="exploratory sequential mixed methods design", keywords="school admission criteria", keywords="medical students", keywords="communication", keywords="multiple mini interviews", keywords="interview", keywords="patient", keywords="student", keywords="medical school", keywords="acceptance", keywords="study design", abstract="Background: Standardized patients (SPs) are essential stakeholders in the multiple mini interviews (MMIs) that are increasingly used to assess medical school applicants' interpersonal skills. However, there is little evidence for their inclusion in the development of instruments. Objective: This study aimed to describe the process and evaluate the impact of having SPs co-design and cocreate a global measurement question that assesses medical school applicants' readiness for medical school and acceptance status. Methods: This study used an exploratory, sequential, and mixed methods study design. First, we evaluated the initial MMI program and determined the next quality improvement steps. Second, we held a collaborative workshop with SPs to codevelop the assessment question and response options. Third, we evaluated the created question and the additional MMI rubric items through statistical tests based on 1084 applicants' data from 3 cohorts of applicants starting in the 2018-2019 academic year. The internal reliability of the MMI was measured using a Cronbach $\alpha$ test, and its prediction of admission status was tested using a forward stepwise binary logistic regression. Results: Program evaluation indicated the need for an additional quantitative question to assess applicant readiness for medical school. In total, 3 simulation specialists, 2 researchers, and 21 SPs participated in a workshop leading to a final global assessment question and responses. The Cronbach $\alpha$'s were >0.8 overall and in each cohort year. The final stepwise logistic model for all cohorts combined was statistically significant (P<.001), explained 9.2\% (R2) of the variance in acceptance status, and correctly classified 65.5\% (637/972) of cases. The final model consisted of 3 variables: empathy, rank of readiness, and opening the encounter. Conclusions: The collaborative nature of this project between stakeholders, including nonacademics and researchers, was vital for the success of this project. The SP-created question had a significant impact on the final model predicting acceptance to medical school. This finding indicates that SPs bring a critical perspective that can improve the process of evaluating medical school applicants. ", doi="10.2196/38209", url="https://jopm.jmir.org/2022/1/e38209", url="http://www.ncbi.nlm.nih.gov/pubmed/36040776" } @Article{info:doi/10.2196/35319, author="Lobchuk, Michelle and Bathi, Reddy Prachotan and Ademeyo, Adedotun and Livingston, Aislinn", title="Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis", journal="JMIR Form Res", year="2022", month="Aug", day="3", volume="6", number="8", pages="e35319", keywords="web browser", keywords="user-centered design", keywords="qualitative research", keywords="internet", keywords="empathy", abstract="Background: COVID-19 restrictions severely curtailed empirical endeavors that involved in-person interaction, such as usability testing sessions for technology development. Researchers and developers found themselves using web-based moderation for usability testing. Skilled remote moderators and observers are fundamental in this approach. However, to date, more empirical work is needed that captures the perceptions and support needs of moderators and observers in testing situations. Objective: The aim of this paper was to identify remote moderator and observer participant experiences and their use of certain tools to capture feedback of users as they interact with the web browser application. Methods: This research is part of a broader study on an educational web browser application for nursing students to learn perspective taking and enhance their perceptual understanding of a dialogue partner's thoughts and feelings. The broader study used a quantitative and think-aloud qualitative problem-discovery usability study design. This case study explored written accounts of the remote moderator and observer participants regarding their roles, experiences, and reactions to the testing protocol and their suggestions for improved techniques and strategies for conducting remote usability testing. Content analysis was used to analyze participants' experiences in the usability testing sessions. Results: We collected data from 1 remote moderator and 2 remote observers. Five themes were identified: dealing with personal stressors, dealing with user anxiety, maintaining social presence, ethical response to the study protocol, and communication during sessions. The participants offered recommendations for the design of future remote testing activities as well as evidence-informed training materials for usability project personnel. Conclusions: This study's findings contribute to a growing body of endeavors to understand human-computer interaction and its impact on remote moderator and observer roles. As technology rapidly advances, more remote usability testing will occur where the knowledge gleaned in this study can have an impact. Recommendations based on moderator and observer participant perspectives identify the need for more evidence-informed training materials for their roles that focus on web-based interpersonal communication skills, execution of user testing protocols, troubleshooting technology and test user issues, proficiency in web conferencing platforms, behavior analysis and feedback technologies, and time management. ", doi="10.2196/35319", url="https://formative.jmir.org/2022/8/e35319", url="http://www.ncbi.nlm.nih.gov/pubmed/35921138" } @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/10.2196/38508, author="Taramarcaz, Victor and Herren, Tara and Golay, Eric and Regard, Simon and Martin-Achard, S{\'e}bastien and Mach, Francois and Schnetzler, Nicolas and Ricci, Ga{\"e}tan and Zamberg, Ido and Larribau, Robert and Niquille, Marc and Suppan, M{\'e}lanie and Schiffer, Eduardo and Suppan, Laurent", title="A Short Intervention and an Interactive e-Learning Module to Motivate Medical and Dental Students to Enlist as First Responders: Implementation Study", journal="J Med Internet Res", year="2022", month="May", day="18", volume="24", number="5", pages="e38508", keywords="basic life support", keywords="cardiopulmonary resuscitation", keywords="first responder", keywords="undergraduate medical education", keywords="out-of-hospital cardiac arrest", keywords="medical education", keywords="e-learning", keywords="digital education", keywords="medical student", keywords="blended learning", abstract="Background: Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students. Objective: Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders. Methods: A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders. Results: Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9\%) initially agreed to participate. Moreover, 102 (19.3\%) attended the practice sessions, and 48 (9.1\%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56). Conclusions: This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders. International Registered Report Identifier (IRRID): RR2-10.2196/24664 ", doi="10.2196/38508", url="https://www.jmir.org/2022/5/e38508", url="http://www.ncbi.nlm.nih.gov/pubmed/35583927" } @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/10.2196/34302, author="Dunn, Sheila and Munro, Sarah and Devane, Courtney and Guilbert, Edith and Jeong, Dahn and Stroulia, Eleni and Soon, A. Judith and Norman, V. Wendy", title="A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study", journal="J Med Internet Res", year="2022", month="May", day="5", volume="24", number="5", pages="e34302", keywords="mifepristone", keywords="abortion", keywords="community of practice", keywords="virtual community of practice", keywords="diffusion of innovation", keywords="learning community", abstract="Background: Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective: The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communaut{\'e} de pratique canadienne sur l'avortement (CAPS-CPCA) VCoP and explore physicians' experience with CAPS-CPCA and their views on its value in supporting implementation. Methods: This was a mixed methods intrinsic case study of Canadian health care providers' use and physicians' perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians' characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians' experiences and perceptions of the VCoP. Results: From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6\%) completed a baseline survey. Of these 222 respondents, 156 (70.3\%) were family physicians, 170 (80.2\%) were women, and 78 (35.1\%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9\% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9\% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project's knowledge translation activities with policy makers to mitigate these barriers. Conclusions: A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028443 ", doi="10.2196/34302", url="https://www.jmir.org/2022/5/e34302", url="http://www.ncbi.nlm.nih.gov/pubmed/35511226" } @Article{info:doi/10.2196/36948, author="Ayivi-Vinz, Gloria and Bakwa Kanyinga, Felly and Bergeron, Lysa and D{\'e}cary, Simon and Adisso, Lionel {\'E}v{\`e}hou{\'e}nou and Zomahoun, Vignon Herv{\'e} Tchala and