@Article{info:doi/10.2196/65217, author="D'Amiano, Anjali and Kollings, Jack and Sunshine, Joel", title="The Quality of Dermatology Match Information on Social Media Platforms: Cross-Sectional Analysis", journal="JMIR Dermatol", year="2025", month="May", day="28", volume="8", pages="e65217", keywords="residency", keywords="dermatology match", keywords="Reddit", keywords="Student Doctor Network", keywords="dermatology", keywords="information", keywords="cross-section", keywords="cross-sectional analysis", keywords="online", keywords="qualifications", keywords="misinformation", keywords="media", keywords="online data", keywords="TikTok", keywords="online platform", keywords="health platform", keywords="web platform", keywords="online health", keywords="health information", keywords="social media", keywords="digital health", keywords="social media posts", keywords="online content", keywords="health content", keywords="social media content", keywords="residency program", keywords="medical residency", keywords="MD", keywords="medical school", doi="10.2196/65217", url="https://derma.jmir.org/2025/1/e65217" } @Article{info:doi/10.2196/63655, author="Tahmasebi, Houman and Ko, Gary and Lam, M. Christine and Bilgen, Idil and Freeman, Zachary and Varghese, Rhea and Reel, Emma and Englesakis, Marina and Cil, D. Tulin", title="Multidisciplinary Oncology Education Among Postgraduate Trainees: Systematic Review", journal="JMIR Med Educ", year="2025", month="May", day="26", volume="11", pages="e63655", keywords="multidisciplinary", keywords="oncology", keywords="postgraduate medical education", keywords="resident", keywords="fellow", keywords="surgery", keywords="hematology", keywords="radiation oncology", keywords="geriatrics", keywords="palliative", abstract="Background: Understanding the roles and patient management approaches of the entire oncology team is imperative for effective communication and optimal cancer treatment. Currently, there is no standard residency or fellowship curriculum to ensure the delivery of fundamental knowledge and skills associated with oncology specialties with which trainees often collaborate. Objective: This study is a systematic review that aims to evaluate the multidisciplinary oncology education in postgraduate medical training. Methods: A systematic literature search was performed using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, APA PsycINFO, and Education Resources Information Center in July 2021. Updates were performed in February 2023 and October 2024. Original studies reporting the effectiveness of multidisciplinary oncology training among residents and fellows were included. Results: A total of 6991 studies were screened and 24 were included. Fifteen studies analyzed gaps in existing multidisciplinary training of residents and fellows from numerous fields, including surgical, medical, and radiation oncology; geriatrics; palliative medicine; radiology; and pathology programs. Trainees reported limited teaching and knowledge of oncology outside of their respective fields and endorsed the need for further multidisciplinary oncology training. The remaining 9 studies assessed the effectiveness of educational interventions, including tumor boards, didactic sessions, clinical rotations, and case-based learning. Trainees reported significant improvements in multidisciplinary oncology knowledge and skills following the interventions. Conclusions: These data suggest postgraduate medical trainees have limited formal multidisciplinary oncology training. Existing educational interventions show promising results in improving trainees' oncology knowledge and skills. There is a need for further research and the development of multidisciplinary oncology curricula for postgraduate medical training programs. Trial Registration: PROSPERO CRD42022271308; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022271308 ", doi="10.2196/63655", url="https://mededu.jmir.org/2025/1/e63655" } @Article{info:doi/10.2196/64767, author="Gouvea Silva, Gabriela and da Silva Costa, Dario Carlos and Cardoso Gon{\c{c}}alves, Bruno and Vianney Saldanha Cidr{\~a}o Nunes, Luiz and Roberto dos Santos, Emerson and Almeida de Arnaldo Rodriguez Castro, Natalia and de Abreu Lima, Regina Alba and Sabadoto Brienze, Maria V{\^a}nia and Oliani, H{\'e}lio Ant{\^o}nio and Andr{\'e}, C{\'e}sar J{\'u}lio", title="Evolution of Learning Styles in Surgery Comparing Residents and Teachers: Cross-Sectional Study", journal="JMIR Med Educ", year="2025", month="May", day="8", volume="11", pages="e64767", keywords="learning", keywords="general surgery", keywords="medical education", keywords="internship and residency", keywords="surgeons", keywords="Brazil", abstract="Background: Studies confirm a relationship between learning style and medical career choice in the learning style patterns observed in distinct types of residency programs. Such patterns can also be applied to general surgery, from medical school to the latest stages of training. Aligning teaching strategies with the predominant learning styles in surgical residency programs has the potential to make training more effective. Objective: This study aimed to determine the learning styles of general surgery residents and professors in a Brazilian teaching hospital and compare the results with the existing literature. Methods: This was a cross-sectional study conducted in a teaching hospital of a public university in Brazil. Thirty-four general surgery residents of any year of training and 30 professors participated in the study. Participants completed a sociodemographic survey and David Kolb's Learning Style Inventory. This was used to classify participants into one of four distinct types of learners: accommodating, diverging, assimilating, and converging. The relationship between sociodemographic data and learning styles was analyzed using the Fisher test, adjusted using the Bonferroni method, and the effect size was measured using the Cramer V test. Results: The learning style distribution was similar in both groups, with 43,75\% diverging, 42,18\% accommodating, 10.93\% assimilating, and 3.12\% converging styles. A significant relationship was found between sex and learning style (P=.049) and between age and learning style for professors (P=.029). The effect sizes were strong (0.46) and very strong (0.506). Conclusions: The prevalence of learning styles among general surgery residents and professors at this Brazilian hospital differs from that observed in previous studies, with more diverging and accommodating learners and fewer converging learners, suggesting a shift in learning styles. Understanding learning styles is important for effective surgical training programs. Further research with larger and more diverse populations is needed to confirm these results and explore the factors contributing to the observed differences in learning styles. ", doi="10.2196/64767", url="https://mededu.jmir.org/2025/1/e64767" } @Article{info:doi/10.2196/54228, author="Wang, Peicheng and Wu, Ziye and Zhang, Jingfeng and He, Yanrong and Jiang, Maoqing and Zheng, Jianjun and Wang, Zhenchang and Yang, Zhenghan and Chen, Yanhua and Zhu, Jiming", title="Distance Learning During the COVID-19 Lockdown and Self-Assessed Competency Development Among Radiology Residents in China: Cross-Sectional Survey", journal="JMIR Med Educ", year="2025", month="May", day="8", volume="11", pages="e54228", keywords="radiology residents", keywords="distance learning", keywords="mental health status", keywords="self-assessed competency", keywords="ACGME competencies", keywords="Accreditation Council of Graduate Medical Education", abstract="Background: During the COVID-19 lockdown, it was difficult for residency training programs to conduct on-site, hands-on training. Distance learning, as an alternative to in-person training, could serve as a viable option during this challenging period, but few studies have assessed its role. Objective: This study aims to investigate the impact of distance learning during the lockdown on residents' self-assessed competency development and to explore the moderating effect of poor mental health on the associations. It is hypothesized that radiology residents who were trained through distance learning during the lockdown were more likely to report higher self-assessed competency compared to those who did not receive organized, formal training. Methods: A cross-sectional survey was conducted in 2021 among all of the radiology residents in 407 radiology residency programs across 31 provinces of China. To estimate the long-term outcomes of radiology residents' training after the initial COVID-19 outbreak, this study measured 6 core competencies developed by the US Accreditation Council for Graduate Medical Education reported by radiology residents. Multiple linear regression and moderating effect analysis were conducted to examine the associations between distance learning, mental health status, and self-assessed competencies. Mental health status moderated the association between distance learning and self-assessed competency of radiology residents. Results: A total of 2381 radiology residents (29.7\% of the 8,008 nationwide) met the inclusion criteria and were included in the analysis. Among them, 71.4\% (n=1699) received distance learning during the COVID-19 lockdown, and 73.2\% (n=1742) reported mental health struggles ranging in severity from slight to extremely severe. Radiology residents who were trained through distance learning ($\beta$=0.35, 90\% CI 0.24?0.45) were more likely to report higher self-assessed competencies. This was particularly true for the competency of ``interpersonal and communication skills'' ($\beta$=0.55, 90\% CI 0.39?0.70). Whereas, the competency of ``patient care and technical skills'' ($\beta$=0.14, 90\% CI 0.01?0.26) benefited the least from distance learning. Poor mental health significantly moderated the relationship between distance learning and competency ($\beta$=?0.15, 90\% CI ?0.27 to ?0.02). Conclusions: Distance learning, a means of promoting enabling environments during the COVID-19 lockdown, serves its purpose and helps generally improve residents' self-assessed competencies, though different competency domains benefit unequally. The impact of mental health status calls for special attention so that distance learning can fulfill its potential. ", doi="10.2196/54228", url="https://mededu.jmir.org/2025/1/e54228" } @Article{info:doi/10.2196/59417, author="Jandu, Simi and Carey, L. Jennifer", title="Exploring Social Media Use Among Medical Students Applying for Residency Training: Cross-Sectional Survey Study", journal="JMIR Med Educ", year="2025", month="Feb", day="21", volume="11", pages="e59417", keywords="social media", keywords="residency recruitment", keywords="Instagram", keywords="Reddit", keywords="medical students", keywords="student", keywords="residency", keywords="residency training", keywords="social media engagement", keywords="training programs", keywords="social media usage", keywords="cross-sectional survey", keywords="survey", keywords="residency training program", keywords="thematic analysis", abstract="Background: Since the COVID-19 pandemic, residency candidates have moved from attending traditional in-person interviews to virtual interviews with residency training programs. This transition spurred increased social media engagement by residency candidates, in an effort to learn about prospective programs, and by residency programs, to improve recruitment efforts. There is a paucity of literature on the effectiveness of social media outreach and its impact on candidates' perceptions of residency programs. Objective: We aimed to determine patterns of social media platform usage among prospective residency candidates and social media's influence on students' perceptions of residency programs. Methods: A cross-sectional survey was administered anonymously to fourth-year medical students who successfully matched to a residency training program at a single institution in 2023. These data were analyzed using descriptive statistics, as well as thematic analysis for open-ended questions. Results: Of the 148 eligible participants, 69 (46.6\%) responded to the survey, of whom 45 (65.2\%) used social media. Widely used social media platforms were Instagram (19/40, 47.5\%) and Reddit (18/40, 45\%). Social media influenced 47.6\% (20/42) of respondents' opinions of programs and had a moderate or major effect on 26.2\% (11/42) of respondents' decisions on program ranking. Resident-faculty relations and social events showcasing camaraderie and wellness were the most desired content. Conclusions: Social media is used by the majority of residency candidates during the residency application process and influences residency program ranking. This highlights the importance of residency programs in leveraging social media usage to recruit applicants and provide information that allows the candidate to better understand the program. ", doi="10.2196/59417", url="https://mededu.jmir.org/2025/1/e59417" } @Article{info:doi/10.2196/63861, author="Almeziny, Abdullah and Almutairi, Rahaf and Altamimi, Amal and Alshehri, Khloud and Almehaideb, Latifah and Shadid, Asem and Al Mashali, Mohammed", title="The Prevalence of Dermoscopy Use Among Dermatology Residents in Riyadh, Saudi Arabia: Cross-Sectional Study", journal="JMIR