%0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e74282 %T Exploring Clinical Decision-Making Competencies of Emergency Nurses in Trauma Care in Indonesia: Qualitative Study %A Saharuddin,Saharuddin %A Nurachmah,Elly %A Masfuri,Masfuri %A Gayatri,Dewi %A Kimin,Amelia %A Sakti,Muhammad %A Saidi,Sanisah Binti %A Yona,Sri %K clinical decision-making %K emergency nursing %K trauma care %K Indonesia %K emergency nurse %D 2025 %7 25.6.2025 %9 %J Asian Pac Isl Nurs J %G English %X Background: Clinical decision-making is vital for emergency nurses, especially in trauma care that requires swift, accurate actions. In Indonesia, where resources are limited, little is known about how nurses manage such challenges. Objective: This study aimed to explore the clinical decision-making competencies of emergency nurses in trauma care, focusing on challenges, strategies, and influencing factors. Methods: This was a qualitative study using semi-structured interviews with 16 emergency nurses, complemented by observations and document analyses. Data were analyzed thematically, with triangulation, thereby ensuring validity. Results: Six key themes emerged: (1) recognize cues; (2) analyze cues; (3) prioritize hypothesis; (4) generate solutions; (5) take actions; and (6) evaluate outcomes. These highlight the adaptive and multidimensional nature of decision-making in emergencies. Conclusions: The decision-making of emergency nurses integrates analysis, prioritization, collaboration, and reflection. Enhanced training, such as simulation-based learning, and addressing systemic barriers can improve competencies. Policymakers should provide adequate resources and robust standards to support nurses under pressure. %R 10.2196/74282 %U https://apinj.jmir.org/2025/1/e74282 %U https://doi.org/10.2196/74282 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e74225 %T Functional Elements of Entrusted Professional Activities for Dental Educators: Protocol for a Scoping Review %A Abu Bakar,Noraini %A Roslan,Nurhanis Syazni %A Haq,Muhammad Ainul %A Mustafa Byrnes,Yasmin %A Yusoff,Muhamad Saiful Bahri %+ Department of Orthodontics, Kulliyyah of Dentistry, International Islamic University Malaysia, 25200 Indera Mahkota, Kuantan, Pahang 25200, Malaysia, 60 0127140094, nor_aini@iium.edu.my %K dental educators %K entrusted professional activities %K functional elements %K competency-based education %K faculty development %K assessment %K framework %D 2025 %7 25.6.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Assessing the competencies of health profession educators presents significant challenges, leading to the suggestion of implementing Entrustable Professional Activities (EPAs) as a potential solution. EPAs refer to the authority granted to individuals to perform tasks with a specified level of trust and competence. The concept of EPAs emerged from the complexities of competency-based medical education. This scoping review highlights the emerging yet underdeveloped field of EPAs for dental educators. Despite their established utility in medical education, the concept remains relatively novel for dental educators, with limited literature and inconsistent application across studies. Objective: This paper presents a scoping review protocol aimed at systematically elucidating the extent, range, and nature of the literature on EPAs for dental educators, as evaluated in the included resources. This review seeks to answer the following research question: what are the key functional elements of EPAs for dental educators as described in the existing literature? Methods: This scoping review will be conducted in accordance with the framework outlined by Arksey and O’Malley, enhanced by the Joanna Briggs Institute (JBI) guidelines. The literature search will use a 3-step strategy across 5 electronic databases (PubMed, Google Scholar, Scopus, Cochrane Library, and ProQuest), along with additional screening of gray literature. Primary data from relevant studies published from the introduction of EPAs in 2005 through 2024 will be analyzed. This review will include peer-reviewed literature focused on EPAs, specifically those involving dental educators in undergraduate, postgraduate, or continuing education contexts. Studies of any design (qualitative, quantitative, or mixed methods), as well as conceptual papers and reviews, will be considered. Only English-language studies will be included. The literature search process will involve a librarian, while study selection and evidence charting will be conducted by 4 independent reviewers. These reviewers will independently screen titles, abstracts, and full texts against the inclusion criteria. Data will be charted using a standardized extraction form and analyzed thematically. Results: Findings will be presented in both tabular and narrative formats, highlighting the range, characteristics, and key components of EPAs relevant to dental educators. In addition, these findings will be mapped to the competencies of dental educators. This review is estimated to be completed within 6 months and aims to identify gaps for future research, ultimately supporting the advancement of competency-based dental education. The results of this review will serve as a foundation for a larger study focused on developing a framework of EPAs specifically tailored for dental educators. Conclusions: The identification of EPAs and their themes provides an initial framework that can guide the development of more structured, competency-based academic roles for dental educators. A tailored EPA framework holds promise not only for clarifying faculty expectations and enhancing performance assessment but also for supporting faculty development. International Registered Report Identifier (IRRID): DERR1-10.2196/74225 %M 40560634 %R 10.2196/74225 %U https://www.researchprotocols.org/2025/1/e74225 %U https://doi.org/10.2196/74225 %U http://www.ncbi.nlm.nih.gov/pubmed/40560634 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63066 %T Income-Based Disparities in Perceived Benefits and Challenges of Virtual Global Health Activities During the COVID-19 Pandemic: Mixed Methods Analysis %A Zhou,Shuo %A Kagoya,Enid Kawala %A Coria,Alexandra %A Beck,Alyssa %A Evert,Jessica %A Haque,Marina %A Lamb,Molly M %A Rule,Amy RL %A Umphrey,Lisa %+ Center for Global Health, Colorado School of Public Health, 13123 East 16th Avenue, B302, Aurora, CO, 80045, United States, 1 720 777 5211, lisaaumphrey@gmail.com %K global health %K virtual %K in-person %K perceived benefits and challenges %K COVID-19 pandemic %K medical education %D 2025 %7 7.