Daniel, J. Sam and Tremblay, Martin and Plourde, V. Karine and Guay-B{\'e}langer, Sabrina and L{\'e}gar{\'e}, France", title="Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review", journal="JMIR Med Educ", year="2022", month="May", day="2", volume="8", number="2", pages="e36948", keywords="CPD-REACTION", keywords="behavior", keywords="intention", keywords="education medical", keywords="continuing", keywords="health care professionals", keywords="questionnaire", keywords="web-based", keywords="continuing professional development", abstract="Background: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory--informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory--informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions. Objective: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. Methods: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58\%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65\%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31\% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60\%). Conclusions: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. Trial Registration: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=116492 ", doi="10.2196/36948", url="https://mededu.jmir.org/2022/2/e36948", url="http://www.ncbi.nlm.nih.gov/pubmed/35318188" } @Article{info:doi/10.2196/32657, author="Beverly, Elizabeth and Rigot, Brooke and Love, Carrie and Love, Matt", title="Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals", journal="JMIR Med Educ", year="2022", month="Apr", day="29", volume="8", number="2", pages="e32657", keywords="virtual reality", keywords="qualitative", keywords="medical education", keywords="health care", keywords="digital learning", keywords="learning platform", keywords="health care providers", abstract="Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals' experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67\%, women; n=22, 92\%, White; and n=4, 17\%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character's frustrations and disappointments; perceived ease of use of cine-VR: 96\% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. ", doi="10.2196/32657", url="https://mededu.jmir.org/2022/2/e32657", url="http://www.ncbi.nlm.nih.gov/pubmed/35486427" } @Article{info:doi/10.2196/30988, author="White, A. Andrew and King, M. Ann and D'Addario, E. Angelo and Brigham, Berg Karen and Dintzis, Suzanne and Fay, E. Emily and Gallagher, H. Thomas and Mazor, M. Kathleen", title="Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory", journal="JMIR Med Educ", year="2022", month="Apr", day="29", volume="8", number="2", pages="e30988", keywords="medical error disclosure", keywords="simulation studies", keywords="communication assessment", keywords="graduate medical education", keywords="crowdsourcing", keywords="patient-centered care", keywords="generalizability theory", keywords="medical education", keywords="medical error", keywords="communication", abstract="Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents' error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates' and crowdsourced laypeople's ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. ", doi="10.2196/30988", url="https://mededu.jmir.org/2022/2/e30988", url="http://www.ncbi.nlm.nih.gov/pubmed/35486423" } @Article{info:doi/10.2196/28625, author="Main, Penelope and Anderson, Sarah", title="Evidence for Continuing Professional Development and Recency of Practice Standards for Regulated Health Professionals in Australia: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2022", month="Apr", day="13", volume="11", number="4", pages="e28625", keywords="protocol", keywords="systematic review", keywords="continuing professional development", keywords="continuing education", keywords="recency of practice", keywords="regulatory standards", keywords="health practitioners", abstract="Background: Continuing professional development (CPD) and recency of practice (ROP) standards are components of health practitioner regulation in Australia. The CPD and ROP standards are currently under review, and an evidence base to assist the development of consistent standards is required. Preliminary searching was unable to find a recent systematic review of the literature to provide an evidence base to underpin the standards review. Objective: This paper presents the protocol for a systematic review that aims to develop a current evidence base that will support the National Boards to develop more consistent, evidence-based, effective standards that are clear and easy to understand and operationalize. Methods: Research questions were developed to support the planned review of CPD and ROP registration standards. Major databases and relevant journals were searched for articles published in English between 2015 and 2021, using key search terms based on previous unpublished reviews of the CPD and ROP registration standards. The quality of the articles retrieved will be assessed using an instrument suitable for use in the development of public policy. The findings will be published in a peer-reviewed journal. Results: In September 2021, our search strategy identified 18,002 studies for the CPD-related research questions after removal of duplicates. Of these, 509 records were screened based on their title, and 66 full-text articles were assessed for eligibility based on their abstract, of which 31 met the inclusion criteria. A further 291 articles were identified as relevant to the ROP research questions. Of these, 87 records were screened based on their title, and 46 full-text articles were assessed for eligibility based on their abstract, of which 8 studies met our inclusion criteria. Conclusions: This protocol outlines the scope and methodology that will be used to conduct a systematic review of evidence for CPD and ROP and inform a review of the standards for regulated health professionals in Australia. Previous research has shown that while CPD improves practitioner knowledge, the link to public safety is unclear. While there has been a greater focus on maintenance of certification and other quality assurance activities over the past 10 years, there remains great variability in CPD requirements across both professions and jurisdictions. ROP was found to be a poorly researched area with most research concentrating on medical practitioners, nurses, and midwives and no clear consensus about the optimal time period after which retraining or an assessment of competence should be introduced. As the CPD and ROP standards are currently under review, it is timely that a review of current evidence be undertaken. International Registered Report Identifier (IRRID): DERR1-10.2196/28625 ", doi="10.2196/28625", url="https://www.researchprotocols.org/2022/4/e28625", url="http://www.ncbi.nlm.nih.gov/pubmed/35416788" } @Article{info:doi/10.2196/34751, 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/10.2196/32818, author="Herrera, Tara and Fiori, P. Kevin and Archer-Dyer, Heather and Lounsbury, W. David and Wylie-Rosett, Judith", title="Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study", journal="JMIR Med Educ", year="2022", month="Jan", day="17", volume="8", number="1", pages="e32818", keywords="social determinants of health", keywords="service-based learning", keywords="telehealth", keywords="preclinical education", keywords="screening", keywords="referral", keywords="community health workers", keywords="determinant", keywords="medical student", keywords="case study", keywords="service", keywords="preparation", keywords="pilot", keywords="feasibility", keywords="training", keywords="assessment", keywords="needs", keywords="electronic health record", keywords="questionnaire", abstract="Background: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. Objective: This pilot project's objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020). Methods: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers' notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum. Results: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44\%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95\%) were referred to the community health worker. Half (8/16, 50\%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need. Conclusions: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures. ", doi="10.2196/32818", url="https://mededu.jmir.org/2022/1/e32818", url="http://www.ncbi.nlm.nih.gov/pubmed/35037885" } @Article{info:doi/10.2196/32422, author="Sutherland, Stephanie and Jeong, Dahn and Cheng, Michael and St-Jean, Mireille and Jalali, Alireza", title="Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study", journal="JMIR Form Res", year="2022", month="Jan", day="7", volume="6", number="1", pages="e32422", keywords="mental health", keywords="Canada", keywords="qualitative research", keywords="caregiver", keywords="family physician", keywords="mentorship", abstract="Background: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers' willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. Objective: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. Methods: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. Results: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician's office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son's or daughter's mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. Conclusions: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other's perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives. ", doi="10.2196/32422", url="https://formative.jmir.org/2022/1/e32422", url="http://www.ncbi.nlm.nih.gov/pubmed/34994704" } @Article{info:doi/10.2196/31042, author="Burgon, Trever and Casebeer, Linda and Aasen, Holly and Valdenor, Czarlota and Tamondong-Lachica, Diana and de Belen, Enrico and Paculdo, David and Peabody, John", title="Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Dec", day="23", volume="23", number="12", pages="e31042", keywords="quality improvement", keywords="physician engagement", keywords="MIPS", keywords="case simulation", keywords="feedback", keywords="value-based care", keywords="care standardization", keywords="simulation", keywords="gamification", keywords="medical education", keywords="continuing education", keywords="outcome", keywords="serious game", keywords="decision-support", abstract="Background: Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. Objective: In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). Methods: We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians ``cared'' for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. Results: We found strong, scalable engagement with the tool, with 75\% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3\%, P<.001) and osteoarthritis (+7.6\%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22\%, P<.001), depression screening (+11\%, P<.001), and asthma medications (+33\%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. Conclusions: Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. Trial Registration: ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901 ", doi="10.2196/31042", url="https://www.jmir.org/2021/12/e31042", url="http://www.ncbi.nlm.nih.gov/pubmed/34941547" } @Article{info:doi/10.2196/33695, author="Darnell, Doyanne and Are{\'a}n, A. Patricia and Dorsey, Shannon and Atkins, C. David and Tanana, J. Michael and Hirsch, Tad and Mooney, D. Sean and Boudreaux, D. Edwin and Comtois, Anne Katherine", title="Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research", journal="JMIR Res Protoc", year="2021", month="Dec", day="15", volume="10", number="12", pages="e33695", keywords="suicide prevention", keywords="hospital", keywords="training", keywords="e-learning", keywords="artificial intelligence", keywords="implementation science", keywords="user-centered design", keywords="task-shifting", keywords="quality assessment", keywords="fidelity", abstract="Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence--based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/33695 ", doi="10.2196/33695", url="https://www.researchprotocols.org/2021/12/e33695", url="http://www.ncbi.nlm.nih.gov/pubmed/34914618" } @Article{info:doi/10.2196/25110, author="Xie, Wenxiu and Ji, Christine and Hao, Tianyong and Chow, Chi-Yin", title="Predicting the Easiness and Complexity of English Health Materials for International Tertiary Students With Linguistically Enhanced Machine Learning Algorithms: Development and Validation Study", journal="JMIR Med Inform", year="2021", month="Oct", day="26", volume="9", number="10", pages="e25110", keywords="feature selection", keywords="logistic regression", keywords="online health resources", abstract="Background: There is an increasing body of research on the development of machine learning algorithms in the evaluation of online health educational resources for specific readerships. Machine learning algorithms are known for their lack of interpretability compared with statistics. Given their high predictive precision, improving the interpretability of these algorithms can help increase their applicability and replicability in health educational research and applied linguistics, as well as in the development and review of new health education resources for effective and accessible health education. Objective: Our study aimed to develop a linguistically enriched machine learning model to predict binary outcomes of online English health educational resources in terms of their easiness and complexity for international tertiary students. Methods: Logistic regression emerged as the best performing algorithm compared with support vector machine (SVM) (linear), SVM (radial basis function), random forest, and extreme gradient boosting on the transformed data set using L2 normalization. We applied recursive feature elimination with SVM to perform automatic feature selection. The automatically selected features (n=67) were then further streamlined through expert review. The finalized feature set of 22 semantic features achieved a similar area under the curve, sensitivity, specificity, and accuracy compared with the initial (n=115) and automatically selected feature sets (n=67). Logistic regression with the linguistically enhanced feature set (n=22) exhibited important stability and robustness on the training data of different sizes (20\%, 40\%, 60\%, and 80\%), and showed consistently high performance when compared with the other 4 algorithms (SVM [linear], SVM [radial basis function], random forest, and extreme gradient boosting). Results: We identified semantic features (with positive regression coefficients) contributing to the prediction of easy-to-understand online health texts and semantic features (with negative regression coefficients) contributing to the prediction of hard-to-understand health materials for readers with nonnative English backgrounds. Language complexity was explained by lexical difficulty (rarity and medical terminology), verbs typical of medical discourse, and syntactic complexity. Language easiness of online health materials was associated with features such as common speech act verbs, personal pronouns, and familiar reasoning verbs. Successive permutation of features illustrated the interaction between these features and their impact on key performance indicators of the machine learning algorithms. Conclusions: The new logistic regression model developed exhibited consistency, scalability, and, more importantly, interpretability based on existing health and linguistic research. It was found that low and high linguistic accessibilities of online health materials were explained by 2 sets of distinct semantic features. This revealed the inherent complexity of effective health communication beyond current readability analyses, which were limited to syntactic complexity and lexical difficulty. ", doi="10.2196/25110", url="https://medinform.jmir.org/2021/10/e25110", url="http://www.ncbi.nlm.nih.gov/pubmed/34698644" } @Article{info:doi/10.2196/30613, author="Jeyakumar, Tharshini and Ambata-Villanueva, Sharon and McClure, Sarah and Henderson, Carolyn and Wiljer, David", title="Best Practices for the Implementation and Sustainment of Virtual Health Information System Training: Qualitative Study", journal="JMIR Med Educ", year="2021", month="Oct", day="22", volume="7", number="4", pages="e30613", keywords="training", keywords="health care providers", keywords="educational technology", keywords="patient care", keywords="COVID-19", keywords="development", keywords="practice", keywords="best practice", keywords="pedagogy", keywords="teaching", keywords="implementation", keywords="medical education", keywords="online education", keywords="care delivery", keywords="perception", keywords="effectiveness", abstract="Background: The COVID-19 pandemic has necessitated the adoption and implementation of digital technologies to help transform the educational ecosystem and the delivery of care. Objective: We sought to understand instructors' and learners' perceptions of the challenges and opportunities faced in implementing health information system virtual training amid the COVID-19 pandemic. Methods: Semistructured interviews were conducted with education specialists and health care staff who provided or had taken part in a virtual instructor-led training at a large Canadian academic health sciences center. Guided by the Technology Acceptance Model and the Community of Inquiry framework, we analyzed interview transcript themes deductively and inductively. Results: Of the 18 individuals participating in the study, 9 were education specialists, 5 were learners, 3 were program coordinators, and 1 was a senior manager at the Centre for Learning, Innovation, and Simulation. We found 3 predominant themes: adopting a learner-centered approach for a meaningful learning experience, embracing the advances in educational technologies to maximize the transfer of learning, and enhancing the virtual user experience. Conclusions: This study adds to the literature on designing and implementing virtual training in health care organizations by highlighting the importance of recognizing learners' needs and maximizing the transfer of learning. Findings from this study can be used to help inform the design and development of training strategies to support learners across an organization during the current climate and to ensure changes are sustainable. ", doi="10.2196/30613", url="https://mededu.jmir.org/2021/4/e30613", url="http://www.ncbi.nlm.nih.gov/pubmed/34449402" } @Article{info:doi/10.2196/26675, author="Tahri Sqalli, Mohammed and Al-Thani, Dena and Elshazly, B. Mohamed and Al-Hijji, ?Mohammed", title="Interpretation of a 12-Lead Electrocardiogram by Medical Students: Quantitative Eye-Tracking Approach", journal="JMIR Med Educ", year="2021", month="Oct", day="14", volume="7", number="4", pages="e26675", keywords="eye tracking", keywords="electrocardiogram", keywords="ECG interpretation", keywords="medical education", keywords="human-computer