Dermatol", year="2025", month="Jan", day="23", volume="8", pages="e63861", keywords="dermoscopy", keywords="Saudi Arabia", keywords="questionnaire", keywords="skin lesion", keywords="noninvasive", keywords="cross-sectional study", keywords="dermatology", abstract="Background: Dermoscopy is a noninvasive technology used to examine the skin's invisible microstructures in dermatological practice and is gaining prominence as a crucial tool. Dermoscopy is an evidence-based practice used to enhance the early detection of skin malignancies and to help distinguish between various skin conditions, including pigmented and nonpigmented skin malignancies. Currently, the vast majority of global guidelines for skin cancer recommend dermoscopy as a critical component. Dermoscopy use is increasing worldwide, but to date, no study has documented the attitudes toward and use of dermoscopy among future dermatologists in Saudi Arabia. Objective: We aimed to determine the proportion of dermatology residents in Riyadh who use dermoscopy in their clinical practice; identify factors influencing the use of dermoscopy, such as availability of equipment, training, and the perceived importance of dermoscopy in clinical practice; explore barriers to dermoscopy use, including the lack of access to necessary resources (eg, dermoscopes) and insufficient training; and provide insights into the adoption and integration of dermoscopy into dermatology training and clinical practice in Saudi Arabia. Methods: In January 2024, a validated and published questionnaire was modified to meet research requirements and was sent to all registered dermatology residents in the The Saudi Board of Dermatology and Venereology Program. Results: In total, 63 dermatology residents in Riyadh, Saudi Arabia, completed the web-based questionnaire (response rate=87.5\%). The sample was predominantly female (n=34, 54.0\%), with the majority (n=53, 84.1\%) aged between 26 and 30 years. A notable proportion of participants (n=22, 34.9\%) were in their final year of residency. Over half of the participants (n=34, 54.0\%) owned a dermoscope, and a substantial number of them (n=23, 36.5\%) reported conducting 21-30 clinic consultations per month on average. More than half of the participants (n=36, 57.1\%) had received dermoscopy training, and 16 (36.4\%) had used dermoscopy for 2 years. Additionally, most participants (n=20, 45.5\%) had used nonpolarized immersion-contact dermoscopy, while 19 (43.2\%) had used polarized light dermoscopy. Furthermore, the majority (n=22, 50.0\%) used dermoscopy in fewer than 10\% of cases involving patients with inflammatory skin lesions. Statistical analysis revealed significant associations between the participants' ages (P=.003), residency levels (P=.001), and practice centers and the use of dermoscopy (P=.004). Conclusions: Dermoscopy has been widely adopted by dermatology residents in their daily clinical practice due to its benefits in early detection and diagnosis of skin diseases. However, the overall extent of dermoscopy use within the dermatology community remains unclear, highlighting the need for further education. In Saudi Arabia, the key factors influencing dermoscopy use include residents' ages, residency levels, and practice centers. Younger dermatologists have expressed strong interest in improving their dermoscopy knowledge and skills. Expanding access to dermoscopy equipment and providing training during residency could further promote its use across the country. ", doi="10.2196/63861", url="https://derma.jmir.org/2025/1/e63861" } @Article{info:doi/10.2196/60255, author="Nykiel-Bailey, Sydney and Burrows, Kathryn and Szafarowicz, E. Bianca and Moquin, Rachel", title="Faculty Perceptions on the Roles of Mentoring, Advising, and Coaching in an Anesthesiology Residency Program: Mixed Methods Study", journal="JMIR Med Educ", year="2025", month="Jan", day="21", volume="11", pages="e60255", keywords="coaching", keywords="faculty perceptions", keywords="mentoring", keywords="perception", keywords="medical education", keywords="anesthesia", keywords="modality", keywords="support", keywords="Washington University", keywords="university", keywords="coaching skills", keywords="training", keywords="culture change", keywords="culture", keywords="flexibility", keywords="systematic framework", abstract="Background: Mentoring, advising, and coaching are essential components of resident education and professional development. Despite their importance, there is limited literature exploring how anesthesiology faculty perceive these practices and their role in supporting residents. Objective: This study aims to investigate anesthesiology faculty perspectives on the significance, implantation strategies, and challenges associated with mentorship, advising, and coaching in resident education. Methods: A comprehensive survey was administrated to 93 anesthesiology faculty members at Washington University School of Medicine. The survey incorporated quantitative Likert-scale questions and qualitative short-answer responses to assess faculty perceptions of the value, preferred formats, essential skills, and capacity for fulfilling multiple roles in these support practices. Additional areas of focus included the impact of staffing shortages, training requirements, and the potential of these practices to enhance faculty recruitment and retention. Results: The response rate was 44\% (n=41). Mentoring was identified as the most important aspect, with 88\% (n=36) of faculty respondents indicating its significance, followed by coaching, which was highlighted by 78\% (n=32) of respondents. The majority felt 1 faculty member can effectively hold multiple roles for a given trainee. The respondents desired additional training for roles and found roles to be rewarding. All roles were seen as facilitating recruitment and retention. Barriers included faculty burnout; confusion between roles; time constraints; and desire for specialized training, especially in coaching skills. Conclusions: Implementing structured mentoring, advising, and coaching can profoundly impact resident education but requires role clarity, protected time, culture change, leadership buy-in, and faculty development. Targeted training and operational investments could enable programs to actualize immense benefits from high-quality resident support modalities. Respondents emphasized that resident needs evolve over time, necessitating flexibility in appropriate faculty guidance. While coaching demands unique skills, advising hinges on expertise and mentoring depends on relationship-building. Systematic frameworks of coaching, mentoring, and advising programs could unlock immense potential. However, realizing this vision demands surmounting barriers such as burnout, productivity pressures, confusion about logistics, and culture change. Ultimately, prioritizing resident support through high-quality personalized guidance can recenter graduate medical education. ", doi="10.2196/60255", url="https://mededu.jmir.org/2025/1/e60255" } @Article{info:doi/10.2196/54280, 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/10.2196/57157, author="Miao, Jing and Thongprayoon, Charat and Garcia Valencia, Oscar and Craici, M. Iasmina and Cheungpasitporn, Wisit", title="Navigating Nephrology's Decline Through a GPT-4 Analysis of Internal Medicine Specialties in the United States: Qualitative Study", journal="JMIR Med Educ", year="2024", month="Oct", day="10", volume="10", pages="e57157", keywords="artificial intelligence", keywords="ChatGPT", keywords="nephrology fellowship training", keywords="fellowship matching", keywords="medical education", keywords="AI", keywords="nephrology", keywords="fellowship", keywords="United States", keywords="factor", keywords="chatbots", keywords="intellectual", keywords="complexity", keywords="work-life balance", keywords="procedural involvement", keywords="opportunity", keywords="career demand", keywords="financial compensation", abstract="Background: The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11\% drop in candidates and a mere 66\% (321/488) of positions filled. Objective: The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Methods: Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. Results: GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology's filled rate was 66\%, only higher than the 45\% (155/348) filled rate of geriatric medicine. Nephrology's score decreased by 4\%?14\% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. Conclusions: ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents. ", doi="10.2196/57157", url="https://mededu.jmir.org/2024/1/e57157" } @Article{info:doi/10.2196/56859, author="Yoon, Soo-Hyuk and Oh, Kyeong Seok and Lim, Gun Byung and Lee, Ho-Jin", title="Performance of ChatGPT in the In-Training Examination for Anesthesiology and Pain Medicine Residents in South Korea: Observational Study", journal="JMIR Med Educ", year="2024", month="Sep", day="16", volume="10", pages="e56859", keywords="AI tools", keywords="problem solving", keywords="anesthesiology", keywords="artificial intelligence", keywords="pain medicine", keywords="ChatGPT", keywords="health care", keywords="medical education", keywords="South Korea", abstract="Background: ChatGPT has been tested in health care, including the US Medical Licensing Examination and specialty exams, showing near-passing results. Its performance in the field of anesthesiology has been assessed using English board examination questions; however, its effectiveness in Korea remains unexplored. Objective: This study investigated the problem-solving performance of ChatGPT in the fields of anesthesiology and pain medicine in the Korean language context, highlighted advancements in artificial intelligence (AI), and explored its potential applications in medical education. Methods: We investigated the performance (number of correct answers/number of questions) of GPT-4, GPT-3.5, and CLOVA X in the fields of anesthesiology and pain medicine, using in-training examinations that have been administered to Korean anesthesiology residents over the past 5 years, with an annual composition of 100 questions. Questions containing images, diagrams, or photographs were excluded from the analysis. Furthermore, to assess the performance differences of the GPT across different languages, we conducted a comparative analysis of the GPT-4's problem-solving proficiency using both the original Korean texts and their English translations. Results: A total of 398 questions were analyzed. GPT-4 (67.8\%) demonstrated a significantly better overall performance than GPT-3.5 (37.2\%) and CLOVA-X (36.7\%). However, GPT-3.5 and CLOVA X did not show significant differences in their overall performance. Additionally, the GPT-4 showed superior performance on questions translated into English, indicating a language processing discrepancy (English: 75.4\% vs Korean: 67.8\%; difference 7.5\%; 95\% CI 3.1\%-11.9\%; P=.001). Conclusions: This study underscores the potential of AI tools, such as ChatGPT, in medical education and practice but emphasizes the need for cautious application and further refinement, especially in non-English medical contexts. The findings suggest that although AI advancements are promising, they require careful evaluation and development to ensure acceptable performance across diverse linguistic and professional settings. ", doi="10.2196/56859", url="https://mededu.jmir.org/2024/1/e56859" } @Article{info:doi/10.2196/57243, author="Kiani, Parmiss and Dolling-Boreham, Roberta and Hameed, Saif Mohamed and Masino, Caterina and Fecso, Andras and Okrainec, Allan and Madani, Amin", title="Usability, Ergonomics, and Educational Value of a Novel Telestration Tool for Surgical Coaching: Usability Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="10", volume="11", pages="e57243", keywords="augmented reality", keywords="AR", keywords="surgical training", keywords="telestration", keywords="tele-stration", keywords="surgical training technology", keywords="minimally invasive surgery", keywords="surgery", keywords="surgeon", keywords="surgeons", keywords="surgical", keywords="surgical coaching", keywords="surgical teaching", keywords="telemonitoring", keywords="telemonitor", keywords="tele-monitoring", keywords="tele-monitor", keywords="usability", keywords="usable", keywords="usableness", keywords="usefulness", keywords="utility", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", abstract="Background: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. Objective: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. Methods: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. Results: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90\% and neutral 0, 0\%), video feed navigation (SA/A 8, 80\% and neutral 1, 10\%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60\% and neutral 3, 30\%). Regarding ergonomics, 40\% (4) of participants agreed or strongly agreed (neutral 4, 40\%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device's size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device's perceived educational value, particularly for postoperative coaching (agree 6, 60\%, strongly agree 4, 40\%). Conclusions: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training. ", doi="10.2196/57243", url="https://humanfactors.jmir.org/2024/1/e57243" } @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/10.2196/41573, author="Noori, Sofia and