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Global health activities (GHAs) can potentially reduce health disparities by facilitating resource sharing, promoting medical education and professional development worldwide, and enhancing collaboration among high-income countries (HICs) and low- and middle-income countries (LMICs). However, the COVID-19 pandemic disrupted in-person GHAs due to strict infection control and travel restrictions. To ensure the continuity of GHAs and further address health inequity, virtual GHAs (VGHAs) are gaining traction. Objective: Our research aimed to understand how people perceive the benefits and challenges of VGHAs, analyze and compare whether HIC and LMIC respondents have different perceptions of virtual and in-person GHAs, and summarize suggestions for improvement to inform the future development of VGHAs. Methods: We conducted a cross-sectional web-based survey during the COVID-19 pandemic in early 2022. Eligible participants were adult students, trainees, or professionals who participated in, created, taught, or facilitated GHAs. We thematically analyzed participants’ free-text responses regarding their perceptions of the benefits and challenges of virtual and in-person GHAs. The patterns differed depending on whether respondents were from HICs or LMICs; thus, we compared frequencies of each theme between the 2 groups. Results: A total of 154 respondents from 34 countries were included in the analysis. Key benefits of VGHAs were improved access to global health resources or content, reduced cost, easier scheduling and planning, expanded remote participation, and wider participation and reach. The themes that emerged as challenges of VGHAs included a lack of infrastructure to engage virtually, being less motivated and engaged, a lack of in-person and hands-on experience, and challenges with virtual communication and collaboration. LMIC respondents, compared to HIC counterparts, were more likely to identify reduced cost (26/67, 39% LMIC compared to 20/87, 23% HIC; χ21=4.5; P=.03) and expanding knowledge, experience, or skills (15/67, 22% LMIC compared to 8/87, 9% HIC; χ21=5.2; P=.02) as benefits of VGHAs, lack of infrastructure to engage virtually as a challenge of VGHAs (38/67, 57% LMIC compared to 31/87, 36% HIC; χ21=6.8; P=.009), and to suggest improving the content to be more interesting and relevant (6/67, 9% LMIC compared to 1/87, 1% HIC; χ21=5.3, P=.02). In contrast, HIC respondents were more likely to identify fostering continuity of relationship or activities (28/87, 32% HIC compared to 6/67, 9% LMIC; χ21=11.9; P<.001) as a benefit of VGHAs and being less engaged and motivated to participate virtually (43/87, 49% HIC compared to 19/67, 28% LMIC; χ21=7.0; P=.008) as a challenge of VGHAs. Conclusions: Our findings add to the existing literature by understanding how GHA participants from HICs and LMICs perceive the benefits and challenges of VGHAs differently. These data help elucidate what makes VGHAs acceptable to global health partners and suggest improvements to ensure partner needs are served equitably within the partnership. %M 40334270 %R 10.2196/63066 %U https://www.jmir.org/2025/1/e63066 %U https://doi.org/10.2196/63066 %U http://www.ncbi.nlm.nih.gov/pubmed/40334270 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e63082 %T Virtual Simulation Tools for Communication Skills Training in Health Care Professionals: Literature Review %A Fernández-Alcántara,Manuel %A Escribano,Silvia %A Juliá-Sanchis,Rocío %A Castillo-López,Ana %A Pérez-Manzano,Antonio %A Macur,M %A Kalender-Smajlović,Sedina %A García-Sanjuán,Sofía %A Cabañero-Martínez,María José %K communication skills %K virtual patient %K virtual simulation %K health care professionals %K virtual simulation tool %K skill training %K communication %K heterogeneous %K heterogeneous characteristics %K virtual tool %K patient-centered %K patient-centered communication %K implementation %D 2025 %7 6.5.2025 %9 %J JMIR Med Educ %G English %X Background: Quality clinical care is supported by effective patient-centered communication. Health care professionals can improve their communication skills through simulation-based training, but our knowledge about virtual simulation and its effectiveness and use in training health professionals and students is still growing rapidly. Objective: The objective of this study was to review the current academic literature to identify and evaluate the virtual simulation tools used to train communication skills in health care students and professionals. Methods: This review was carried out in June 2023 by collecting data from the MEDLINE/PubMed and Web of Science electronic databases. Once applicable studies were identified, we recorded data related to type of technology used, learning objectives, degree of learning autonomy, outcomes, and other details. Results: We found 35 articles that had developed and/or applied a virtual environment for training communication skills aimed at patients, in which 24 different learning tools were identified. Most had been developed to independently train communication skills in English, either generally or in the specific context of medical history (anamnesis) interviews. Many of these tools used a virtual patient that looked like a person and had the ability to vocally respond. Almost half of the tools analyzed allowed the person being trained to respond orally using natural language. Of note, not all these studies described the technology they had used in detail. Conclusions: Many different learning tools with very heterogeneous characteristics are being used for the purposes of communication skills training. Continued research will still be required to develop virtual tools that include the most advanced features to achieve high-fidelity simulation training. %R 10.2196/63082 %U https://mededu.jmir.org/2025/1/e63082 %U https://doi.org/10.2196/63082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69881 %T The Role of AI in Nursing Education and Practice: Umbrella Review %A El Arab,Rabie Adel %A Al Moosa,Omayma Abdulaziz %A Abuadas,Fuad H %A Somerville,Joel %+ , Almoosa College of Health Sciences, Ain Najm Road, Al Ahsa, 36422, Saudi Arabia, 966 508948967, r.adel@almoosacollege.edu.sa %K artificial intelligence %K nursing practice %K nursing education %K ethical implications %K social implications %K AI integration %K AI literacy %K ethical frameworks %D 2025 %7 4.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) is rapidly transforming health care, offering substantial advancements in patient care, clinical workflows, and nursing education. Objective: This umbrella review aims to evaluate the integration of AI into nursing practice and education, with a focus on ethical and social implications, and to propose evidence-based recommendations to support the responsible and effective adoption of AI technologies in nursing. Methods: We included systematic reviews, scoping reviews, rapid reviews, narrative reviews, literature reviews, and meta-analyses focusing on AI integration in nursing, published up to October 2024. A new search was conducted in January 2025 to identify any potentially eligible reviews published thereafter. However, no new reviews were found. Eligibility was guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework; databases (PubMed or MEDLINE, CINAHL, Web of Science, Embase, and IEEE Xplore) were searched using comprehensive keywords. Two reviewers independently screened records and extracted data. Risk of bias was assessed with Risk of Bias in Systematic Reviews (ROBIS) and A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2), which we adapted for systematic and nonsystematic review types. A thematic synthesis approach, conducted independently by 2 reviewers, identified recurring patterns across the included reviews. Results: The search strategy yielded 18 eligible studies after screening 274 records. These studies encompassed diverse methodologies and focused on nursing professionals, students, educators, and researchers. First, ethical and social implications were consistently highlighted, with studies emphasizing concerns about data privacy, algorithmic bias, transparency, accountability, and