interaction", keywords="medical student", keywords="eye", keywords="tracking", keywords="interpretation", keywords="ECG", abstract="Background: Accurate interpretation of a 12-lead electrocardiogram (ECG) demands high levels of skill and expertise. Early training in medical school plays an important role in building the ECG interpretation skill. Thus, understanding how medical students perform the task of interpretation is important for improving this skill. Objective: We aimed to use eye tracking as a tool to research how eye fixation can be used to gain a deeper understanding of how medical students interpret ECGs. Methods: In total, 16 medical students were recruited to interpret 10 different ECGs each. Their eye movements were recorded using an eye tracker. Fixation heatmaps of where the students looked were generated from the collected data set. Statistical analysis was conducted on the fixation count and duration using the Mann-Whitney U test and the Kruskal-Wallis test. Results: The average percentage of correct interpretations was 55.63\%, with an SD of 4.63\%. After analyzing the average fixation duration, we found that medical students study the three lower leads (rhythm strips) the most using a top-down approach: lead II (mean=2727 ms, SD=456), followed by leads V1 (mean=1476 ms, SD=320) and V5 (mean=1301 ms, SD=236). We also found that medical students develop a personal system of interpretation that adapts to the nature and complexity of the diagnosis. In addition, we found that medical students consider some leads as their guiding point toward finding a hint leading to the correct interpretation. Conclusions: The use of eye tracking successfully provides a quantitative explanation of how medical students learn to interpret a 12-lead ECG. ", doi="10.2196/26675", url="https://mededu.jmir.org/2021/4/e26675", url="http://www.ncbi.nlm.nih.gov/pubmed/34647899" } @Article{info:doi/10.2196/28335, author="Bragin, Ilya and Cohen, T. Dylan", title="Certified Examination Assistants in the Age of Telemedicine: A Blueprint Through Neurology", journal="JMIR Med Educ", year="2021", month="Oct", day="6", volume="7", number="4", pages="e28335", keywords="telemedicine", keywords="physical examination", keywords="neurological exam", keywords="telemedicine assistants", keywords="telemedicine implementation", keywords="telemedicine certification", keywords="telemedicine jobs", keywords="telemedicine education", keywords="telehealth", keywords="teleneurology", doi="10.2196/28335", url="https://mededu.jmir.org/2021/4/e28335", url="http://www.ncbi.nlm.nih.gov/pubmed/34612828" } @Article{info:doi/10.2196/29707, author="Amod, Hafaza and Mkhize, Wellington Sipho and Muraraneza, Claudine", title="Analyzing Evidence on Interventions to Strengthen the Clinical Support for Midwifery Students in Clinical Placements: Protocol for a Systematic Scoping Review", journal="JMIR Res Protoc", year="2021", month="Sep", day="21", volume="10", number="9", pages="e29707", keywords="midwifery students", keywords="registered midwives", keywords="clinical support interventions", keywords="midwives", keywords="midwifery", keywords="students", keywords="mentorship", keywords="clinical supervision", keywords="collaboration", keywords="clinician attitudes", abstract="Background: The benefits of clinical support are evident in various mentorship, preceptorship, or clinical supervision models. Poor collaboration between lecturers and clinical staff, lack of confidence about student support, large student intakes coupled with core demands create negative attitudes toward student supervision, and this poses a huge challenge to midwifery students who are expected to become competent in the process. Objective: This study aims to identify and analyze interventions, strategies, and/or mechanisms in order to strengthen the clinical support for midwifery students in clinical practice areas from a global perspective. Methods: This review will follow the Arksey and O'Malley framework (2005). The search strategy will include primary studies searched for in electronic databases such as EBSCOhost (CINAHL, MEDLINE, and Health Source: Nursing/Academic edition), PubMed, Google, and Google Scholar. Keywords such as ``midwifery students,'' ``midwifery education,'' and ``clinical support'' will be used to search for related articles. The search will include articles from the cited by search, as well as citations from the reference list of included articles. All title-screened articles will be exported to an EndNote library, and duplicate studies will be removed. Two independent reviewers will concurrently carry out the abstract and full-text article screening according to the eligibility criteria. Extracted data will highlight the aims, geographical setting, and level of training; intervention outcomes; and the most relevant and most significant findings. This review will also include a mixed methods quality appraisal check. A narrative summary of data extracted will be analyzed using content analysis. Results: Interventions to strengthen the clinical support for midwifery students in practice will be extracted from this review, and data will be analyzed and extracted to develop a comprehensive guide or framework for clinical mentorship. As of August 2021, the electronic search, the data extraction, and the analysis have been completed. The results paper is expected to be published within the next 6 months. Conclusions: It is expected that this review will contribute to midwifery education by identifying quality evidence on clinical support interventions available to midwifery students globally, as well as best practice methods, procedures, or interventions that can be used to develop a midwifery mentorship training program. International Registered Report Identifier (IRRID): DERR1-10.2196/29707 ", doi="10.2196/29707", url="https://www.researchprotocols.org/2021/9/e29707", url="http://www.ncbi.nlm.nih.gov/pubmed/34546180" } @Article{info:doi/10.2196/32105, author="Wei, Chapman and Bernstein, Sophie and Adusumilli, Nagasai and Marchitto, Mark and Chen, Frank and Rajpara, Anand", title="Assessment and Evaluation of Social Engagement in Dermatology Residency Programs on Instagram: Cross-sectional Study", journal="JMIR Dermatol", year="2021", month="Aug", day="26", volume="4", number="2", pages="e32105", keywords="Instagram", keywords="social media", keywords="dermatology residency", keywords="Instagram engagement score", keywords="residency recruitment", keywords="medical education", doi="10.2196/32105", url="https://derma.jmir.org/2021/2/e32105", url="http://www.ncbi.nlm.nih.gov/pubmed/37632856" } @Article{info:doi/10.2196/27239, author="Amosun, Seyi and Kimmie-Dhansay, Faheema and Geerts, Greta and Basson, Reneda", title="Career Development of Academic Staff in Faculties of Dentistry by Means of Mentorship Programs: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Jul", day="21", volume="10", number="7", pages="e27239", keywords="scoping review protocol", keywords="academic staff development", keywords="mentorship", keywords="capacity development", keywords="dental education", keywords="dentistry", keywords="dental educators", abstract="Background: Globally, the demands on dental educators continue to diversify and expand. Due to their importance and value, mentoring programs have been acknowledged as a means of recruiting, developing, and retaining academics in dental education. Objective: This protocol is for a scoping review that aims to identify the goals of mentoring programs for academic staff in dental faculties and determine how these programs were structured, delivered, and evaluated. Methods: The review will be performed in accordance with the Joanna Briggs Institute's methodology for scoping reviews, which covers both qualitative and quantitative scientific literature as well as grey literature written in English and published between 2000 and 2020. The databases will include PubMed, Ovid, the Educational Resources Information Center database, Science Direct, Scopus, Google Scholar, Trove, Web of Science, Openthesis.org, and the website of the American Dental Education Association. A manual search will also be conducted by using the reference lists of included studies to identify additional articles. Working independently, the authors will participate iteratively in literature screening, paper selection, and data extraction. Disagreements between the reviewers will be resolved by discussion until a consensus is reached or after consultation with the research team. Key information that is relevant to the review questions will be extracted from the selected articles and imported into a Microsoft Excel file. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) will be used to guide the reporting of this protocol. Results: The search for appropriate literature has commenced, and we aim to present the results before the end of the 2021 academic year. Conclusions: The development of formal mentorship programs for academics in dental education will enhance the retention of academic staff. International Registered Report Identifier (IRRID): PRR1-10.2196/27239 ", doi="10.2196/27239", url="https://www.researchprotocols.org/2021/7/e27239", url="http://www.ncbi.nlm.nih.gov/pubmed/34287219" } @Article{info:doi/10.2196/24697, author="Dohnt, C. Henriette and Dowling, J. Mitchell and Davenport, A. Tracey and Lee, Grace and Cross, P. Shane and Scott, M. Elizabeth and Song, C. Yun Ju and Hamilton, Blake and Hockey, J. Samuel and Rohleder, Cathrin and LaMonica, M. Haley and Hickie, B. Ian", title="Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study", journal="JMIR Res Protoc", year="2021", month="Jun", day="14", volume="10", number="6", pages="e24697", keywords="mental health service delivery", keywords="youth mental health", keywords="model of care coordination", keywords="transdiagnostic", keywords="health information technology", keywords="education", keywords="training", keywords="adoption into clinical practice", keywords="Kirkpatrick evaluation", abstract="Background: Australia's mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney's Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC's Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. Objective: This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. Methods: The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. Results: This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District's Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. Conclusions: The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. International Registered Report Identifier (IRRID): PRR1-10.2196/24697 ", doi="10.2196/24697", url="https://www.researchprotocols.org/2021/6/e24697", url="http://www.ncbi.nlm.nih.gov/pubmed/34125074" } @Article{info:doi/10.2196/27664, author="Gambril, Alan John and Boyd, J. Carter and Egbaria, Jamal", title="The Numerous Benefits of Social Media for Medicine. Comment on ``Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions''", journal="J Med Internet Res", year="2021", month="Jun", day="9", volume="23", number="6", pages="e27664", keywords="social media", keywords="medical education", keywords="internet", keywords="academic medicine", keywords="promotion", keywords="tenure", keywords="health professions", keywords="scholarship", keywords="medicine", keywords="research", keywords="accomplishment", keywords="crowd source", keywords="contribution", keywords="innovation", keywords="education", keywords="dissemination", doi="10.2196/27664", url="https://www.jmir.org/2021/6/e27664", url="http://www.ncbi.nlm.nih.gov/pubmed/34106082" } @Article{info:doi/10.2196/17277, author="van Tetering, Cornelia Anne Antonia and Segers, Martine Maartje Henrica and Ntuyo, Peter and Namagambe, Imelda and van der Hout-van der Jagt, Beatrijs M. and Byamugisha, K. Josaphat and Oei, Guid S.", title="Evaluating the Instructional Design and Effect on Knowledge, Teamwork, and Skills of Technology-Enhanced Simulation-Based Training in Obstetrics in Uganda: Stepped-Wedge Cluster Randomized Trial", journal="JMIR Med Educ", year="2021", month="Feb", day="5", volume="7", number="1", pages="e17277", keywords="simulation training", keywords="medical education", keywords="instructional design", keywords="low- and middle-income countries", keywords="obstetrics", abstract="Background: Simulation-based training is a common strategy for improving the quality of facility-based maternity services and is often evaluated using Kirkpatrick's theoretical model. The results on the Kirkpatrick levels are closely related to the quality of the instructional design of a training program. The instructional design is generally defined as the ``set of prescriptions for teaching methods to improve the quality of instruction with a goal of optimizing learning outcomes.'' Objective: The aim of this study is to evaluate the instructional design of a technology-enhanced simulation-based training in obstetrics, the reaction of participants, and the effect on knowledge, teamwork, and skills in a low-income country. Methods: A stepped-wedge cluster randomized trial was performed in a university hospital in Kampala, Uganda, with an annual delivery volume of over 31,000. In November 2014, a medical simulation center was installed with a full-body birthing simulator (Noelle S550, Gaumard Scientific), an interactive neonate (Simon S102 Newborn CPR Simulator, Gaumard Scientific), and an audio and video recording system. Twelve local obstetricians were trained and certified as medical simulation trainers. From 2014 to 2016, training was provided to 57 residents in groups of 6 to 9 students. Descriptive statistics were calculated for ten instructional design features of the training course measured by the 42-item ID-SIM (Instructional Design of a Simulation Improved by Monitoring). The Wilcoxon signed rank test was conducted to investigate the differences in scores on knowledge, the Clinical Teamwork Scale, and medical technical skills. Results: The mean scores on the ten instructional design features ranged from 54.9 (95\% CI 48.5-61.3) to 84.3 (95\% CI 80.9-87.6) out of 100. The highest mean score was given on the feature feedback and the lowest scores on repetitive practice and controlled environment. The overall score for the training day was 92.8 out of 100 (95\% CI 89.5-96.1). Knowledge improved significantly, with a test score of 63.4\% (95\% CI 60.7-66.1) before and 78.9\% (95\% CI 76.8-81.1) after the training (P<.001). The overall score on the 10-point Clinical Teamwork Scale was 6.0 (95\% CI 4.4-7.6) before and 5.9 (95\% CI 4.5-7.2) after the training (P=.78). Medical technical skills were scored at 55.5\% (95\% CI 47.2-63.8) before and 65.6\% (95\% CI 56.5-74.7) after training (P=.08). Conclusions: Most instructional design features of a technology-enhanced simulation-based training in obstetrics in a low-income country were scored high, although intervals were large. The overall score for the training day was high, and knowledge did improve after the training program, but no changes in teamwork and (most) medical technical skills were found. The lowest-scored instructional design features may be improved to achieve further learning aims. Trial Registration: ISRCTN Registry ISRCTN98617255; http://www.isrctn.com/ISRCTN98617255 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-020-03050-3 ", doi="10.2196/17277", url="http://mededu.jmir.org/2021/1/e17277/", url="http://www.ncbi.nlm.nih.gov/pubmed/33544086" } @Article{info:doi/10.2196/21220, author="Shaikhain, Ahmad Talal and Al-Husayni, Abdulmohsen Faisal and Alhejaili, Awadh Essam and Al-Harbi, Nawaf Maha and Bogari, Abdullah Anas and Baghlaf, Abdulaziz Bayan and Alzahrani, Saeed Mohammed", title="COVID-19--Related Knowledge and Practices Among Health Care Workers in Saudi Arabia: Cross-sectional Questionnaire Study", journal="JMIR Form Res", year="2021", month="Jan", day="25", volume="5", number="1", pages="e21220", keywords="COVID-19", keywords="health care workers", keywords="infection control", keywords="attitude", keywords="knowledge", keywords="Saudi Arabia", abstract="Background: Health care workers are at the front line against COVID-19. The risk of transmission decreases with adequate knowledge of infection prevention methods. However, health care workers reportedly lack a proper attitude and knowledge of different viral outbreaks. Objective: This study aimed to assess the knowledge and attitude of health care workers in Saudi Arabia toward COVID-19. Assessment of these parameters may help researchers focus on areas that require improvement. Methods: A cross-sectional questionnaire study was conducted among 563 participants recruited from multiple cities in Saudi Arabia. An online questionnaire was shared via social media applications, which contained questions to health care workers about general information regarding COVID-19 and standard practices. Results: The mean age of the study population was 30.7 (SD 8) years. Approximately 8.3\% (47/563) of the health care workers were isolated as suspected cases of COVID-19, and 0.9\% (n=5) were found positive. The majority agreed that social distancing, face masks, and hand washing are effective methods for preventing disease transmission. However, only 63.7\% (n=359) knew the correct duration of hand washing. Almost 70\% (n=394) strictly adhered to hand hygiene practices, but less than half complied with the practice of wearing a face mask. Significant differences in health care workers' attitudes were observed on the basis of their city of residence, their adherence to COVID-19 practices, and their compliance with the use of a face mask. Among the health care workers, 27.2\% (n=153) declared that they will isolate themselves at home and take influenza medication if they experience COVID-19 symptoms. Conclusions: The majority of health care workers in Saudi Arabia presented acceptable levels of general knowledge on COVID-19, but they lack awareness in some crucial details that may prevent disease spread. Intense courses and competency assessments are highly recommended. Prevention of disease progression is the only option for the time being. ", doi="10.2196/21220", url="http://formative.jmir.org/2021/1/e21220/", url="http://www.ncbi.nlm.nih.gov/pubmed/33460390" } @Article{info:doi/10.2196/21620, author="Mitre-Hernandez, Hugo and Covarrubias Carrillo, Roberto and Lara-Alvarez, Carlos", title="Pupillary Responses for Cognitive Load Measurement to Classify Difficulty Levels in an Educational Video Game: Empirical Study", journal="JMIR Serious Games", year="2021", month="Jan", day="11", volume="9", number="1", pages="e21620", keywords="video games", keywords="pupil", keywords="metacognitive monitoring", keywords="educational technology", keywords="machine learning", abstract="Background: A learning task recurrently perceived as easy (or hard) may cause poor learning results. Gamer data such as errors, attempts, or time to finish a challenge are widely used to estimate the perceived