Khasnavis, Siddharth and DeCroce-Movson, Eliza and Blay-Tofey, Morkeh and Vitiello, Evan", title="A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study", journal="JMIR Form Res", year="2024", month="May", day="13", volume="8", pages="e41573", keywords="digital psychiatry", keywords="digital mental health", keywords="didactic curriculum", keywords="residency training", keywords="psychiatry residency", keywords="training classes", keywords="trainee response", keywords="residency curriculum", keywords="trainee feedback", abstract="Background: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. Objective: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Methods: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Results: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03),?assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed ``somewhat comfortable'' on any of the above measures. Conclusions: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum. ", doi="10.2196/41573", url="https://formative.jmir.org/2024/1/e41573", url="http://www.ncbi.nlm.nih.gov/pubmed/38739423" } @Article{info:doi/10.2196/45919, author="Ulin, Lindsey and Bernstein, A. Simone and Nunes, C. Julio and Gu, Alex and Hammoud, M. Maya and Gold, A. Jessica and Mirza, M. Kamran", title="Improving Transparency in the Residency Application Process: Survey Study", journal="JMIR Form Res", year="2023", month="Dec", day="25", volume="7", pages="e45919", keywords="data elaboration", keywords="information transparency", keywords="medical school", keywords="residency application", keywords="residency programs", keywords="resident", abstract="Background: Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process. Objective: This study aims to determine the information applicants find most beneficial from residency programs when deciding where to apply, by type of medical school education background. Methods: Match 2023 applicants voluntarily completed an anonymous survey through the Twitter and Instagram social media platforms. We asked the respondents to select 3 top factors from a multiple-choice list of what information they would like from residency programs to help determine if the characteristics of their application align with program values. We examined differences in helpful factors selected by medical school backgrounds using ANOVA. Results: There were 4649 survey respondents. When responses were analyzed by United States-allopathic (US-MD), doctor of osteopathic medicine (DO), and international medical graduate (IMG) educational backgrounds, respondents chose different factors as most helpful: minimum United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Step 2 scores (565/3042, 18.57\% US-MD; 485/3042, 15.9\% DO; and 1992/3042, 65.48\% IMG; P<.001), resident hometown region (281/1132, 24.82\% US-MD; 189/1132, 16.7\% DO; and 662/1132, 58.48\% IMG; P=.02), resident medical school region (476/2179, 22\% US-MD; 250/2179, 11.5\% DO; and 1453/2179, 66.7\% IMG; P=.002), and percent of residents or attendings underrepresented in medicine (417/1815, 22.98\% US-MD; 158/1815, 8.71\% DO; and 1240/1815, 68.32\% IMG; P<.001). Conclusions: When applying to residency programs, this study found that the factors that respondents consider most helpful from programs in deciding where to apply differ by educational background. Across all educational groups, respondents want transparency around standardized exam scores, geography, and the racial or ethnic backgrounds of residents and attendings. ", doi="10.2196/45919", url="https://formative.jmir.org/2023/1/e45919", url="http://www.ncbi.nlm.nih.gov/pubmed/38145482" } @Article{info:doi/10.2196/44240, author="Martindale, M. Jaclyn and Carrasquillo, A. Rachel and Otallah, Ireland Scott and Brooks, K. Amber and Denizard-Thompson, Nancy and Pharr, Emily and Choate, Nakiea and Sokolosky, Mitchell and Strauss, Doyle Lauren", title="Local Culture and Community Through a Digital Lens: Viewpoint on Designing and Implementing a Virtual Second Look Event for Residency Applicants", journal="JMIR Med Educ", year="2023", month="Sep", day="11", volume="9", pages="e44240", keywords="medical education", keywords="graduate medical education", keywords="residency application", keywords="virtual interviews", keywords="match", keywords="recruitment", abstract="Background: The COVID-19 pandemic altered how residency interviews occur. Despite 2 years of web-based interviews, these are still perceived as inferior to in-person experiences. Showcasing a program and location is critical for recruitment; however, it is difficult to highlight the program's location and community digitally. This article presents the authors' viewpoints on designing and implementing a virtual second look for residency applicants. Objective: Our objective was to host a web-based event to feature the benefits of living in Winston-Salem, North Carolina, for residency applicants, enhance recruitment efforts, and ensure a successful residency match. The goal was to cover topics that interested all applicants, highlight how Winston-Salem is a special place to live, involve current residents, and engage community members. Methods: Three programs--child neurology, neurology, and family medicine were chosen for a pilot virtual second look. All residency program directors' were asked to recommend community contacts and help identify residents and faculty who may serve as content experts on one of the topics in the panel discussions. A total of 24 community leaders from restaurants, venues, schools, and businesses were contacted, and 18 agreed to participate. The panel discussions included living in and raising a family in Winston-Salem, experiencing Winston-Salem arts and music, where to eat and drink like a local, and enjoying sports and outdoors in the area. The 2-hour event was hosted on Zoom. Postevent feedback assessments were automatically sent to each registrant through Research Electronic Data Capture (REDCap). This study was deemed exempt from Wake Forest University Health Sciences institutional review board review (IRB00088703). Results: There were 51 registrants for the event, and 28 of 48 registrants provided postevent feedback, which was positive. The authors found in the MATCH residency results that 2 of 2 child neurology positions, 4 of 6 adult neurology positions, and 1 of 10 family medicine positions attended our second look event. One adult neurology resident who did not participate was an internal candidate. All respondents agreed or strongly agreed that the session was valuable, well organized, and met their expectations or goals. Furthermore, all respondents gained new information during this web-based event not obtained during their interview day. Conclusions: The virtual second look event for residency attendees featured the benefits of living in Winston-Salem, and the perspectives of current residents. Feedback from the session was overall positive; however, a top desire would be devoting more time for the applicants to ask questions directly to the community leaders and our resident trainees. This program could be reproducible by other institutions. It could be broadened to a graduate medical education--wide virtual second look event where all medical and surgical programs could opt to participate, facilitating an equitable opportunity for prospective applicants. ", doi="10.2196/44240", url="https://mededu.jmir.org/2023/1/e44240", url="http://www.ncbi.nlm.nih.gov/pubmed/37695665" } @Article{info:doi/10.2196/50109, author="Ozair, Ahmad and Bhat, Vivek and Detchou, E. Donald K.", title="Authors' Reply to: Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on ``The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators''", journal="JMIR Med Educ", year="2023", month="Aug", day="17", volume="9", pages="e50109", keywords="admission", keywords="assessment", keywords="postgraduate training", keywords="selection", keywords="standardized testing", keywords="graduate medical education", keywords="medical education", doi="10.2196/50109", url="https://mededu.jmir.org/2023/1/e50109", url="http://www.ncbi.nlm.nih.gov/pubmed/37590044" } @Article{info:doi/10.2196/47763, author="Sow, Yacine and Gangal, Ameya and Yeung, Howa and Blalock, Travis and Stoff, Benjamin", title="Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on ``The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators''", journal="JMIR Med Educ", year="2023", month="Aug", day="17", volume="9", pages="e47763", keywords="admission", keywords="assessment", keywords="postgraduate training", keywords="selection", keywords="standardized testing", keywords="USMLE", keywords="medical school", keywords="medical students", keywords="residency application", keywords="research training", doi="10.2196/47763", url="https://mededu.jmir.org/2023/1/e47763", url="http://www.ncbi.nlm.nih.gov/pubmed/37590047" } @Article{info:doi/10.2196/39831, author="Dunn, Tyler and Patel, Shyam and Milam, J. Adam and Brinkman, Joseph and Gorlin, Andrew and Harbell, W. Monica", title="Influence of Social Media on Applicant Perceptions of Anesthesiology Residency Programs During the COVID-19 Pandemic: Quantitative Survey", journal="JMIR Med Educ", year="2023", month="Jun", day="29", volume="9", pages="e39831", keywords="anesthesiology residency", keywords="application", keywords="COVID-19 pandemic", keywords="social media", keywords="impact", keywords="residency", keywords="anesthesia", keywords="anesthesiology", keywords="pandemic", keywords="effectiveness", keywords="restrictions", keywords="barriers", keywords="rotations", keywords="visits", keywords="interviews", keywords="applicants", keywords="perception", keywords="students", keywords="program", abstract="Background: Social media may be an effective tool in residency recruitment, given its ability to engage a broad audience; however, there are limited data regarding the influence of social media on applicants' evaluation of anesthesiology residency programs. Objective: This study evaluates the influence of social media on applicants' perceptions of anesthesiology residency programs during the COVID-19 pandemic to allow programs to evaluate the importance of a social media presence for residency recruitment. The study also sought to understand if there were differences in the use of social media by applicant demographic characteristics (eg, race, ethnicity, gender, and age). We hypothesized that given the COVID-19 pandemic restrictions on visiting rotations and the interview process, the social media presence of anesthesiology residency programs would have a positive impact on the recruitment process and be an effective form of communication about program characteristics. Methods: All anesthesiology residency applicants who applied to Mayo Clinic Arizona were emailed a survey in October 2020 along with statements regarding the anonymity and optional nature of the survey. The 20-item Qualtrics survey included questions regarding subinternship rotation completion, social media resource use and impact (eg, ``residency-based social media accounts positively impacted my opinion of the program''), and applicant demographic characteristics. Descriptive statistics were examined, and perceptions of social media were stratified by gender, race, and ethnicity; a factor analysis was performed, and the resulting scale was regressed on race, ethnicity, age, and gender. Results: The survey was emailed to 1091 individuals who applied to the Mayo Clinic Arizona anesthesiology residency program; there were 640 unique responses recorded (response rate=58.6\%). Nearly 65\% of applicants reported an inability to complete 2 or more planned subinternships due to COVID-19 restrictions (n=361, 55.9\%), with 25\% of applicants reporting inability to do any visiting student rotations (n=167). Official program websites (91.5\%), Doximity (47.6\%), Instagram (38.5\%), and Twitter (19.4\%) were reported as the most used resources by applicants. The majority of applicants (n=385, 67.3\%) agreed that social media was an effective means to inform applicants, and 57.5\% (n=328) of them indicated that social media positively impacted their perception of the program. An 8-item scale with good reliability was created, representing the importance of social media (Cronbach $\alpha$=.838). There was a positive and statistically significant relationship such that male applicants (standardized $\beta$=.151; P=.002) and older applicants ($\beta$=.159; P<.001) had less trust and reliance in social media for information regarding anesthesiology residency programs. The applicants' race and ethnicity were not associated with the social media scale ($\beta$=--.089; P=.08). Conclusions: Social media was an effective means to inform applicants, and generally positively impacted applicants' perception of programs. Thus, residency programs should consider investing time and resources toward building a social media presence to improve resident recruitment. ", doi="10.2196/39831", url="https://mededu.jmir.org/2023/1/e39831", url="http://www.ncbi.nlm.nih.gov/pubmed/37205642" } @Article{info:doi/10.2196/23287, author="Mahajan, Arnav and Hawkins, Austin", title="Current Implementation Outcomes of Digital Surgical Simulation in Low- and Middle-Income Countries: Scoping Review", journal="JMIR Med Educ", year="2023", month="Jun", day="15", volume="9", pages="e23287", keywords="adaptation", keywords="digital surgery", keywords="global surgery", keywords="simulation", keywords="surgery", keywords="systematic review", keywords="technology", keywords="video game", abstract="Background: Digital surgical simulation and telecommunication provides an attractive option for improving surgical skills, widening access to training, and improving patient outcomes; however, it is unclear whether sufficient simulations and telecommunications are accessible, effective, or feasible in low- and middle-income countries (LMICs). Objective: This study aims to determine which types of surgical simulation tools have been most widely used in LMICs, how surgical simulation technology is being implemented, and what the outcomes of these efforts have been. We also offer recommendations for the future development of digital surgical simulation implementation in LMICs. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials to look for qualitative studies in published literature discussing implementation and outcomes of surgical simulation training in LMICs. Eligible papers involved surgical trainees or practitioners who were based in LMICs. Papers that include allied health care professionals involved in task sharing were excluded. We focused specifically on digital surgical innovations and excluded flipped classroom models and 3D models. Implementation outcome had to be reported according to Proctor's taxonomy. Results: This scoping review examined the outcomes of digital surgical simulation implementation in LMICs for 7 papers. The majority of participants were medical students and residents who were identified as male. Participants rated surgical simulators and telecommunications devices highly for acceptability and usefulness, and they believed that the simulators increased their anatomical and procedural knowledge. However, limitations such as image distortion, excessive light exposure, and video stream latency were frequently reported. Depending on the product, the implementation cost varied between US \$25 and US \$6990. Penetration and sustainability are understudied implementation outcomes, as all papers lacked long-term monitoring of the digital surgical simulations. Most authors are from high-income countries, suggesting that innovations are being proposed without a clear understanding of how they can be incorporated into surgeons' practical training. Overall, the study indicates that digital surgical simulation is a promising tool for medical education in LMICs; however, additional research is required to address some of the limitations in order to achieve successful implementation, unless scaling efforts prove futile. Conclusions: This study indicates that digital surgical simulation is a promising tool for medical education in LMICs, but further research is necessary to address some of the limitations and ensure successful implementation. We urge more consistent reporting and understanding of implementation of science approaches in the development of digital surgical tools, as this is the critical factor that will determine whether we are able to meet the 2030 goals for surgical training in LMICs. Sustainability of implemented digital surgical tools is a pain point that must be focused on if we are to deliver digital surgical simulation tools to the populations that demand them the most. ", doi="10.2196/23287", url="https://mededu.jmir.org/2023/1/e23287", url="http://www.ncbi.nlm.nih.gov/pubmed/37318901" } @Article{info:doi/10.2196/40541, author="Ulbrich, Max and Van den Bosch, Vincent and B{\"o}nsch, Andrea and Gruber, Johannes Lennart and Ooms, Mark and Melchior, Claire and Motmaen, Ila and Wilpert, Caroline and Rashad, Ashkan and Kuhlen, Wolfgang Torsten and H{\"o}lzle, Frank and Puladi, Behrus", title="Advantages of a Training Course for Surgical Planning in Virtual Reality for Oral and Maxillofacial Surgery: Crossover Study", journal="JMIR Serious Games", year="2023", month="Jan", day="19", volume="11", pages="e40541", keywords="virtual surgical planning", keywords="virtual reality", keywords="Elucis", keywords="3D Slicer", keywords="oral and maxillofacial surgery", abstract="Background: As an integral part of computer-assisted surgery, virtual surgical planning (VSP) leads to significantly better surgery results, such as for oral and maxillofacial reconstruction with microvascular grafts of the fibula or iliac crest. It is performed on a 2D computer desktop screen (DS) based on preoperative medical imaging. However, in this environment, VSP is associated with shortcomings, such as a time-consuming planning process and the requirement of a learning process. Therefore, a virtual reality (VR)--based VSP application has great potential to reduce or even overcome these shortcomings due to the benefits of visuospatial vision, bimanual interaction, and full immersion. However, the efficacy of such a VR environment has not yet been investigated. Objective: This study aimed to demonstrate the possible advantages of a VR environment through a substep of VSP, specifically the segmentation of the fibula (calf bone) and os coxae (hip bone), by conducting a training course in both DS and VR environments and comparing the results. Methods: During the training course, 6 novices were taught how to use a software application in a DS environment (3D Slicer) and in a VR environment (Elucis) for the segmentation of the fibula and os coxae, and they were asked to carry out the maneuvers as accurately and quickly as possible. Overall, 13 fibula and 13 os coxae were segmented for each participant in both methods (VR and DS), resulting in 156 different models (78 fibula and 78 os coxae) per method (VR and DS) and 312 models in total. The individual learning processes in both environments were compared using objective criteria (time and segmentation performance) and self-reported questionnaires. The models resulting from the segmentation were compared mathematically (Hausdorff distance and Dice coefficient) and evaluated by 2 experienced radiologists in a blinded manner. Results: A much faster learning curve was observed for the VR environment than the DS environment ($\beta$=.86 vs $\beta$=.25). This nearly doubled the segmentation speed (cm3/min) by the end of training, leading to a shorter time (P<.001) to reach a qualitative result. However, there was no qualitative difference between the models for VR and DS (P=.99). The VR environment was perceived by participants as more intuitive and less exhausting, and was favored over the DS environment. Conclusions: The more rapid learning process and the ability to work faster in the VR environment could save time and reduce the VSP workload, providing certain advantages over the DS environment. ", doi="10.2196/40541", url="https://games.jmir.org/2023/1/e40541", url="http://www.ncbi.nlm.nih.gov/pubmed/36656632" } @Article{info:doi/10.2196/37069, author="Ozair, Ahmad and Bhat, Vivek and Detchou, E. Donald K.", title="The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators", journal="JMIR Med Educ", year="2023", month="Jan", day="6", volume="9", pages="e37069", keywords="admission", keywords="assessment", keywords="postgraduate training", keywords="selection", keywords="standardized testing", doi="10.2196/37069", url="https://mededu.jmir.org/2023/1/e37069", url="http://www.ncbi.nlm.nih.gov/pubmed/36607718" } @Article{info:doi/10.2196/40106, author="Barlow, Emma and Zahra, Wajiha and Hornsby, Jane and Wilkins, Alex and Davies, M. Benjamin and Burke, Joshua", title="Defining a Role for Webinars in Surgical Training Beyond the COVID-19 Pandemic in the United Kingdom: Trainee Consensus Qualitative Study", journal="JMIR Med Educ", year="2022", month="Dec", day="21", volume="8", number="4", pages="e40106", keywords="webinars", keywords="surgical training", keywords="trainee consensus", keywords="teaching", keywords="training", keywords="integration", keywords="trainee experience", keywords="user experience", keywords="perception", keywords="education", keywords="medical education", keywords="surgical skills", abstract="Background: The COVID-19 pandemic posed several challenges for surgical training, including the suspension of many in-person teaching sessions in lieu of webinars. As restrictions have eased, both prepandemic and postpandemic training methods should be used. Objective: This study investigates trainees' experiences of webinars during the COVID-19 pandemic to develop recommendations for their effective integration into surgical training going forward. Methods: This project was led by the Association of Surgeons in Training and used an iterative process with mixed qualitative methods to consolidate arguments for and against webinars, and the drivers and barriers to their effective delivery, into recommendations. This involved 3 phases: (1) a web-based survey, (2) focus group interviews, and (3) a consensus session using a nominal group technique. Results: Trainees (N=281) from across specialties and grades confirmed that the COVID-19 pandemic led to an increase in webinars for surgical training. While there were concerns, particularly around the utility for practical training (80.9\%), the majority agreed that webinars had a role in training following the COVID-19 pandemic (90.2\%). The cited benefits included improved access or flexibility and potential standardization of training. The majority of limitations were technical. These perspectives were refined through focus group interviews (n=18) into 25 recommendations, 23 of which were ratified at a consensus meeting, which was held at the Association of Surgeons in Training 2021 conference. Conclusions: Webinars have a role in surgical training following the COVID-19 pandemic. The 23 recommendations encompass indications and technical considerations but also discuss important knowledge gaps. They should serve as an initial framework for ensuring that webinars add value and continue to evolve as a tool for training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055325; http://www.chictr.org.cn/showprojen.aspx?proj=142802 ", doi="10.2196/40106", url="https://mededu.jmir.org/2022/4/e40106", url="http://www.ncbi.nlm.nih.gov/pubmed/36542431" } @Article{info:doi/10.2196/35074, author="Jensen, Katherine and Yan, Qi and Davies, G. Mark", title="Critical Comparison of the Quality and Content of Integrated Vascular Surgery, Thoracic Surgery, and Interventional Radiology Residency Training Program Websites: Qualitative Study", journal="JMIR Med Educ", year="2022", month="Jun", day="29", volume="8", number="2", pages="e35074", keywords="training", keywords="recruitment", keywords="website", keywords="content", keywords="quality", keywords="vascular surgery", keywords="thoracic surgery", keywords="interventional radiology", keywords="radiology", keywords="surgery", keywords="web-based", keywords="web resource", keywords="surgeon", keywords="comparison", keywords="residency", keywords="integrated program", abstract="Background: With the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery, and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program. Objective: The aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs. Methods: A list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) database. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software. Results: Of ACGME-accredited programs, 56 of 61 (92\%) vascular surgery, 27 of 27 (100\%) thoracic surgery, and 74 of 85 (87\%) interventional radiology programs had functional websites (P=.12). Vascular surgery websites contained a median of 26 (IQR 20-32) content items, thoracic surgery websites contained a median of 27 (IQR 21-32) content items, and interventional radiology websites contained a median of 23 (IQR 18-27) content items. Two content items considered highly influential to applicant program decisions are procedural experience and faculty mentorship, which were reported at 32\% (18/56) and 11\% (6/56) for vascular surgery, 19\% (5/27) and 11\% (3/27) for thoracic surgery, and 50\% (37/74) and 15\% (11/74) for interventional radiology (P=.008 and P=.75), respectively. Key deficits were work hours, debt management, and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; and operative experiences and the program director's contact and message for thoracic surgery. Interventional radiology deficits were work hours, and thoracic surgery deficits were procedural experience. Both interventional radiology and thoracic surgery websites lacked information on evaluation criteria and faculty mentorship. Conclusions: This study has uncovered key differences in the availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content to attract valuable candidates. ", doi="10.2196/35074", url="https://mededu.jmir.org/2022/2/e35074", url="http://www.ncbi.nlm.nih.gov/pubmed/35767342" } @Article{info:doi/10.2196/34791, author="James, K. Hannah and Fawdington, A. Ross", title="Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study", journal="JMIR Med Educ", year="2022", month="Jun", day="29", volume="8", number="2", pages="e34791", keywords="simulation", keywords="high fidelity simulation", keywords="orthopedic residency", keywords="surgical training", keywords="postgraduate education", keywords="medical education", keywords="medical student", keywords="surgeon", keywords="hand", keywords="hand surgery", keywords="surgery", keywords="orthopedic", keywords="cadaver", keywords="cadaveric simulation", keywords="cadaveric", keywords="training", keywords="cadaveric