the necessity for equitable access to AI technologies. Second, the transformation of nursing education emerged as a critical area, with an urgent need to update curricula by integrating AI-driven educational tools and fostering both technical competencies and ethical decision-making skills among nursing students and professionals. Third, strategies for integration were identified as essential for effective implementation, calling for scalable models, robust ethical frameworks, and interdisciplinary collaboration, while also addressing key barriers such as resistance to AI adoption, lack of standardized AI education, and disparities in technology access. Conclusions: AI holds substantial promises for revolutionizing nursing practice and education. However, realizing this potential necessitates a strategic approach that addresses ethical concerns, integrates AI literacy into nursing curricula, and ensures equitable access to AI technologies. Limitations of this review include the heterogeneity of included studies and potential publication bias. Our findings underscore the need for comprehensive ethical frameworks and regulatory guidelines tailored to nursing applications, updated nursing curricula to include AI literacy and ethical training, and investments in infrastructure to promote equitable AI access. Future research should focus on developing standardized implementation strategies and evaluating the long-term impacts of AI integration on nursing practice and patient outcomes. %M 40072926 %R 10.2196/69881 %U https://www.jmir.org/2025/1/e69881 %U https://doi.org/10.2196/69881 %U http://www.ncbi.nlm.nih.gov/pubmed/40072926 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60790 %T Web-Based Human Papillomavirus Education and Professional Skills Intervention for Health Care Providers: Protocol for a Randomized Controlled Trial %A Martinez,Jacob %A Cordero,Jacquelin I %A Whitney,Meagan %A LaRoche,Katie L %A Frietze,Gabriel %A Moya,Eva M %A Gosselink,Kristin %+ Border Biomedical Research Center, College of Science, The University of Texas at El Paso, 500 W University Ave, El Paso, TX, 79968, United States, 1 9157476313, jcordero5@utep.edu %K human papillomavirus %K randomized controlled trial %K HPV knowledge %K HPV vaccine %K health care provider %K provider recommendations %K communication strategies %K Hispanic %D 2025 %7 3.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background:  The human papillomavirus (HPV) vaccine is an effective way to prevent HPV and its associated cancers. Provider recommendation has been shown to be one of the most successful strategies for increasing the uptake of the HPV vaccine; however, more training and resources are needed to help boost health care providers’ confidence and communication skills in recommending the HPV vaccine to their patients, particularly in underserved Hispanic communities where vaccination rates among all ages are lower. Objective:  This study aims to compare HPV educational and professional skills intervention effectiveness on improving provider recommendations and patient communication strategies with health care providers serving the El Paso United States–Mexico border region. Methods:  We will conduct a randomized, blinded, multiple posttest-only controlled behavioral trial using a parallel group design that will examine the effectiveness of a fully automated, web-based, culturally tailored HPV education and professional skills intervention containing unique reading material and video role-play, as compared to a standard Centers for Disease Control and Prevention fact sheet and video about general communication skills. Participants were recruited using a purposive sampling technique, both internet-based and in-person outreach events. Study data are being collected and managed using REDCap (Research Electronic Data Capture; Vanderbilt University) hosted at the University of Texas at El Paso. Chi-square analyses, ANOVA, and other statistical tests will be used with 2-tail α to reject null hypotheses at .05 to analyze the self-assessed outcome data. The Mauchly test of sphericity for each ANOVA and the Huynh-Feldt epsilon test or Greenhouse-Geisser correction to the degrees of freedom of the F-ratio will be reported for each significant effect. We may use multiple imputation procedures to handle the missing data (if applicable). This study is being conducted in the west Texas or southeast New Mexico region of the United States. Chi-square analyses will be used to assess associations between variables reported on the baseline provider knowledge, attitudes, and practice scales. We seek to examine self-assessed changes in provider attitudes and behaviors regarding HPV vaccine recommendation 1 month after receiving our unique multimedia and culturally tailored intervention. Results:  Research and data collection for this clinical trial began in December 2023. Participant recruitment was closed by May 2024 (N=128), with final data collection expected to be completed by December 2024. Conclusions:  This study team decided to report on the intervention protocol to help ensure transparency in the research process and facilitate the improvement of the research design. Tailored web-based educational programs for health care professionals, designed to address regional and patient population characteristics, may be a promising approach to enhancing the real-world implementation of clinical practice guidelines. Trial Registration: ClinicalTrials.gov NCT05120869; http://clinicaltrials.gov/ct2/show/NCT05120869 International Registered Report Identifier (IRRID): PRR1-10.2196/60790 %M 40179382 %R 10.2196/60790 %U https://www.researchprotocols.org/2025/1/e60790 %U https://doi.org/10.2196/60790 %U http://www.ncbi.nlm.nih.gov/pubmed/40179382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64933 %T Factors Influencing Primary Care Physicians’ Intent to Refer Patients With Hypertension to a Digital Remote Blood Pressure Monitoring Program: Mixed Methods Study %A Wu,Jennifer J %A Graham,Ross %A Çelebi,Julie %A Fraser,Kevin %A Gin,Geneen T %A Dang,Laurel %A Hatamy,Esmatullah %A Walker,Amanda %A Barbato,Courtney %A Lunde,Ottar %A Coles,Lisa %A Agnihotri,Parag %A Morn,Cassandra %A Tai-Seale,Ming %+ Department of Family Medicine, University of California, San Diego, 200 West Arbor Drive, San Diego, CA, 92103 - 8201A, United States, 1 6194719260, j1wu@health.ucsd.edu %K digital health %K primary care %K electronic health records %K referral %K hypertension %K remote monitoring %K remote blood pressure %K digital technology %K mobile phone %K mixed method %K quantitative analysis %K linear regression %K clinical information %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Primary care physicians’ (PCP) referral rates to digital health programs are highly variable. This study explores whether knowledge of the digital remote blood pressure monitoring (RBPM) program and information on referral patterns influence PCPs’ intention to refer patients. Objective: This study aims to examine the relationship between PCPs’ knowledge of the digital RBPM program and information on their own prior referral rates versus their own with their peers’ referral rates and their likelihood to refer patients to the digital RBPM program. Methods: This is a mixed methods study integrating quantitative analysis of electronic health record data regarding the frequency of