difficulty level. In other contexts, pupillometry is widely used to measure cognitive load (mental effort); hence, this may describe the perceived task difficulty. Objective: This study aims to assess the use of task-evoked pupillary responses to measure the cognitive load measure for describing the difficulty levels in a video game. In addition, it proposes an image filter to better estimate baseline pupil size and to reduce the screen luminescence effect. Methods: We conducted an experiment that compares the baseline estimated from our filter against that estimated from common approaches. Then, a classifier with different pupil features was used to classify the difficulty of a data set containing information from students playing a video game for practicing math fractions. Results: We observed that the proposed filter better estimates a baseline. Mauchly's test of sphericity indicated that the assumption of sphericity had been violated ($\chi$214=0.05; P=.001); therefore, a Greenhouse-Geisser correction was used ($\epsilon$=0.47). There was a significant difference in mean pupil diameter change (MPDC) estimated from different baseline images with the scramble filter (F5,78=30.965; P<.001). Moreover, according to the Wilcoxon signed rank test, pupillary response features that better describe the difficulty level were MPDC (z=?2.15; P=.03) and peak dilation (z=?3.58; P<.001). A random forest classifier for easy and hard levels of difficulty showed an accuracy of 75\% when the gamer data were used, but the accuracy increased to 87.5\% when pupillary measurements were included. Conclusions: The screen luminescence effect on pupil size is reduced with a scrambled filter on the background video game image. Finally, pupillary response data can improve classifier accuracy for the perceived difficulty of levels in educational video games. ", doi="10.2196/21620", url="http://games.jmir.org/2021/1/e21620/", url="http://www.ncbi.nlm.nih.gov/pubmed/33427677" } @Article{info:doi/10.2196/18956, author="Roka, Gura Zeinab and Oyugi, Omondi Elvis and Githuku, Njoki Jane and Kanyina, Evalyne and Obonyo, Mark and Omballa, Victor and Boru, Gufu Waqo and Ransom, James", title="Impact Evaluation of the Kenya Frontline Field Epidemiology Training Program: Repeated-Measures Study", journal="JMIR Med Educ", year="2021", month="Jan", day="8", volume="7", number="1", pages="e18956", keywords="field epidemiology", keywords="workforce development", keywords="Kenya", keywords="training", abstract="Background: In 2014, Kenya's Field Epidemiology and Laboratory Training Program (FELTP) initiated a 3-month field-based frontline training, Field Epidemiology Training Program (FETP-F), for local public health workers. Objective: This study aimed to measure the effect of FETP-F on participant workplace practices regarding quality and consistency of public health data, critical interaction with public health data, and improvements in on-time reporting (OTR). Methods: Between February and April 2017, FELTP conducted a mixed methods evaluation via online survey to examine outcomes achieved among all 215 graduates from 2014 and 2015. Data quality assessment (DQA) and data consistency assessment (DCA) scores, OTR percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months postcompletion of the training. The qualitative component consisted of semistructured face-to-face interviews and observations. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions. Results: In total, 103 (47\%) graduates responded to the survey. Quantitative analyses showed that the training significantly increased the mean DQA and OTR scores but there was a nonsignificant increase in mean DCA scores. Qualitative analyses found that 68\% of respondents acquired new skills, 83\% applied those skills to their day-to-day work, and 91\% improved work methods. Conclusions: FETP-F improved overall data quality and OTR at the agency level but had minimal impact on data consistency between local, county, and national public health agencies. Participants reported that they acquired practical skills that improved data collation and analysis and OTR. ", doi="10.2196/18956", url="https://mededu.jmir.org/2021/1/e18956", url="http://www.ncbi.nlm.nih.gov/pubmed/33416507" } @Article{info:doi/10.2196/25070, author="Acquaviva, D. Kimberly and Mugele, Josh and Abadilla, Natasha and Adamson, Tyler and Bernstein, L. Samantha and Bhayani, K. Rakhee and B{\"u}chi, Elisabeth Annina and Burbage, Darcy and Carroll, L. Christopher and Davis, P. Samantha and Dhawan, Natasha and Eaton, Alice and English, Kim and Grier, T. Jennifer and Gurney, K. Mary and Hahn, S. Emily and Haq, Heather and Huang, Brendan and Jain, Shikha and Jun, Jin and Kerr, T. Wesley and Keyes, Timothy and Kirby, R. Amelia and Leary, Marion and Marr, Mollie and Major, Ajay and Meisel, V. Jason and Petersen, A. Erika and Raguan, Barak and Rhodes, Allison and Rupert, D. Deborah and Sam-Agudu, A. Nadia and Saul, Naledi and Shah, R. Jarna and Sheldon, Kennedy Lisa and Sinclair, T. Christian and Spencer, Kerry and Strand, H. Natalie and Streed Jr, G. Carl and Trudell, M. Avery", title="Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions", journal="J Med Internet Res", year="2020", month="Dec", day="2", volume="22", number="12", pages="e25070", keywords="social media", keywords="promotion", keywords="tenure", keywords="health professions", keywords="scholarship", keywords="medicine", keywords="research", keywords="accomplishment", keywords="crowdsource", keywords="contribution", keywords="innovation", keywords="education", keywords="dissemination", abstract="Background: The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider audiences in creative ways and have a broader impact. Conventional metrics like the h-index do not account for social media impact. Social media engagement is poorly represented in most curricula vitae (CV) and therefore is undervalued in promotion and tenure reviews. Objective: The objective was to develop crowdsourced guidelines for documenting social media scholarship. These guidelines aimed to provide a structure for documenting a scholar's general impact on social media, as well as methods of documenting individual social media contributions exemplifying innovation, education, mentorship, advocacy, and dissemination. Methods: To create unifying guidelines, we created a crowdsourced process that capitalized on the strengths of social media and generated a case example of successful use of the medium for academic collaboration. The primary author created a draft of the guidelines and then sought input from users on Twitter via a publicly accessible Google Document. There was no limitation on who could provide input and the work was done in a democratic, collaborative fashion. Contributors edited the draft over a period of 1 week (September 12-18, 2020). The primary and secondary authors then revised the draft to make it more concise. The guidelines and manuscript were then distributed to the contributors for edits and adopted by the group. All contributors were given the opportunity to serve as coauthors on the publication and were told upfront that authorship would depend on whether they were able to document the ways in which they met the 4 International Committee of Medical Journal Editors authorship criteria. Results: We developed 2 sets of guidelines: Guidelines for Listing All Social Media Scholarship Under Public Scholarship (in Research/Scholarship Section of CV) and Guidelines for Listing Social Media Scholarship Under Research, Teaching, and Service Sections of CV. Institutions can choose which set fits their existing CV format. Conclusions: With more uniformity, scholars can better represent the full scope and impact of their work. These guidelines are not intended to dictate how individual institutions should weigh social media contributions within promotion and tenure cases. Instead, by providing an initial set of guidelines, we hope to provide scholars and their institutions with a common format and language to document social media scholarship. ", doi="10.2196/25070", url="https://www.jmir.org/2020/12/e25070", url="http://www.ncbi.nlm.nih.gov/pubmed/33263554" } @Article{info:doi/10.2196/17719, author="Grima-Murcia, D. M. and Sanchez-Ferrer, Francisco and Ramos-Rinc{\'o}n, Manuel Jose and Fern{\'a}ndez, Eduardo", title="Use of Eye-Tracking Technology by Medical Students Taking the Objective Structured Clinical Examination: Descriptive Study", journal="J Med Internet Res", year="2020", month="Aug", day="21", volume="22", number="8", pages="e17719", keywords="visual perception", keywords="medical education", keywords="eye tracking", keywords="objective structured clinical examination", keywords="medical evaluation", abstract="Background: The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students. Objective: The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement. Methods: We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary. Results: Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided. Conclusions: Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies. ", doi="10.2196/17719", url="http://www.jmir.org/2020/8/e17719/", url="http://www.ncbi.nlm.nih.gov/pubmed/32821060" } @Article{info:doi/10.2196/20182, author="Liu, Benjamin", title="The United States Medical Licensing Examination Step 1 Is Changing---US Medical Curricula Should Too", journal="JMIR Med Educ", year="2020", month="Jul", day="30", volume="6", number="2", pages="e20182", keywords="USMLE", keywords="US