training", keywords="DP", keywords="deliberate practice", abstract="Background: Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact. Objective: The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training. Methods: This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study. Results: The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training. Conclusions: Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work. ", doi="10.2196/34791", url="https://mededu.jmir.org/2022/2/e34791", url="http://www.ncbi.nlm.nih.gov/pubmed/35767315" } @Article{info:doi/10.2196/34990, author="Landis-Lewis, Zach and Flynn, Allen and Janda, Allison and Shah, Nirav", title="A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="May", day="10", volume="11", number="5", pages="e34990", keywords="learning health system", keywords="audit and feedback", keywords="anesthesiology", keywords="knowledge-based system", keywords="human-centered design", abstract="Background: Health care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A\&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A\&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric's level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A\&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A\&F. From an informatics perspective, precision A\&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels. Objective: This study aims to implement and evaluate a demonstration system for precision A\&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium. Methods: We propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A\&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes. Results: The proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024. Conclusions: The proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective. International Registered Report Identifier (IRRID): PRR1-10.2196/34990 ", doi="10.2196/34990", url="https://www.researchprotocols.org/2022/5/e34990", url="http://www.ncbi.nlm.nih.gov/pubmed/35536637" } @Article{info:doi/10.2196/34522, author="Kunkes, Taylor and Makled, Basiel and Norfleet, Jack and Schwaitzberg, Steven and Cavuoto, Lora", title="Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis", journal="JMIR Perioper Med", year="2022", month="Apr", day="21", volume="5", number="1", pages="e34522", keywords="knowledge elicitation", keywords="knowledge acquisition", keywords="medical simulation", keywords="medical training", keywords="medical assessment", keywords="critical care", keywords="cognitive task analysis", keywords="qualitative methods", keywords="qualitative", keywords="endotracheal intubation", keywords="preoperative", keywords="training", keywords="health care professional", keywords="medical education", keywords="cognitive skill", abstract="Background: Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. Objective: This study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties. Methods: A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task. Results: The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment. Conclusions: Although the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices. ", doi="10.2196/34522", url="https://periop.jmir.org/2022/1/e34522", url="http://www.ncbi.nlm.nih.gov/pubmed/35451970" } @Article{info:doi/10.2196/33592, author="Gibney, Ryan and Cantwell, Christina and Wray, Alisa and Boysen-Osborn, Megan and Wiechmann, Warren and Saadat, Soheil and Smart, Jonathan and Toohey, Shannon", title="Influence of Factors Relating to Sex and Gender on Rank List Decisions and Perceptions of Residency Training: Survey Study", journal="JMIR Med Educ", year="2022", month="Apr", day="5", volume="8", number="2", pages="e33592", keywords="residency", keywords="sex", keywords="gender", keywords="graduate medical education", keywords="emergency medicine", keywords="residents", keywords="program leadership", keywords="rank list", abstract="Background: Females make up more than half of medical school matriculants but only one-third of emergency medicine (EM) residents. Various factors may contribute to why fewer females choose the field of EM, such as the existing presence of females in the specialty. Objective: This study is a follow-up to previous work, and a survey is used to assess current residents' attitudes and perceptions on various factors, including those relating to sex and gender on creating rank lists as medical students and in perceived effects on residency education. Methods: A web-based survey consisting of Likert scale questions regarding a variety of factors influencing a student's decision to create a rank list and in perceived effects on residency education was sent to current EM residents in 2020. Results: Residents from 17 programs participated in the survey with an 18.2\% (138/758) response rate. The most important factors in creating a rank list were the personality of residents in the program, location, and facility type. For factors specifically related to gender, respondents who answered affirmatively to whether the gender composition of residents affected the selection of a program in making a rank list were more likely to also answer affirmatively to subsequent questions related to the gender of program leadership (P<.001) and gender composition of attending physicians (P<.001). The personality of residents was also the most important factor perceived to affect residency education. For factors influencing rank list and residency education, female respondents placed higher importance on subcategories related to gender (ie, gender composition of the residents, of the program leadership, and of the attending physicians) to a significant degree compared with their male counterparts. Conclusions: Although factors such as location and resident personality show the most importance in influencing residency selection, when stratifying based on respondent sex, females tend to indicate that factors relating to gender have more influence on rank list and residency education compared with males. ", doi="10.2196/33592", url="https://mededu.jmir.org/2022/2/e33592", url="http://www.ncbi.nlm.nih.gov/pubmed/35380547" } @Article{info:doi/10.2196/33630, author="Sanavro, M. Sanne and van der Worp, Henk and Jansen, Danielle and Koning, Paul and Blanker, H. Marco and ", title="Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study", journal="JMIR Hum Factors", year="2022", month="Apr", day="1", volume="9", number="2", pages="e33630", keywords="primary care", keywords="digital consultation", keywords="interdisciplinary", keywords="specialist care", abstract="Background: Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective: This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods: We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results: In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions: Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking. ", doi="10.2196/33630", url="https://humanfactors.jmir.org/2022/2/e33630", url="http://www.ncbi.nlm.nih.gov/pubmed/35363155" } @Article{info:doi/10.2196/31080, author="Nozari, Ala and Mukerji, Shivali and Lok, Ling-Ling and Gu, Qingrou and Buhl, Lauren and Jain, Sanjay and Ortega, Rafael", title="Perception of Web-Based Didactic Activities During the COVID-19 Pandemic Among Anesthesia Residents: Pilot Questionnaire Study", journal="JMIR Med Educ", year="2022", month="Mar", day="31", volume="8", number="1", pages="e31080", keywords="resident education", keywords="COVID-19", keywords="barriers to education", keywords="didactic", keywords="medical education", keywords="online education", keywords="web-based education", keywords="virtual training", keywords="anesthesiology residents", keywords="medical residents", keywords="pandemic", keywords="virtual didactics", abstract="Background: Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. Objective: In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineate the perceived barriers to the successful implementation of web-based medical education. Methods: A 19-item survey was compiled and distributed electronically using Qualtrics. This anonymous survey included information on the training level of each resident, their participation in formal didactics before and during the pandemic, and their perception of the ease and limitations of virtual didactics. The resident's opinions on specific educational resources were assessed, and the effectiveness of new delivery methods on resident engagement and learning was examined. Results: Thirty anesthesiology residents were surveyed, 19 of whom agreed to participate in the pilot study. One participant with incomplete responses was excluded, yielding a final cohort of 18 respondents. Most residents (56\%, 10/18) reported that the COVID-19 pandemic negatively affected their residency training. The time spent on didactic training and independent studies was, nevertheless, not affected by the pandemic for 90\% (16/18) of respondents. Nonetheless, 72\% (13/18) of residents were less engaged during virtual lectures in comparison to in-person didactics. Important limitations included distraction from the physical environment (67\%, 12/18), internet instability (67\%, 12/18), less obligation to participate (44\%, 8/18), technical difficulty and unmuted microphones (33\%, 6/18, each), and people speaking over each other (28\%, 5/18). Despite these limitations, most residents stated that they would like to keep a combination of virtual didactics including live Zoom lectures (56\%, 10/18), prerecorded web didactics (56\%, 10/18), and virtual ground rounds via Zoom (50\%, 9/18) as the ``new normal.'' Conclusions: Despite important limitations listed in this report, anesthesia residents would like to keep a combination of virtual lectures and presentations as the new normal after the COVID-19 pandemic. ", doi="10.2196/31080", url="https://mededu.jmir.org/2022/1/e31080", url="http://www.ncbi.nlm.nih.gov/pubmed/35275840" } @Article{info:doi/10.2196/35199, author="Tamblyn, Robert and Brieva, Jorge and Cain, Madeleine and Martinez, Eduardo F.", title="The Effects of Introducing a Mobile App--Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="7", volume="9", number="1", pages="e35199", keywords="logbook", keywords="education", keywords="training", keywords="central venous catheter", keywords="CVC", keywords="intensive care", keywords="smartphone", keywords="mobile phone", keywords="mobile apps", keywords="mHealth", keywords="mobile health", keywords="accreditation program", keywords="digital health", keywords="digital record", abstract="Background: To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU). Objective: The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook. Methods: This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients' electronic medical records appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor's signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. Results: Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72\%) were included and separated into cohorts before and after the app's introduction. Following the introduction of the app-based logbook, the percentage of CVC insertions appearing as logbook entries increased from 3.6\% (38/1059) to 20.5\% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor's signature before and after the introduction of the app, with 76.3\% (29/38) and 83.2\% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3\% (13/85) to 62.8\% (54/86; P<.001). Adherence to one's logbook was similar in both groups with 60\% (6/10) of first-time users in the before group and 79.5\% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU. Conclusions: The addition of an electronic app-based logbook to a preexisting paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook use observed without a reduction in the quality of logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted. ", doi="10.2196/35199", url="https://humanfactors.jmir.org/2022/1/e35199", url="http://www.ncbi.nlm.nih.gov/pubmed/35051900" } @Article{info:doi/10.2196/30456, author="Sadeghi, H. Amir and Peek, J. Jette and Max, A. Samuel and Smit, L. Liselot and Martina, G. Bryan and Rosalia, A. Rodney and Bakhuis, Wouter and Bogers, JJC Ad and Mahtab, AF Edris", title="Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study", journal="JMIR Serious Games", year="2022", month="Mar", day="2", volume="10", number="1", pages="e30456", keywords="cardiac surgery", keywords="cardiopulmonary resuscitation", keywords="emergency resternotomy", keywords="virtual reality", keywords="simulation training", keywords="serious games", keywords="virtual reality simulation", keywords="digital health", keywords="medical training", keywords="virtual training", abstract="Background: Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim. Objective: We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery. Methods: Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator's usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. Results: Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87\%) felt actively involved in the simulation, and 23 (77\%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80\%) and thought that the software responded adequately (n=21, 70\%). All 15 (100\%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87\%) of the expert participants would recommend VR training to other colleagues, and 14 (93\%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post--cardiac surgery emergencies requiring CPR. Additionally, 10 (91\%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario. Conclusions: We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform. ", doi="10.2196/30456", url="https://games.jmir.org/2022/1/e30456", url="http://www.ncbi.nlm.nih.gov/pubmed/35234652" } @Article{info:doi/10.2196/28644, author="Zombre, David and Kortenaar, Jean-Luc and Zareef, Farhana and Doumbia, Moussa and Doumbia, Sekou and Haidara, Fadima and McLaughlin, Katie and Sow, Samba and Bhutta, A. Zulfiqar and Bassani, G. Diego", title="Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="10", volume="10", number="12", pages="e28644", keywords="perinatal mortality", keywords="low dose high frequency training", keywords="maternal and newborn health outcomes", keywords="Mali", abstract="Background: Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. Objective: This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality. Methods: The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. Results: The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol. Conclusions: The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237 International Registered Report Identifier (IRRID): DERR1-10.2196/28644 ", doi="10.2196/28644", url="https://www.researchprotocols.org/2021/12/e28644", url="http://www.ncbi.nlm.nih.gov/pubmed/34889776" } @Article{info:doi/10.2196/28623, author="Wu, Andrew and Radhakrishnan, Varsha and Targan, Elizabeth and Scarella, M. Timothy and Torous, John and Hill, P. Kevin", title="Self-Reported Preferences for Help-Seeking and Barriers to Using Mental Health Supports Among Internal Medicine Residents: Exploratory Use of an Econometric Best-Worst Scaling Framework for Gathering Physician Wellness Preferences", journal="JMIR Med Educ", year="2021", month="Oct", day="6", volume="7", number="4", pages="e28623", keywords="residency program", keywords="choice", keywords="burnout", keywords="wellness", abstract="Background: Burnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions. Objective: This study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers. Methods: Internal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options. Results: Of the 163 invited residents, 77 (47.2\% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71\%; worst: 0.6\%) and support from friends and family (best: 70\%; worst: 1.6\%). Top-ranking barriers to seeking counseling included time (best: 75\%; worst: 5\%) and money (best: 35\%; worst: 21\%). Conclusions: Overall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework. ", doi="10.2196/28623", url="https://mededu.jmir.org/2021/4/e28623", url="http://www.ncbi.nlm.nih.gov/pubmed/34612838" } @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/10.2196/29486, author="Naaseh, Ariana and Thompson, Sean and Tohmasi, Steven and Wiechmann, Warren and Toohey, Shannon and Wray, Alisa and Boysen-Osborn, Megan", title="Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study", journal="JMIR Med Educ", year="2021", month="Oct", day="5", volume="7", number="4", pages="e29486", keywords="residency application", keywords="social media", keywords="medical education", keywords="resident", keywords="medical student", keywords="perspective", keywords="residency recruitment", keywords="virtual application", keywords="virtual residency", abstract="Background: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media--based communication and dissemination of information. Objective: We sought to determine social media's impact on residency applicants during an entirely virtual application cycle. Methods: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. Results: A total of 72 participants (15.5\% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53\% (n=38) reported following prospective residency accounts on social media, and 89\% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53\% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26\%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74\%) increasing the number of programs to which they applied. Survey respondents ranked social media's effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86\%) felt that programs should use social media in future application cycles even if they are nonvirtual. Conclusions: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match. ", doi="10.2196/29486", url="https://mededu.jmir.org/2021/4/e29486", url="http://www.ncbi.nlm.nih.gov/pubmed/34591779" } @Article{info:doi/10.2196/31212, author="Rebelo, Artur and Ukkat, J{\"o}rg and Klose, Johannes and Ronellenfitsch, Ulrich and Kleeff, J{\"o}rg", title="Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis", journal="JMIR Res Protoc", year="2021", month="Oct", day="5", volume="10", number="10", pages="e31212", keywords="meta-analysis", keywords="cholangiocarcinoma", keywords="arterial resection", keywords="surgery", keywords="vascular resections", keywords="cardiology", keywords="outcomes", keywords="mortality", keywords="morbidity", keywords="perioperative", keywords="cancer", keywords="tumor", keywords="liver", keywords="liver cancer", abstract="Background: In light of recent advances in multimodality treatment, an analysis of vascular resection outcomes in surgery for hilar cholangiocarcinoma is lacking. Objective: The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma. Methods: A systematic literature search in the databases PubMed/MEDLINE, Cochrane Library, and CINAHL, and the trial registries ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform will be carried out. Predefined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication), vascular complications (thrombosis or stenosis of the portal vein or hepatic artery, pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3-, and 5-year survival), complete/incomplete resection rates, histologic arterial invasion, and lymph node positivity (number of positive lymph nodes and lymph node ratio). Results: Database searches will commence in December 2020. The meta-analysis will be completed by December 2021. Conclusions: Our findings will enable us to present the current evidence on the feasibility, safety, and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. Our data will support health care professionals and patients in their clinical decision-making. Trial Registration: PROSPERO 223396; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=223396 International Registered Report Identifier (IRRID): DERR1-10.2196/31212 ", doi="10.2196/31212", url="https://www.researchprotocols.org/2021/10/e31212", url="http://www.ncbi.nlm.nih.gov/pubmed/34609321" } @Article{info:doi/10.2196/27544, author="Mok, Tsz-Ngai and Chen, Junyuan and Pan, Jinghua and Ming, Wai-Kit and He, Qiyu and Sin, Tat-Hang and Deng, Jialin and Li, Jieruo and Zha, Zhengang", title="Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial", journal="JMIR Serious Games", year="2021", month="Jul", day="12", volume="9", number="3", pages="e27544", keywords="virtual reality simulators", keywords="tendon suture", keywords="medical education", abstract="Background: Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective: The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods: In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the ``Kessler tendon repair with 2 interrupted tendon repair knots'' (KS) method and the ``Bunnell tendon repair with figure 8 tendon repair'' (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results: Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions: Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180 ", doi="10.2196/27544", url="https://games.jmir.org/2021/3/e27544", url="http://www.ncbi.nlm.nih.gov/pubmed/34255649" } @Article{info:doi/10.2196/24644, author="Thompson, Daniel", title="Utilization of the iOS Shortcuts App to Generate a Surgical Logbook Tool: Feasibility Study", journal="JMIR Perioper Med", year="2021", month="May", day="13", volume="4", number="1", pages="e24644", keywords="app", keywords="audit", keywords="data collection", keywords="data", keywords="feasibility", keywords="medical education", keywords="mHealth", keywords="surgery", keywords="surgical audit", keywords="surgical education", keywords="utility", abstract="Background: Surgical audit is an essential aspect of modern reflective surgical practice and is key to improving surgical outcomes. The surgical logbook is an important method of data collection for both personal and unit audits; however, current electronic data collection tools, especially mobile apps, lack the minimum recommended data fields. Objective: This feasibility study details the creation of a free, effective surgical logbook tool with the iOS Shortcuts app and investigates the time investment required to maintain a surgical logbook with this tool. In addition, we investigate the potential utility of the Shortcuts app in creating medical data collection tools. Methods: Using the iOS Shortcuts app, we created a shortcut ``Operation Note,'' which collects surgical logbook data by using the minimum and extended audit data sets recommended by the Royal Australasian College of Surgeons. We practically assessed the feasibility of the tool, assessing the time requirement for entry, accuracy, and completeness of the entered data. Results: The shortcut collected accurate and useful data for a surgical audit. Data entry took on average 65 seconds per case for the minimum data set, and 135 seconds per case for the extended data set, with a mean difference of 68 seconds (P<.001; 95\% CI 61.6-77.7). Conclusions: This feasibility study demonstrates the utility of the iOS Shortcuts app in the creation of a surgical logbook and the time-consuming nature of data collection for surgical audit. Our iOS Operation Note shortcut is a free, rapid, and customizable alternative to currently available logbook apps and offers surgical trainees and consultants a method for recording surgical operations, complications, and demographic data. ", doi="10.2196/24644", url="https://periop.jmir.org/2021/1/e24644", url="http://www.ncbi.nlm.nih.gov/pubmed/33983132" } @Article{info:doi/10.2196/25606, author="Haq, Ul Irfan and Hameed, Ali Mansoor and Thomas, Marry Merlin and Syed, Shahzada Khezar and Othman, Mahmoud Ahmad Mohammad and Ahmed, Shakeel and Alabbas, Abdallah Abbas and Ahmad, Mushtaq", title="Knowledge of Sleep Disorders Among Physicians at a Tertiary Care Hospital in Qatar: Cross-sectional Study", journal="Interact J Med Res", year="2021", month="May", day="12", volume="10", number="2", pages="e25606", keywords="sleep disordered breathing", keywords="obstructive sleep apnea", keywords="sleep", keywords="physician", keywords="physician knowledge", keywords="sleep disorder", keywords="survey method", keywords="attitudes", keywords="practice", abstract="Background: Sleep disorders constitute a major health problem because of their relatively high and rising prevalence. Several studies worldwide have analyzed health care providers' knowledge of sleep disorders. Objective: In this study, we aimed to assess the knowledge of sleep disorders among physicians in Qatar. Methods: A total of 250 physicians were surveyed regarding their knowledge of sleep medicine by using the validated 30-item Assessment of Sleep Knowledge in Medical Education (ASKME) Survey. The participants included residents, fellows, and consultants in medicine and allied subspecialties. A high score was defined as ?60\% of correctly answered questions, implying the respondent has adequate knowledge of sleep disorders. Results: Responses were received from 158 of the 250 physicians, with a response rate of 63.2\%. This included responses from 34 residents, 74 clinical fellows, and 50 consultants. The overall mean score was 15.53 (SD 4.42), with the highest possible score of 30. Only 57 of 158 (36.1\%) respondents were able to answer ?60\% of the questions correctly. No statistically significant difference was found in the scores of participants with regard to their ranks (ie, residents, fellows, or consultants) or years of medical training. Conclusions: This study demonstrates that health care providers in Qatar have decreased awareness and knowledge about sleep medicine, which may reflect reduced emphasis on sleep disorders during medical school and training. Increasing awareness regarding sleep medicine among nonspecialist physicians will allow early detection and treatment of sleep disorders, thereby reducing the morbidity associated with these disorders. ", doi="10.2196/25606", url="https://www.i-jmr.org/2021/2/e25606", url="http://www.ncbi.nlm.nih.gov/pubmed/33978594" } @Article{info:doi/10.2196/25213, author="Rivera, Ronald and Smart, Jonathan and Sakaria, Sangeeta and Wray, Alisa and Wiechmann, Warren and Boysen-Osborn, Megan and Toohey, Shannon", title="Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era", journal="JMIR Med Educ", year="2021", month="May", day="11", volume="7", number="2", pages="e25213", keywords="distance education", keywords="videoconferencing", keywords="emergency medicine", keywords="teaching", keywords="learning", keywords="web-based lecture", keywords="medical education", keywords="technology", keywords="SARS-CoV-2", keywords="COVID-19", doi="10.2196/25213", url="https://mededu.jmir.org/2021/2/e25213", url="http://www.ncbi.nlm.nih.gov/pubmed/33872191" } @Article{info:doi/10.2196/17237, author="Poole, Jane