PCPs’ referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs’ knowledge of the program and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient. They were randomized to either receive their own referral rate or their own plus their peers’ referral rate. They were assessed on their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined participant characteristics and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31% (n=70) responded to the survey. From electronic health record data, the mean referral rate of patients per PCP was 11.80% (SD 13.30%). The mean self-reported knowledge of the digital health program was 6.47 (SD 1.81). The mean likelihood of referring an eligible patient (on a scale of 0 to 10, with 0 being not at all, and 10 being definitely) based on a vignette was 8.54 (SD 2.12). The own referral data group’s mean likelihood to refer was 8.91 (SD 1.28), whereas the own plus peer prior referral data group was 8.35 (SD 2.19). Regression analyses suggested the intention to refer the vignette patient was significantly associated with their knowledge (coefficient 0.46, 95% CI 0.20-0.73; P<.001), whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95% CI 0.46-0.78; P<.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95% CI –0.43 to 0.89; P=.48). Conclusions: Physicians’ intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, which was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program. %M 40126550 %R 10.2196/64933 %U https://www.jmir.org/2025/1/e64933 %U https://doi.org/10.2196/64933 %U http://www.ncbi.nlm.nih.gov/pubmed/40126550 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e55313 %T Creation of the ECHO Idaho Podcast: Tutorial and Pilot Assessment %A Wiet,Ryan %A Casanova,Madeline P %A Moore,Jonathan D %A Deming,Sarah M %A Baker Jr,Russell T %K Project ECHO %K ECHO Idaho %K medical education %K medical training %K medication teaching %K medical knowledge %K rural health care %K rural medicine %K underserved population %K underserved people %K substance use %K substance use disorder %K SUD %K drug abuse %K drug use %K alcoholism %K addiction %K pain %K behavioral health %K podcast %K webinar %D 2025 %7 21.3.2025 %9 %J JMIR Med Educ %G English %X Background: Project ECHO (Extension for Community Health Outcomes) is an innovative program that uses videoconferencing technology to connect health care providers with experts. The model has been successful in reaching health care providers in rural and underserved areas and positively impacting clinical practice. ECHO Idaho, a replication partner, has developed programming that has increased knowledge and confidence of health care professionals throughout the state of Idaho, United States. Although the ECHO model has a demonstrated ability to recruit, educate, and train health care providers, barriers to attending Project ECHO continuing education (CE) programs remain. The asynchronous nature of podcasts could be used as an innovative medium to help address barriers to CE access that health care professionals face. The ECHO Idaho “Something for the Pain” podcast was developed to increase CE accessibility to rural and frontier providers, while upscaling their knowledge of and competence to treat and assess substance use disorders, pain, and behavioral health conditions. Objective: This paper describes the creation and preliminary assessment of the ECHO Idaho “Something for the Pain” podcast. Methods: Podcast episodes consisted of interviews with individuals as well as didactic lectures. Audio from these recordings were edited for content and length and then professionally reviewed by subject matter experts (eg, featured episode speakers). Target audiences consisted of health care providers and community members interested in behavioral health and substance use disorders. Metrics on podcast listeners were assessed using SoundCloud’s RSS feed, continuing education survey completion, and iECHO. Results: The ECHO Idaho “Something for the Pain” podcast’s inaugural season comprised 14 episodes with 626 minutes of CE material. The podcast series received a total of 2441 listens from individuals in 14 different cities across Idaho, and 63 health care providers listened and claimed CE credits. The largest professional group was social workers (n=22; 35%). Conclusions: We provide preliminary evidence that podcasts can be used to provide health care providers with opportunities to access CE material. Health care providers listened to and claimed CE credits from the ECHO Idaho “Something for the Pain” podcast. Project ECHO programs should consider creating podcasts as an additional platform for disseminating ECHO material. %R 10.2196/55313 %U https://mededu.jmir.org/2025/1/e55313 %U https://doi.org/10.2196/55313 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65373 %T The Chinese Version of the DigiHealthCom (Digital Health Competence) Instrument for Assessing Digital Health Competence of Health Care Professionals: Translation, Adaptation, and Validation Study %A Gao,Lu %A Chen,Meilian %A Wei,Jingxin %A Wang,Jinni %A Liao,Xiaoyan %K competence %K digital health %K health care professionals %K instrument %K reliability %K validity %D 2025 %7 21.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Digital health competence is increasingly recognized as a core competence for health care professionals. A comprehensive evaluation of knowledge, skills, performance, values, and attitudes necessary to adapt to evolving digital health technologies is essential. DigiHealthCom (Digital Health Competence) is a well-established instrument designed to assess digital health competence across diverse health care professionals. Objective: This study aimed to translate and culturally adapt DigiHealthCom into simplified Chinese (Mandarin) and verify its reliability and validity in assessing digital health competence of Chinese health care professionals. Methods: DigiHealthCom was translated into Chinese following the guideline proposed by its original developers. The cultural adaptation involved expert review and cognitive interviewing. Internal consistency, test-retest reliability, content validity, convergent validity, discriminant validity, and factor structure were examined. Item analysis tested item discrimination, item correlation, and item homogeneity. Internal consistency was assessed using Cronbach α, and test-retest reliability was measured using the intraclass correlation coefficient. Content validity was assessed through both item and scale content validity indices. Convergent validity was measured by the Average Variance Extracted and Composite Reliability, while discriminant validity was measured by the heterotrait-monotrait ratio. A five-dimension model of DigiHealthCom was confirmed using confirmatory factor analysis. Results: The finalized Chinese version of the DigiHealthCom was completed after addressing differences between the back-translations and the original version. No discrepancies affecting item clarity were reported during cognitive interviewing. The validation process involved 398 eligible health care professionals from 36 cities across 15 provinces in China, with 43 participants undergoing a retest after a 2-week interval. Critical ratio values (range 16.05‐23.77, P<.001), item-total correlation coefficients (range 0.69‐0.89), and Cronbach α if the item deleted (range 0.91‐0.96) indicated satisfactory