medical students", keywords="USMLE pass/fail", keywords="new curricula", keywords="medical education", keywords="medical learning", keywords="medical school", doi="10.2196/20182", url="http://mededu.jmir.org/2020/2/e20182/", url="http://www.ncbi.nlm.nih.gov/pubmed/32667900" } @Article{info:doi/10.2196/14651, author="Rosenberg, E. Mark and Gauer, L. Jacqueline and Smith, Barbara and Calhoun, Austin and Olson, J. Andrew P. and Melcher, Emily", title="Building a Medical Education Outcomes Center: Development Study", journal="JMIR Med Educ", year="2019", month="Oct", day="31", volume="5", number="2", pages="e14651", keywords="outcome measures", keywords="data analysis", keywords="physicians", keywords="medical students", keywords="database management systems", keywords="data linkage", abstract="Background: Medical education outcomes and clinical data exist in multiple unconnected databases, resulting in 3 problems: (1) it is difficult to connect learner outcomes with patient outcomes, (2) learners cannot be easily tracked over time through the education-training-practice continuum, and (3) no standard methodology ensures quality and privacy of the data. Objective: The purpose of this study was to develop a Medical Education Outcomes Center (MEOC) to integrate education data and to build a framework to standardize the intake and processing of requests for using these data. Methods: An inventory of over 100 data sources owned or utilized by the medical school was conducted, and nearly 2 dozen of these data sources have been vetted and integrated into the MEOC. In addition, the American Medical Association (AMA) Physician Masterfile data of the University of Minnesota Medical School (UMMS) graduates were linked to the data from the National Provider Identifier (NPI) registry to develop a mechanism to connect alumni practice data to education data. Results: Over 160 data requests have been fulfilled, culminating in a range of outcomes analyses, including support of accreditation efforts. The MEOC received data on 13,092 UMMS graduates in the AMA Physician Masterfile and could link 10,443 with NPI numbers and began to explore their practice demographics. The technical and operational work to expand the MEOC continues. Next steps are to link the educational data to the clinical practice data through NPI numbers to assess the effectiveness of our medical education programs by the clinical outcomes of our graduates. Conclusions: The MEOC provides a replicable framework to allow other schools to more effectively operate their programs and drive innovation. ", doi="10.2196/14651", url="http://mededu.jmir.org/2019/2/e14651/", url="http://www.ncbi.nlm.nih.gov/pubmed/31674919" } @Article{info:doi/10.2196/13529, author="Bientzle, Martina and Hircin, Emrah and Kimmerle, Joachim and Knipfer, Christian and Smeets, Ralf and Gaudin, Robert and Holtz, Peter", title="Association of Online Learning Behavior and Learning Outcomes for Medical Students: Large-Scale Usage Data Analysis", journal="JMIR Med Educ", year="2019", month="Aug", day="21", volume="5", number="2", pages="e13529", keywords="learning engagement", keywords="medical online learning platform", keywords="big data analytics", keywords="writing notes", keywords="learning outcomes", abstract="Background: Digital learning environments have become very common in the training of medical professionals, and students often use such platforms for exam preparation. Multiple choice questions (MCQs) are a common format in medical exams and are used by students to prepare for said exams. Objective: We aimed to examine whether particular learning activities contributed more strongly than others to users' exam performance. Methods: We analyzed data from users of an online platform that provides learning materials for medical students in preparation for their final exams. We analyzed whether the number of learning cards viewed and the number of MCQs taken were positively related to learning outcomes. We also examined whether viewing learning cards or answering MCQs was more effective. Finally, we tested whether taking individual notes predicted learning outcomes, and whether taking notes had an effect after controlling for the effects of learning cards and MCQs. Our analyses from the online platform Amboss are based on user activity data, which supplied the number of learning cards studied and test questions answered. We also included the number of notes from each of those 23,633 users who had studied at least 200 learning cards and had answered at least 1000 test exam questions in the 180 days before their state exam. The activity data for this analysis was collected retrospectively, using Amboss archival usage data from April 2014 to April 2017. Learning outcomes were measured using the final state exam scores that were calculated by using the answers voluntarily entered by the participants. Results: We found correlations between the number of cards studied (r=.22; P<.001) and the number of test questions that had been answered (r=.23; P<.001) with the percentage of correct answers in the learners' medical exams. The number of test questions answered still yielded a significant effect, even after controlling for the number of learning cards studied using a hierarchical regression analysis ($\beta$=.14; P<.001; $\Delta$R2=.017; P<.001). We found a negative interaction between the number of learning cards and MCQs, indicating that users with high scores for learning cards and MCQs had the highest exam scores. Those 8040 participants who had taken at least one note had a higher percentage of correct answers (80.94\%; SD=7.44) than those who had not taken any notes (78.73\%; SD=7.80; t23631=20.95; P<.001). In a stepwise regression, the number of notes the participants had taken predicted the percentage of correct answers over and above the effect of the number of learning cards studied and of the number of test questions entered in step one ($\beta$=.06; P<.001; $\Delta$R2=.004; P<.001). Conclusions: These results show that online learning platforms are particularly helpful whenever learners engage in active elaboration in learning material, such as by answering MCQs or taking notes. ", doi="10.2196/13529", url="http://mededu.jmir.org/2019/2/e13529/", url="http://www.ncbi.nlm.nih.gov/pubmed/31436166" } @Article{info:doi/10.2196/13386, author="Schuelper, Nikolai and Ludwig, Sascha and Anders, Sven and Raupach, Tobias", title="The Impact of Medical Students' Individual Teaching Format Choice on the Learning Outcome Related to Clinical Reasoning", journal="JMIR Med Educ", year="2019", month="Jul", day="22", volume="5", number="2", pages="e13386", keywords="undergraduate medical education", keywords="case histories", abstract="Background: Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences. Objective: The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own. Methods: In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories. Results: Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5\%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2\% [SD 12.6] vs 70.0\% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3\% [SD 16.6] vs 63.4\% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams. Conclusions: Despite students' overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods. ", doi="10.2196/13386", url="http://mededu.jmir.org/2019/2/e13386/", url="http://www.ncbi.nlm.nih.gov/pubmed/31333193" } @Article{info:doi/10.2196/12474, author="Gorfinkel, Renee Lauren and Giesler, Amanda and Dong, Huiru and Wood, Evan and Fairbairn, Nadia and Klimas, Jan", title="Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting", journal="JMIR Med Educ", year="2019", month="May", day="24", volume="5", number="1", pages="e12474", keywords="medical education", keywords="substance-related disorders", keywords="education, distance", abstract="Background: Despite the enormous bur?den of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evi?dence-based addiction care and treatment modalities. This is partly because of a persistent lack of accessible, specialized training in addiction medicine. In response, a new online certificate in addiction medicine has been established in Vancouver, Canada, free of charge to participants globally. Objective: The objective of this study was to evaluate and examine changes in knowledge acquisition among health care professionals before and after the completion of an online certificate in addiction medicine. Methods: Learners enrolled in a 17-module certificate program and completed pre- and postknowledge tests using online multiple-choice questionnaires. Knowledge acquisition was then evaluated using a repeated measures t test of mean test scores before and after the online course. Following the certificate completion, a subset of learners completed the online course evaluation form. Results: Of the total 6985 participants who registered for the online course between May 15, 2017 and February 22, 2018, 3466 (49.62\%) completed the online pretest questionnaire. A total of 1010 participants completed the full course, achieving the required 70\% scores. TThe participants self-reported working in a broad range of health-related fields, including nursing (n=371), medicine (n=92), counseling or social work (n=69), community health (n=44), and pharmacy (n=34). The median graduation year was 2010 (n=363, interquartile range 2002-2015). Knowledge of the addiction medicine increased significantly