Grace Olivia and Melamed, Naomi and Hubbard, Ella", title="Addressing Disciplinary Misconceptions: Mentorship Programs and Student-Led Surgical Societies. Comment on ``Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study''", journal="Interact J Med Res", year="2021", month="Mar", day="4", volume="10", number="1", pages="e17237", keywords="medical education", keywords="plastic surgery", keywords="students", doi="10.2196/17237", url="https://www.i-jmr.org/2021/1/e17237", url="http://www.ncbi.nlm.nih.gov/pubmed/33661131" } @Article{info:doi/10.2196/22045, author="Hamidian Jahromi, Alireza and Arnautovic, Alisa and Konofaos, Petros", title="Impact of the COVID-19 Pandemic on the Education of Plastic Surgery Trainees in the United States", journal="JMIR Med Educ", year="2020", month="Nov", day="17", volume="6", number="2", pages="e22045", keywords="COVID-19", keywords="coronavirus", keywords="education", keywords="plastic surgery residency", keywords="plastic surgery fellowship", keywords="surgery residency", keywords="impact", keywords="trainee", doi="10.2196/22045", url="http://mededu.jmir.org/2020/2/e22045/", url="http://www.ncbi.nlm.nih.gov/pubmed/33119537" } @Article{info:doi/10.2196/15762, author="Hejjaji, Vittal and Malik, O. Ali and Peri-Okonny, A. Poghni and Thomas, Merrill and Tang, Yuanyuan and Wooldridge, David and Spertus, A. John and Chan, S. Paul", title="Mobile App to Improve House Officers' Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="19", volume="8", number="5", pages="e15762", keywords="cardiac arrest", keywords="advanced cardiac life support", keywords="mHealth", keywords="quality improvement", keywords="medical education", abstract="Background: Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective: The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers' adherence to ACLS guidelines. Methods: As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results: Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95\% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference --0.7 [95\% CI --0.3 to --1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9\% vs 89.0\%; absolute difference 1.9\% [95\% CI 0.6\% to 3.4\%]; P=.007). Conclusions: This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown. ", doi="10.2196/15762", url="https://mhealth.jmir.org/2020/5/e15762", url="http://www.ncbi.nlm.nih.gov/pubmed/32427115" } @Article{info:doi/10.2196/17222, author="IJgosse, Wouter and van Goor, Harry and Rosman, Camiel and Luursema, Jan-Maarten", title="Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study", journal="JMIR Serious Games", year="2020", month="May", day="7", volume="8", number="2", pages="e17222", keywords="laparoscopy", keywords="surgery", keywords="training", keywords="education", keywords="serious game", keywords="resident training", keywords="skills development", keywords="psychomotor skills", keywords="simulation center", abstract="Background: Surgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents' motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training. Objective: The aim of this study was to establish construct validity for the laparoscopic serious game Underground. Methods: All study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience. Results: Controlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable. Conclusions: We established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed. ", doi="10.2196/17222", url="http://games.jmir.org/2020/2/e17222/", url="http://www.ncbi.nlm.nih.gov/pubmed/32379051" } @Article{info:doi/10.2196/14666, author="Abduljabbar, H. Ahmed and Alnajjar, F. Sara and Alshamrani, Hussein and Bashamakh, F. Lujain and Alshehri, Z. Hisham and Alqulayti, M. Waleed and Wazzan, A. Mohammad", title="The Influence of Gender on the Choice of Radiology as a Specialty Among Medical Students in Saudi Arabia: Cross-Sectional Study", journal="Interact J Med Res", year="2020", month="Apr", day="28", volume="9", number="2", pages="e14666", keywords="gender", keywords="radiology", keywords="specialty choice", abstract="Background: Medical undergraduates are the future doctors of the country. Therefore, determining how medical students choose their areas of specialty is essential to obtain a balanced distribution of physicians among all specialties. Although gender is a significant factor that affects specialty choice, the factors underlying gender differences in radiology are not fully elucidated. Objective: This study examined the factors that attracted medical students to and discouraged them from selecting diagnostic radiology and analyzed whether these factors differed between female and male medical students. Methods: This cross-sectional study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, used an electronic questionnaire sent to medical students from all medical years during February 2018. Subgroup analyses for gender and radiology interest were performed using the chi-square test and Cram{\'e}r's V test. Results: In total, 539 students (276 women; 263 men) responded. The most common factor preventing students from choosing radiology as a career was the lack of direct patient contact, which deterred approximately 47\% who decided against considering this specialty. Negative perceptions by other physicians (P<.001), lack of acknowledgment by patients (P=.004), and lack of structured radiology rotations (P=.007) dissuaded significantly more male students than female students. Among those interested in radiology, more female students were attracted by job flexibility (P=.01), while more male students were attracted by focused patient interactions with minimal paperwork (P<.001). Conclusions: No significant difference was found between the genders in terms of considering radiology as a specialty. Misconception plays a central role in students' judgment regarding radiology. Hence, early exposure to radiology, assuming a new teaching method, and using a curriculum that supports the active participation of students in a radiology rotation are needed to overcome this misconception. ", doi="10.2196/14666", url="http://www.i-jmr.org/2020/2/e14666/", url="http://www.ncbi.nlm.nih.gov/pubmed/32141832" } @Article{info:doi/10.2196/16233, author="Li, Shuang and Li, Guoqing and Liu, Ying and Xu, Wanying and Yang, Ningning and Chen, Haoyuan and Li, Ning and Luo, Kunpeng and Jin, Shizhu", title="Development and Assessment of a Gastroscopy Electronic Learning System for Primary Learners: Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Mar", day="23", volume="22", number="3", pages="e16233", keywords="e-learning", keywords="gastroscopy", keywords="endoscopy", keywords="randomized controlled trial", abstract="Background: Endoscopic examination is a popular and routine procedure for the diagnosis and treatment of gastrointestinal (GI) diseases. Skilled endoscopists are in great demand in clinical practice, but the training process for beginners to become endoscopy specialists is fairly long. Convenience and a self-paced, learner-centered approach make electronic learning (e-learning) an excellent instructional prospect. Objective: This study aimed to develop and apply an e-learning system in gastroscopy teaching and learning and to evaluate its effectiveness and user satisfaction. Methods: The e-learning software Gastroscope Roaming System was developed for primary learners. The system simulates the real structure of the upper gastrointestinal (UGI) tract to teach the main characteristics of gastroscopy under both normal conditions and conditions of common UGI tract diseases. A randomized controlled trial was conducted. Participants were randomly allocated to an e-learning group (EG)or a non--e-learning control group after a pretest. On completing the training, participants undertook a posttest and gastroscopy examination. In addition, the EG completed a satisfaction questionnaire. Results: Of the 44 volunteers, 41 (93\%) completed the gastroscopy learning and testing components. No significant pretest differences were found between the intervention and control groups (mean 50.86, SD 6.12 vs mean 50.76, SD 6.88; P=.96). After 1 month of learning, the EG's posttest scores were higher (mean 83.70, SD 5.99 vs mean 78.76, SD 7.58; P=.03) and improved more (P=.01) than those of the control group, with better performance in the gastroscopy examination (mean 91.05, SD 4.58 vs mean 84.38, SD 5.19; P<.001). Overall, 85\% (17/20) of the participants were satisfied with the e-learning system, and 95\% (19/20) of the participants considered it successful. Conclusions: E-learning is an effective educational strategy for primary learners to acquire skills in gastroscopy examination and endoscopic imaging of the GI tract. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17013091; http://www.chictr.org.cn/showproj.aspx?proj=22142 ", doi="10.2196/16233", url="http://www.jmir.org/2020/3/e16233/", url="http://www.ncbi.nlm.nih.gov/pubmed/32202507" } @Article{info:doi/10.2196/17425, author="Katz, Daniel and Shah, Ronak and Kim, Elizabeth and Park, Chang and Shah, Anjan and Levine, Adam and Burnett, Garrett", title="Utilization of a Voice-Based Virtual Reality Advanced Cardiac Life Support Team Leader Refresher: Prospective Observational Study", journal="J Med Internet Res", year="2020", month="Mar", day="12", volume="22", number="3", pages="e17425", keywords="video game", keywords="experimental game", keywords="virtual reality", keywords="advanced cardiac life support", abstract="Background: The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of training are expensive, time consuming, and difficult to scale, which necessitates improvements in advanced cardiac life support (ACLS) training. Virtual reality (VR) has been proposed as an alternative or adjunct to high-fidelity simulation (HFS) in several environments. No evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills and demonstrate a cost comparison. Objective: This study aimed to explore the utility of a voice-based VR ACLS team leader refresher as compared with HFS. Methods: This prospective observational study performed at an academic institution consisted of 25 postgraduate year 2 residents. Participants were randomized to HFS or VR training and then crossed groups after a 2-week washout. Participants were graded on technical and nontechnical skills. Participants also completed self-assessments about the modules. Proctors were assessed for fatigue and task saturation, and cost analysis based on local economic data was performed. Results: A total of 23 of 25 participants were included in the scoring analysis. Fewer participants were familiar with VR compared with HFS (9/25, 36\% vs 25/25, 100\%; P<.001). Self-reported satisfaction and utilization scores were similar; however, significantly more participants felt HFS provided better feedback: 99 (IQR 89-100) vs 79 (IQR 71-88); P<.001. Technical scores were higher in the HFS group; however, nontechnical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 (IQR 19-24) min shorter than HFS sessions, the National Aeronautics and Space Administration task load index scores for proctors were lower in each category, and VR sessions were estimated to be US \$103.68 less expensive in a single-learner, single-session model. Conclusions: Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction. The VR module was more cost-effective and was easier to proctor; however, HFS was better at delivering feedback to participants. Optimal education strategies likely contain elements of both modalities. Further studies are needed to examine the utility of VR-based environments at scale. ", doi="10.2196/17425", url="http://www.jmir.org/2020/3/e17425/", url="http://www.ncbi.nlm.nih.gov/pubmed/32163038" } @Article{info:doi/10.2196/15349, author="Garc{\'i}a-Carbajal, Santiago and Pipa-Muniz, Mar{\'i}a and M{\'u}gica, Luis Jose", title="Using String Metrics to Improve the Design of Virtual Conversational Characters: Behavior Simulator Development Study", journal="JMIR Serious Games", year="2020", month="Feb", day="27", volume="8", number="1", pages="e15349", keywords="spoken interaction", keywords="string metrics", keywords="virtual conversational characters", keywords="serious games", keywords="e-learning", abstract="Background: An emergency waiting room is a place where conflicts often arise. Nervous relatives in a hostile, unknown environment force security and medical staff to be ready to deal with some awkward situations. Additionally, it has been said that the medical interview is the first diagnostic and therapeutic tool, involving both intellectual and emotional skills on the part of the doctor. At the same time, it seems that there is something mysterious about interviewing that cannot be formalized or taught. In this context, virtual conversational characters (VCCs) are progressively present in most e-learning environments. Objective: In this study, we propose and develop a modular architecture for a VCC-based behavior simulator to be used as a tool for conflict avoidance training. Our behavior simulators are now being used in hospital environments, where training exercises must be easily designed and tested. Methods: We define training exercises as labeled, directed graphs that help an instructor in the design of complex training situations. In order to increase the perception of talking to a real person, the simulator must deal with a huge number