item discrimination, item correlation, and item homogeneity. Cronbach α for dimensions and the scale ranged from 0.94 to 0.98, indicating good internal consistency. The intraclass correlation coefficient was 0.90 (95% CI 0.81‐0.95), indicating good test-retest reliability. Item content validity index ranged from 0.82 to 1.00, and the scale content validity index was 0.97, indicating satisfactory content validity. Convergent validity (average variance extracted: 0.60‐0.79; composite reliability: 0.94‐0.95) and divergent validity (heterotrait-monotrait ratio: 0.72‐0.89) were satisfactory. Confirmatory factor analysis confirmed a well-fit five-dimension model (robust chi-square to df ratio=3.10, comparative fit index=0.91, Tucker-Lewis index=0.90, incremental fit index=0.91, root-mean-square error of approximation=0.07, standardized root-mean-square residual=0.05), with each item having a factor loading exceeding 0.40. Conclusions: The Chinese version of DigiHealthCom has been proved to be reliable and valid. It is now available for assessing digital health competence among Chinese health care professionals. This assessment can be used to guide health care policy makers and educators in designing comprehensive and implementable educational programs and interventions. %R 10.2196/65373 %U https://humanfactors.jmir.org/2025/1/e65373 %U https://doi.org/10.2196/65373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66201 %T HUMAn, a Real-Time Evolutive Patient Model for Major Incident Simulation: Development and Validation Study %A Laurent,Maxence %A Jaccard,Arnaud %A Suppan,Laurent %A Erriquez,Elio %A Good,Xavier %A Golay,Eric %A Jaccard,Dominique %A Suppan,Mélanie %K physiological model %K mathematical model %K computer simulation %K major incident management %K emergency medicine %K mass casualties %K healthcare professional education %K professional education %K continuing education %D 2025 %7 7.3.2025 %9 %J JMIR Form Res %G English %X Background: Major incidents correspond to any situation where the location, number, severity, or type of casualties requires extraordinary resources. Major incident management must be efficient to save as many lives as possible. As any paramedic or emergency medical technician may unexpectedly have to respond to major incidents, regular training is mandatory. Those trainings usually include simulations. The vast majority of major incident simulations are limited by the fact that simulated patients do not evolve during the simulation, regardless of the time elapsed and treatment decisions. Therefore, most simulations fail to incorporate the critical temporal effect of decision-making. Objective: This study aimed to develop and validate a simplified mathematical model of physiology, capable of plausibly simulating the real-time evolution of several injuries. Methods: A modified version of the user-centered design framework, including a relevance, development, and validation phase, was used to define the development process of the physiological model. A 12-member design and development team was established, including prehospital physicians, paramedics, and computer scientists. To determine whether the developed model was clinically realistic, 15 experienced professionals working in the prehospital field participated in the validation phase. They were asked to rate clinical and physiological parameters according to a 5-point Likert scale ranging from 1 (impossible) to 5 (absolutely realistic). Results: The design and development team led to the development of the HUMAn model (Human is an Uncomplicated Model of Anatomy). During the relevance phase, the team defined the needed features of the model: clinically realistic, able to compute the evolution of prehospital vital signs, yet simple enough to allow real-time computation for several simulated patients on regular computers or tablets. During the development phase, iterations led to the development of a heart-lung-brain interaction model coupled to functional blocks representing the main anatomical body parts. During the validation phase, the evolution of nine simulated patients presenting pathologies devised to test the different systems and their interactions was assessed. Overall, clinical parameters of all patients had a median rating of 5 (absolutely realistic; IQR 4-5). Most (n=52, 96%) individual clinical parameters had a median rating of 5, the remainder (n=2, 4%) being rated 4. Overall physiological parameters of all patients had a median rating of 5 (absolutely realistic; IQR 3-5). The majority of individual physiological parameters (n=43, 79%) had a median rating of 5, with (n=9, 17%) rated 4, and only (n=2 ,4%) rated 3. Conclusions: A simplified model of trauma patient evolution was successfully created and deemed clinically realistic by experienced clinicians. This model should now be included in computer-based simulations and its impact on the teaching of major incident management assessed through randomized trials. %R 10.2196/66201 %U https://formative.jmir.org/2025/1/e66201 %U https://doi.org/10.2196/66201 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63136 %T Asynchronous Distance Learning Performance and Knowledge Retention of the National Institutes of Health Stroke Scale Among Health Care Professionals Using Video or e-Learning: Web-based Randomized Controlled Trial %A Koka,Avinash %A Stuby,Loric %A Carrera,Emmanuel %A Gabr,Ahmed %A O'Connor,Margaret %A Missilier Peruzzo,Nathalie %A Waeterloot,Olivier %A Medlin,Friedrich %A Rigolet,Fabien %A Schmutz,Thomas %A Michel,Patrik %A Desmettre,Thibaut %A Suppan,Mélanie %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabriel-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 223723311, laurent.suppan@hug.ch %K stroke %K e-learning %K video %K medical education %K randomized controlled trial %K knowledge retention %K knowledge acquisition %K NIHSS %K National Institutes of Health Stroke Scale %K learner satisfaction %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Stroke treatment has significantly improved over the last decades, but the complexity of stroke cases requires specialized care through dedicated teams with specific knowledge and training. The National Institutes of Health Stroke Scale (NIHSS), widely used to assess neurological deficits and make treatment decisions, is reliable but requires specific training and certification. The traditional didactic training method, based on a video, may not adequately address certain NIHSS intricacies nor engage health care professionals (HCPs) in continuous learning, leading to suboptimal proficiency. In the context of time-constrained clinical settings, highly interactive e-learning could be a promising alternative for NIHSS knowledge acquisition and retention. Objective: This study aimed to assess the efficacy of a highly interactive e-learning module compared with a traditional didactic video in improving NIHSS knowledge among previously trained HCPs. Furthermore, its impact on knowledge retention was also assessed. Methods: A prospective, multicentric, triple-blind, and web-based randomized controlled trial was conducted in 3 Swiss university hospitals, involving HCPs previously trained in NIHSS. Invitations were sent through email, and participants were randomized to either the e-learning or traditional didactic video group through a fully automated process upon self-registration on the