postcertificate (mean difference 28.21; 95\% CI 27.32 to 29.10; P<.001). Physicians scored significantly higher on the pretest than any other health discipline, whereas the greatest improvement in scores was seen in the counseling professions and community outreach. Conclusions: This free, online, open-access certificate in addiction medicine appeared to improve knowledge of learners from a variety of disciplines and backgrounds. Scaling up low threshold learning opportunities may further advance addiction medicine training, thereby helping to narrow the evidence-to-practice gap. ", doi="10.2196/12474", url="http://mededu.jmir.org/2019/1/e12474/", url="http://www.ncbi.nlm.nih.gov/pubmed/31127722" } @Article{info:doi/10.2196/10982, author="Alturkistani, Abrar and Majeed, Azeem and Car, Josip and Brindley, David and Wells, Glenn and Meinert, Edward", title="Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study", journal="JMIR Med Educ", year="2019", month="Apr", day="02", volume="5", number="1", pages="e10982", keywords="education, distance", keywords="education", keywords="teaching", keywords="online learning", keywords="online education", keywords="MOOC", keywords="massive open online course", abstract="Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark's method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners' experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology. ", doi="10.2196/10982", url="http://mededu.jmir.org/2019/1/e10982/", url="http://www.ncbi.nlm.nih.gov/pubmed/30938683" } @Article{info:doi/10.2196/mededu.7719, author="Bond, Evan Stuart and Crowther, P. Shelley and Adhikari, Suman and Chubaty, J. Adriana and Yu, Ping and Borchard, P. Jay and Boutlis, Steven Craig and Yeo, Winston Wilfred and Miyakis, Spiros", title="Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study", journal="JMIR Med Educ", year="2018", month="Feb", day="26", volume="4", number="1", pages="e5", keywords="nursing education", keywords="pharmacy education", keywords="medical education", keywords="continuing education", keywords="survey methods", keywords="antibacterial agents", abstract="Background: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Objective: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. Methods: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. Results: Survey response rates were low at 26.87\% (577/2147) preintervention and 8.24\% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. Conclusions: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool's effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future. ", doi="10.2196/mededu.7719", url="http://mededu.jmir.org/2018/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/29483071" } @Article{info:doi/10.2196/mededu.7903, author="George, Mathew and Mandaliya, Hiren and Prawira, Amy", title="A Survey of Medical Oncology Training in Australian Medical Schools: Pilot Study", journal="JMIR Med Educ", year="2017", month="Dec", day="12", volume="3", number="2", pages="e23", keywords="medical", keywords="oncology", keywords="training", keywords="Australia", abstract="Background: Oncology is a rapidly evolving field with continuous advancements in the diagnosis and treatment of cancer. Therefore, it is important that medical students are provided with the knowledge and experience required to care for oncology patients and enable them to diagnose and manage toxicities of novel therapeutic agents. Objective: This study was performed to understand the medical students' perspective of the oncology education provided in universities across Australia and identify areas of education that could potentially be modified or improved to ultimately attract more students to a career in oncology. Methods: This pilot cross-sectional study consisted of an 18-question survey that was submitted online to medical students in their final year and interns rotating to the Tamworth Hospital. Results: The survey was completed by 94 fifth-year medical students and interns. Oncology was taught both theoretically and clinically for 68\% (63/93) of participants, and 48\% (44/92) had an exclusive oncology rotation. Both theoretical and clinical oncology assessments were conducted for only 21\% (19/92) of participants. Overall, 42\% (38/91) of participants were satisfied with their oncology education, and 78\% (40/51) were dissatisfied with the number of oncology teaching hours. The importance of a career in oncology was rated as low by 46\% (41/90) of participants. Conclusions: This pilot study indicates that there are potential areas to improve oncology teaching in Australian universities. The majority of surveyed students were dissatisfied with the number of teaching hours they receive in oncology. More global assessment of students and/or interns from other Australian institutes may yield further useful information. ", doi="10.2196/mededu.7903", url="http://mededu.jmir.org/2017/2/e23/", url="http://www.ncbi.nlm.nih.gov/pubmed/29233799" } @Article{info:doi/10.2196/mededu.6415, author="Badran, Hani and Pluye, Pierre and Grad, Roland", title="When Educational Material Is Delivered: A Mixed Methods Content Validation Study of the Information Assessment Method", journal="JMIR Med Educ", year="2017", month="Mar", day="14", volume="3", number="1", pages="e4", keywords="validity and reliability", keywords="continuing education", keywords="Internet", keywords="electronic mail", keywords="physicians, family", keywords="knowledge translation", keywords="primary health care", abstract="Background: The Information Assessment Method (IAM) allows clinicians to report the cognitive impact, clinical relevance, intention to use, and expected patient health benefits associated with clinical information received by email. More than 15,000 Canadian physicians and pharmacists use the IAM in continuing education programs. In addition, information providers can use IAM ratings and feedback comments from clinicians to improve their products. Objective: Our general objective was to validate the IAM questionnaire for the delivery of educational material (ecological and logical content validity). Our specific objectives were to measure the relevance and evaluate the representativeness of IAM items for assessing information received by email. Methods: A 3-part mixed methods study was conducted (convergent design). In part 1 (quantitative longitudinal study), the relevance of IAM items was measured. Participants were 5596 physician members of the Canadian Medical Association who used the IAM. A total of 234,196 ratings were collected in 2012. The relevance of IAM items with respect to their main construct was calculated using descriptive statistics (relevance ratio R). In part 2 (qualitative descriptive study), the representativeness of IAM items was evaluated. A total of 15 family physicians completed semistructured face-to-face interviews. For each construct, we evaluated the representativeness of IAM items using a deductive-inductive thematic qualitative data analysis. In part 3 (mixing quantitative and qualitative parts), results from quantitative and qualitative analyses were reviewed, juxtaposed in a table, discussed with experts, and integrated. Thus, our final results are derived from the views of users (ecological content validation) and experts (logical content validation). Results: Of the 23 IAM items, 21 were validated for content, while 2 were removed. In part 1 (quantitative results), 21 items were deemed relevant, while 2 items were deemed not relevant (R=4.86\% [N=234,196] and R=3.04\% [n=45,394], respectively). In part 2 (qualitative results), 22 items were deemed representative, while 1 item was not representative. In part 3 (mixing quantitative and qualitative results), the content validity of 21 items was confirmed, and the 2 nonrelevant items were excluded. A fully validated version was generated (IAM-v2014). Conclusions: This study produced a content validated IAM questionnaire that is used by clinicians and information providers to assess the clinical information delivered in continuing education programs. ", doi="10.2196/mededu.6415", url="http://mededu.jmir.org/2017/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28292738" } @Article{info:doi/10.2196/jmir.5378, author="Ling, Lowell and Gomersall, David Charles and Samy, Winnie and Joynt, Matthew Gavin and Leung, CH Czarina and Wong, Wai-Tat and Lee, Anna", title="The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study", journal="J Med Internet Res", year="2016", month="Jul", day="05", volume="18", number="7", pages="e180", keywords="patient safety", keywords="critical care", keywords="education, professional", keywords="education, distance", keywords="safety culture", abstract="Background: Patient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture. Objective: Our aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture. Methods: Health care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User's Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents. Results: We distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8\% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions. Conclusions: Our study demonstrates that a structured, reproducible short course on patient safety may be associated with an enhancement in several domains in ICU patient safety culture. ", doi="10.2196/jmir.5378", url="http://www.jmir.org/2016/7/e180/", url="http://www.ncbi.nlm.nih.gov/pubmed/27381876" } @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" }