of sentences that a VCC must understand and react to. These sentences are grouped into sets identified with a common label. Labels are then used to trigger changes in the active node of the graph that encodes the current state of the training exercise. As a consequence, we need to be able to map every sentence said by the human user into the set it belongs to, in a fast and robust way. In this work, we discuss two different existing string metrics, and compare them to one that we use to assess a designed exercise. Results: Based on the similarities found between different sets, the proposed metric provided valuable information about ill-defined exercises. We also described the environment in which our programs are being used and illustrated it with an example. Conclusions: Initially designed as a tool for training emergency room staff, our software could be of use in many other areas within the same environment. We are currently exploring the possibility of using it in speech therapy situations. ", doi="10.2196/15349", url="http://games.jmir.org/2020/1/e15349/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130121" } @Article{info:doi/10.2196/15748, author="Sapci, Hasan A. and Sapci, Aylin H.", title="Teaching Hands-On Informatics Skills to Future Health Informaticians: A Competency Framework Proposal and Analysis of Health Care Informatics Curricula", journal="JMIR Med Inform", year="2020", month="Jan", day="21", volume="8", number="1", pages="e15748", keywords="health informatics curriculum", keywords="skill-based training", keywords="hands-on health informatics training", abstract="Background: Existing health informatics curriculum requirements mostly use a competency-based approach rather than a skill-based one. Objective: The main objective of this study was to assess the current skills training requirements in graduate health informatics curricula to evaluate graduate students' confidence in specific health informatics skills. Methods: A quantitative cross-sectional observational study was developed to evaluate published health informatics curriculum requirements and to determine the comprehensive health informatics skill sets required in a research university in New York, United States. In addition, a questionnaire to assess students' confidence about specific health informatics skills was developed and sent to all enrolled and graduated Master of Science students in a health informatics program. Results: The evaluation was performed in a graduate health informatics program, and analysis of the students' self-assessments questionnaire showed that 79.4\% (81/102) of participants were not confident (not at all confident or slightly confident) about developing an artificial intelligence app, 58.8\% (60/102) were not confident about designing and developing databases, and 54.9\% (56/102) were not confident about evaluating privacy and security infrastructure. Less than one-third of students (24/105, 23.5\%) were confident (extremely confident and very confident) that they could evaluate the use of data capture technologies and develop mobile health informatics apps (10/102, 9.8\%). Conclusions: Health informatics programs should consider specialized tracks that include specific skills to meet the complex health care delivery and market demand, and specific training components should be defined for different specialties. There is a need to determine new competencies and skill sets that promote inductive and deductive reasoning from diverse and various data platforms and to develop a comprehensive curriculum framework for health informatics skills training. ", doi="10.2196/15748", url="http://medinform.jmir.org/2020/1/e15748/", url="http://www.ncbi.nlm.nih.gov/pubmed/31961328" } @Article{info:doi/10.2196/12999, author="Mortada, Hisham Hatan and Alqahtani, Aayed Yara and Seraj, Zakaria Hadeel and Albishi, Khalid Wahbi and Aljaaly, A. Hattan", title="Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study", journal="Interact J Med Res", year="2019", month="Apr", day="03", volume="8", number="2", pages="e12999", keywords="plastic surgery", keywords="perception", keywords="knowledge", keywords="medical students", keywords="media", keywords="King Abdulaziz University", keywords="Jeddah", keywords="Saudi Arabia", abstract="Background: Although plastic surgery has been gaining a lot of popularity recently, there seems to be limited perception and a poor understanding of this field by both medical professionals, including medical students, and the general public. This might alter referral patterns as well as medical students' choice to pursue a career in plastic surgery. Objective: The purpose of this study was to assess knowledge and perception of plastic surgery among medical students and to explore the influencing factors underlying particular beliefs. Methods: Data for this cross-sectional study were collected between August 22 and December 22, 2017. The questionnaire was formulated on the basis of our own study objectives and from available questionnaires with similar objectives. It was composed of 14 questions divided into three main parts: demographics, the specialty of plastic surgery, and media involvement and its effect on plastic surgery. The study was conducted via an online questionnaire among medical students in all years at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20. Results: A total of 886 medical students participated in this study. We achieved a response rate of 56.79\%. The mean age of the participants was 21.2 years. The mean awareness score was 9.7 (SD 4.2) for female students and 8.3 (SD 4.2) for male students (P<.001). The condition most commonly known to be treated by a plastic surgeon was burns (70.3\% of responses). Conclusions: Medical students do not have adequate awareness of plastic surgery, and early exposure to this specialty may enhance their awareness. ", doi="10.2196/12999", url="http://www.i-jmr.org/2019/2/e12999/", url="http://www.ncbi.nlm.nih.gov/pubmed/30942694" } @Article{info:doi/10.2196/mededu.8904, author="Nandiwada, Rani Deepa and Fischer, S. Gary and Updike, Glenn and Conroy, B. Margaret", title="Resident and Attending Physicians' Perceptions of Patient Access to Provider Notes: Comparison of Perceptions Prior to Pilot Implementation", journal="JMIR Med Educ", year="2018", month="Jun", day="15", volume="4", number="1", pages="e15", keywords="access to information", keywords="electronic health records", keywords="physicians", keywords="internal medicine", keywords="surveys and questionnaires", abstract="Background: As electronic health records have become a more integral part of a physician's daily life, new electronic health record tools will continue to be rolled out to trainees. Patient access to provider notes is becoming a more widespread practice because this has been shown to increase patient empowerment. Objective: In this analysis, we compared differences between resident and attending physicians' perceptions prior to implementation of patient access to provider notes to facilitate optimal use of electronic health record features and as a potential for patient empowerment. Methods: This was a single-site study within an academic internal medicine program. Prior to implementation of patient access to provider notes, we surveyed resident and attending physicians to assess differences in perceptions of this new electronic health record tool using an open access survey provided by OpenNotes. Results: We surveyed 37\% (20/54 total) of resident physicians and obtained a 100\% response rate and 72\% (31/44 total) of attending physicians. Similarities between the groups included concerns about documenting sensitive topics and anticipation of improved patient engagement. Compared with attending physicians, resident physicians were more concerned about litigation, discussing weight, offending patients, and communicated less overall with patients through electronic health record. Conclusions: Patient access to provider notes has the potential to empower patients but concerns of the resident physicians need to be validated and addressed prior to its utilization. ", doi="10.2196/mededu.8904", url="http://mededu.jmir.org/2018/1/e15/", url="http://www.ncbi.nlm.nih.gov/pubmed/29907558" } @Article{info:doi/10.2196/mededu.9635, author="Khan, Zubair and Darr, Umar and Khan, Ali Muhammad and Nawras, Mohamad and Khalil, Basmah and Abdel-Aziz, Yousef and Alastal, Yaseen and Barnett, William and Sodeman, Thomas and Nawras, Ali", title="Improving Internal Medicine Residents' Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study", journal="JMIR Med Educ", year="2018", month="Mar", day="13", volume="4", number="1", pages="e10", keywords="colorectal cancer", keywords="cancer screening", keywords="early detection of cancer", keywords="residents' education", keywords="smartphone", keywords="mobile apps", abstract="Background: Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective: The objective of our study was to assess the improvement in internal medicine residents' CRC screening knowledge via a pilot approach using a smartphone app. Methods: We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents' knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. Results: A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. Conclusions: In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents' knowledge about CRC screening. ", doi="10.2196/mededu.9635", url="http://mededu.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29535080" } @Article{info:doi/10.2196/mededu.9185, author="Vaysse, Charlotte and Chantalat, Elodie and Beyne-Rauzy, Odile and Morineau, Louise and Despas, Fabien and Bachaud, Jean-Marc and Caunes, Nathalie and Poublanc, Muriel and Serrano, Elie and Bugat, Roland and Roug{\'e} Bugat, Marie-Eve and Fize, Anne-Laure", title="The Impact of a Small Private Online Course as a New Approach to Teaching Oncology: Development and Evaluation", journal="JMIR Med Educ", year="2018", month="Mar", day="05", volume="4", number="1", pages="e6", keywords="oncology", keywords="health education", keywords="continuing education", keywords="e-learning", keywords="SPOC", keywords="small private online course", keywords="education, medical", keywords="education, medical, continuing", abstract="Background: Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. Objective: The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). Methods: A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants' satisfaction rate through a questionnaire and the success of the SPOC by participants' completion, success, and commitment rates. Results: Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients' associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7\% (90/446) had an independent medical practice, 38.5\% (140/446) worked in a public institution, and 36.8\% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9\% (384/446) thought they had learned new information, 90.8\% (405/446) felt their expectations were met, and 90.4\% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51\% (559/1574), the success rate was 71.47\% (1025/1574), and the commitment rate was 64.67\% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants. Conclusions: SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students' expectations. ", doi="10.2196/mededu.9185", url="http://mededu.jmir.org/2018/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/29506968" } @Article{info:doi/10.2196/mededu.4434, author="Bergl, A. Paul and Narang, Akhil and Arora, M. Vineet", title="Maintaining a Twitter Feed to Advance an Internal Medicine Residency Program's Educational Mission", journal="JMIR Medical Education", year="2015", month="Jul", day="10", volume="1", number="2", pages="e5", keywords="social media", keywords="medical education", keywords="Twitter messaging", keywords="Internet/ethics", abstract="Background: Residency programs face many challenges in educating learners. The millennial generation's learning preferences also force us to reconsider how to reach physicians in training. Social media is emerging as a viable tool for advancing curricula in graduate medical education. Objective: The authors sought to understand how social media enhances a residency program's educational mission. Methods: While chief residents in the 2013-2014 academic year, two of the authors (PB, AN) maintained a Twitter feed for their academic internal medicine residency program. Participants included the chief residents and categorical internal medicine house staff. Results: At the year's end, the authors surveyed residents about uses and attitudes toward this initiative. Residents generally found the chief residents' tweets informative, and most residents (42/61, 69\%) agreed that Twitter enhanced their overall education in residency. Conclusions: Data from this single-site intervention corroborate that Twitter can strengthen a residency program's educational mission. The program's robust following on Twitter outside of the home program also suggests a need for wider adoption of social media in graduate medical education. Improved use of data analytics and dissemination of these practices to other programs would lend additional insight into social media's role in improving residents' educational experiences. ", doi="10.2196/mededu.4434", url="http://mededu.jmir.org/2015/2/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731845" }