website. A 50-question quiz was administered before and after exposure to the training method, and scores were compared to assess knowledge acquisition. The quiz was repeated after 1 month to evaluate retention. Subjective assessments of learning methods that is, user satisfaction, probability of recommendation, perceived difficulty, and perception of duration, were also collected through a Likert-scale questionnaire. A sample size of 72 participants were deemed necessary to have an 80% chance of detecting a difference of 2 points in the postcourse quiz between groups at the 5% significance level. Results: Invitations to participate were sent through email to an estimated 325 HCPs. 174 HCPs enrolled in the study, of which 97 completed the study course. Both learning methods significantly improved NIHSS knowledge, with an improvement of 3.2 (range 2.0-4.3) points in the e-learning group and of 2.1 (1.2-3.1) points in the video group. However, the e-learning group performed better, with higher scores in knowledge acquisition (median score 39.0, IQR 36.0-41.0 vs 37, IQR 34.0-39.0; P=.03) and in knowledge retention (mean score 38.2, 95% CI 36.7-39.7 vs 35.8, 95% CI 34.8-36.8; P=.007). Participants in the e-learning group were more likely to recommend the learning method (77% vs 49%, P=.02), while no significant difference was found for satisfaction (P=.17), perceived duration (P=.17), and difficulty (P=.32). Conclusions: A highly interactive e-learning module was found to be an effective asynchronous method for NIHSS knowledge acquisition and retention in previously NIHSS-trained HCPs, and may now be considered for inclusion in NIHSS training programs for HCPs. International Registered Report Identifier (IRRID): RR2-10.3390/healthcare9111460 %M 40053772 %R 10.2196/63136 %U https://www.jmir.org/2025/1/e63136 %U https://doi.org/10.2196/63136 %U http://www.ncbi.nlm.nih.gov/pubmed/40053772 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57511 %T Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study %A Fathalla,Ahmed M %A Chiang,Cherie %A Audehm,Ralph %A Gorelik,Alexandra %A Chang,Shanton %A Yates,Christopher J %A Snow,Steve %A Barmanray,Rahul %A Price,Sarah %A Collins,Lucy %A Wark,John D %+ Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, 300 Grattan Street, Parkville, Melbourne, 3050, Australia, 61 03 8344 5892, ahmed.elsayed@unimelb.edu.au %K community-based fracture capture bone hub %K osteoporosis %K virtual communities of practice %K continuing professional development %K primary care physicians %K web-based learning platform %K case-based education %D 2025 %7 25.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program’s design and content, showing promising potential. Objective: We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants’ interactions, satisfaction levels, and overall experience. Methods: Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs’ knowledge and confidence after engagement with the CFC Learning Hub. Results: Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. Conclusions: The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs’ needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. International Registered Report Identifier (IRRID): DERR1-10.2196/57511 %M 39999431 %R 10.2196/57511 %U https://www.researchprotocols.org/2025/1/e57511 %U https://doi.org/10.2196/57511 %U http://www.ncbi.nlm.nih.gov/pubmed/39999431 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58108 %T Use of Augmented Reality for Training Assistance in Laparoscopic Surgery: Scoping Literature Review %A Celdrán,Francisco Javier %A Jiménez-Ruescas,Javier %A Lobato,Carlos %A Salazar,Lucía %A Sánchez-Margallo,Juan Alberto %A Sánchez-Margallo,Francisco M %A González,Pascual %+ I3A, LoUISE Research Group, University of Castilla-La Mancha, C/ Investigación 2, Albacete, 02071, Spain, 34 666649104, franciscoj.celdran@uclm.es %K laparoscopic surgery %K surgical training %K surgical simulator %K augmented reality–based laparoscopic simulator %K AR-based laparoscopic simulator %K augmented reality %K mobile phone %D 2025 %7 28.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Laparoscopic surgery training is a demanding process requiring technical and nontechnical skills. Surgical training has evolved from traditional approaches to the use of immersive digital technologies such as virtual, augmented, and mixed reality. These technologies are now integral to laparoscopic surgery training. Objective: This scoping literature review aimed to analyze the current augmented reality (AR) solutions used in laparoscopic surgery training. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using 4 databases: Scopus, IEEE Xplore, PubMed, and ACM. Inclusion and exclusion criteria were applied to select relevant articles. Exclusion criteria were studies not using AR, not focused on laparoscopic surgery, not focused on training, written in a language other than English, or not providing relevant information on the topics studied. After selecting the articles, research questions (RQs) were formulated to guide the review. In total, 2 independent reviewers then extracted relevant data, and a descriptive analysis of the results was conducted. Results: Of 246 initial records, 172 (69.9%) remained after removing duplicates. After applying the exclusion criteria, 76 articles were selected, with 25 (33%) later excluded for not meeting quality standards, leaving 51 (67%) in the final review. Among the devices analyzed (RQ 1), AR video–based devices were the most prevalent (43/51, 84%). The most common information provided by AR devices (RQ 1) focused on task execution and patient-related data, both appearing in 20% (10/51) of studies. Regarding sensorization (RQ 2), most studies (46/51, 90%) incorporated some form of sensorized environment, with computer vision being the most used technology (21/46, 46%) and the trainee the most frequently sensorized element (41/51, 80%). Regarding training setups (RQ 3), 39% (20/51) of the studies used commercial simulators, and 51% (26/51) made use of artificial models. Concerning the evaluation methods (RQ 4), objective evaluation was the most used, featured in 71% (36/51) of the studies. Regarding tasks (RQ 5), 43% (22/51) of studies focused on full surgical procedures, whereas 57% (29/51) focused on simple training tasks, with suturing being the most common among the latter (11/29, 38%). Conclusions: This scoping review highlights the evolving role of AR technologies in laparoscopic surgery training, although the impact of optical see-through devices remains unclear due to their limited use. It underscores the potential of emerging technologies such as haptic feedback, computer vision, and eye tracking to further enhance laparoscopic skill acquisition. While most relevant articles from other databases were included, some studies may have been missed due to the specific databases and search strategies used. Moreover, the need for standardized evaluation metrics is emphasized, paving the way for future research into AR’s full potential in laparoscopic skill acquisition. %M 39874568 %R 10.2196/58108 %U https://www.jmir.org/2025/1/e58108 %U https://doi.org/10.2196/58108 %U http://www.ncbi.nlm.nih.gov/pubmed/39874568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63241 %T Mass Casualty Incident Training in Immersive Virtual Reality: Quasi-Experimental Evaluation of Multimethod Performance Indicators %A Baetzner,Anke Sabine %A Hill,Yannick %A Roszipal,Benjamin %A Gerwann,Solène %A Beutel,Matthias %A Birrenbach,Tanja %A Karlseder,Markus %A Mohr,Stefan %A Salg,Gabriel Alexander %A Schrom-Feiertag,Helmut %A Frenkel,Marie Ottilie %A Wrzus,Cornelia %+ Institute of Sports and Sports Sciences, Heidelberg University, Im Neuenheimer Feld 700, Heidelberg, 69120, Germany, 49 6221544339, anke.baetzner@issw.uni-heidelberg.de %K prehospital decision-making %K disaster medicine %K emergency medicine %K mass casualty incident %K medical education %K eye tracking %K emergency simulation %K virtual reality %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. Objective: This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. Methods: A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking–based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51% MFRs vs 37/76, 49% non-MFRs) and a knowledge test with patient vignettes. Results: Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman ρ=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. Conclusions: iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers’ feedback and provide trainees with guidance on evaluating and reflecting on their own performance. %M 39869892 %R 10.2196/63241 %U https://www.jmir.org/2025/1/e63241 %U https://doi.org/10.2196/63241 %U http://www.ncbi.nlm.nih.gov/pubmed/39869892 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60427 %T Digital Teaching and Learning Media for Nursing and Health Care Courses in Germany: Protocol for a Scoping Review %A Vogel,Jann Niklas %A Letzin,Jaqueline %A Schmidt,Stefan %+ , Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Straße 2, Neubrandenburg, 17033, Germany, 49 03955693320, jvogel@hs-nb.de %K digital education %K digital learning %K digital teaching %K e-learning %K nursing %K health care %K digital transformation %K digital technology %K online learning %K distance learning %K health care education %D 2025 %7 17.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Germany, digital transformation and legal regulations are leading to the need to integrate digital technologies into the nursing profession. In addition, to nursing practice, they are also being incorporated into nursing training. Despite comprehensive regulations regarding the use of digital teaching and learning media in nursing education, their specific applicability and implementation vary. Objective: This study aims to map evidence and identify the main concepts, theories, sources, and knowledge gaps in the use of digital teaching and learning formats in nursing and health care education in Germany. Methods: The study is planned as a scoping review. The reporting of the study is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. The sources of information for the review include six bibliographic databases (MEDLINE via PubMed, Cochrane Library, Web of Science Core Collection, ERIC, PROSPERO, and APA PsycInfo). The search results will be presented in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The eligibility of studies is based on the population, concept, and context criteria: (1) learners of nursing and health care professions, (2) digital teaching and learning formats, and (3) forms of implementation in Germany since 2007. Results: The literature search is planned for January 2025. The selection of titles, the coding of the data, and the data analysis are expected to be completed by March 2025. Conclusions: In Germany, there is a growing interest in integrating digital teaching and learning formats into nursing and health care education. Our scoping review will map applications of digital teaching and learning media in the education of nursing and health care professions in Germany. In this way, the scoping review provides relevant impulses for fields of application and design aspects of digital teaching or learning media for nursing and health care education. International Registered Report Identifier (IRRID): PRR1-10.2196/60427 %M 39823593 %R 10.2196/60427 %U https://www.researchprotocols.org/2025/1/e60427 %U https://doi.org/10.2196/60427 %U http://www.ncbi.nlm.nih.gov/pubmed/39823593 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63131 %T Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial %A Zhang,Dandan %A Fu,MuLi %A Zhang,Jianzhong %A Li,Yuxuan %A Chen,Li %A Chen,Yong-Jun %A Zhong,Zhefeng %A Zhang,Yin-Ping %+ School of Nursing, Xi'an Jiaotong University Health Science Center, No.76, Yanta West Road, Xi'an, 7100061, China, 86 (29) 8265 7015, cathyzh@mail.xjtu.edu.cn %K virtual reality simulation %K isolation ward %K preparedness %K pandemic %K nurse %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses’ clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited. Objective: This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings. Methods: This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments. Results: After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=–0.30, P=.75; Cohen d=–0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks. Conclusions: This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses’ practical skills and pandemic preparedness. Trial Registration: Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0 %M 39819587 %R 10.2196/63131 %U https://www.jmir.org/2025/1/e63131 %U https://doi.org/10.2196/63131 %U http://www.ncbi.nlm.nih.gov/pubmed/39819587 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e50060 %T A Brief Web-Based Person-Centered Care Group Training Program for the Management of Generalized Anxiety Disorder: Feasibility Randomized Controlled Trial in Spain %A Ramos-García,Vanesa %A Rivero-Santana,Amado %A Peñate-Castro,Wenceslao %A Álvarez-Pérez,Yolanda %A Duarte-Díaz,Andrea %A Torres-Castaño,Alezandra %A Trujillo-Martín,María del Mar %A González-González,Ana Isabel %A Serrano-Aguilar,Pedro %A Perestelo-Pérez,Lilisbeth %K person-centered care %K primary care %K shared decision-making %K anxiety disorder %K training program %K SDM %D 2025 %7 16.1.2025 %9 %J JMIR Med Educ %G English %X Background: Shared decision-making (SDM) is a crucial aspect of patient-centered care. While several SDM training programs for health care professionals have been developed, evaluation of their effectiveness is scarce, especially in mental health disorders such as generalized anxiety disorder. Objective: This study aims to assess the feasibility and impact of a brief training program on the attitudes toward SDM among primary care professionals who attend to patients with generalized anxiety disorder. Methods: A feasibility randomized controlled trial was conducted. Health care professionals recruited in primary care centers were randomized to an intervention group (training program) or a control group (waiting list). The intervention consisted of 2 web-based sessions applied by 2 psychologists (VR and YA), based on the integrated elements of the patient-centered care model and including group dynamics and video viewing. The outcome variable was the Leeds Attitudes Towards Concordance scale, second version (LATCon II), assessed at baseline and after the second session (3 months). After the randomized controlled trial phase, the control group also received the intervention and was assessed again. Results: Among 28 randomized participants, 5 withdrew before the baseline assessment. The intervention significantly increased their scores compared with the control group in the total scale (b=0.57; P=.018) and 2 subscales: communication or empathy (b=0.74; P=.036) and shared control (ie, patient participation in decisions: b=0.68; P=.040). The control group also showed significant pre-post changes after receiving the intervention. Conclusions: For a future effectiveness trial, it is necessary to improve the recruitment and retention strategies. The program produced a significant improvement in participants’ attitude toward the SDM model, but due to this study’s limitations, mainly the small sample size, more research is warranted. %R 10.2196/50060 %U https://mededu.jmir.org/2025/1/e50060 %U https://doi.org/10.2196/50060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66109 %T Teaching in the Digital Age—Developing a Support Program for Nursing Education Providers: Design-Based Research %A Walzer,Stefan %A Barthel,Carolin %A Pazouki,Ronja %A Marx,Helga %A Ziegler,Sven %A Koenig,Peter %A Kugler,Christiane %A Jobst,Stefan %+ Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723 920 2957, stefan.walzer@hs-furtwangen.de %K digital competencies %K nursing education %K support program %K needs assessment %K design-based research %K feasibility study %K nursing education provider %K qualitative research %K nurse %K health care %K focus group %K digital age %K expert consultation %K thematic content analysis %K feasibility test %K satisfaction %K competency-based approach %K workplace barrier %K health care digitalization %K digital technology %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. Objective: This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. Methods: We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Results: Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Conclusions: Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts. %M 39813674 %R 10.2196/66109 %U https://formative.jmir.org/2025/1/e66109 %U https://doi.org/10.2196/66109 %U http://www.ncbi.nlm.nih.gov/pubmed/39813674 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 8 %N %P e64548 %T Exploring Educators’ Perceptions and Experiences of Online Teaching to Foster Caring Profession Students’ Development of Virtual Caring Skills: Sequential Explanatory Mixed Methods Study %A Nowell,Lorelli %A Johnston,Sonja %A Dolan,Sara %A Jacobsen,Michele %A Lorenzetti,Diane L %A Oddone Paolucci,Elizabeth %+ Faculty of Nursing, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada, 1 4036209822, lnowell@ucalgary.ca %K health care education %K virtual care %K telehealth %K online teaching %K mixed methods study %K student %K teaching %K virtual caring skills %K cross-sectional survey %K interview %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Nursing %G English %X Background: Professionals in caring disciplines have been pivotal in advancing virtual care, which leverages remote technologies to deliver effective support and services from a distance. Educators in these caring professions are required to teach students the skills and competencies needed to provide high-quality and effective care. As virtual care becomes more integral, educators must equip students in these fields with both interpersonal and technological skills, bridging traditional hands-on learning with digital literacy. However, there is a gap in evidence exploring educators’ perceptions and experiences of teaching caring profession students about virtual caring skills within online environments. Objective: This study aims to better understand caring profession educators’ online teaching experiences to foster student development of virtual caring skills and competencies. Methods: We used a sequential explanatory mixed methods approach that integrated a cross-sectional survey and individual interviews with educators from caring professions to better understand caring professional educators’ online teaching experiences to foster student development of virtual caring skills and competencies. The survey’s primary objectives were to examine the various elements of existing e-learning opportunities, delve into educators’ perspectives and encounters with these opportunities, and identify the factors that either facilitated or hindered online teaching practices to support students in developing virtual caring skills and competencies. The individual interview guides were based on survey findings and a systematic review of the evidence to gain deeper insights into educators’ experiences and perspectives. Results: A total of 82 survey participants and 8 interview participants were drawn from educators in the fields of education, medicine, nursing, and social work. Various instructional methods were used to help students develop virtual caring skills, including reflections on learning, online modules, online discussion boards, demonstrations of remote care, and consultation with clients. There was a statistically significant difference between educators’ level of experience teaching online and their satisfaction with online teaching and learning technologies (P<.001) and between educators’ faculties (departments) and their satisfaction with online teaching and learning technologies (P=.001). Participants identified barriers (time constraints, underdeveloped curriculum, decreased student engagement, and limited access to virtual caring equipment and technology), facilitators (clearly defined learning objectives, technology software and support, teaching support, stakeholder engagement, and flexibility), and principles of teaching virtual caring skills in online environments (connection, interaction, compassion, empathy, care, and vulnerability). Conclusions: Our study identifies the barriers, facilitators, and principles in teaching virtual caring skills, offering practical strategies for educators in caring professions. This study contributes to the growing body of educational research on virtual caring skills by offering educator insights and suggestions for improved teaching and learning strategies in caring professions’ programs. As educational practices evolve, future research should explore how traditionally in-person educators can effectively teach virtual caring skills across diverse contexts. %M 39608377 %R 10.2196/64548 %U https://nursing.jmir.org/2025/1/e64548 %U https://doi.org/10.2196/64548 %U http://www.ncbi.nlm.nih.gov/pubmed/39608377 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e54152 %T Evaluation of an Interdisciplinary Educational Program to Foster Learning Health Systems: Education Evaluation %A Dushyanthen,Sathana %A Zamri,Nadia Izzati %A Chapman,Wendy %A Capurro,Daniel %A Lyons,Kayley %K continuing professional development %K learning health system %K flipped classroom %K digital health informatics %K data science %K health professions education %K interdisciplinary education %K foster %K foster learning %K health data %K design %K innovative %K innovative solution %K health care workforce %K Australia %K real time %K teaching model %D 2025 %7 14.1.2025 %9 %J JMIR Med Educ %G English %X Background: Learning health systems (LHS) have the potential to use health data in real time through rapid and continuous cycles of data interrogation, implementing insights to practice, feedback, and practice change. However, there is a lack of an appropriately skilled interprofessional informatics workforce that can leverage knowledge to design innovative solutions. Therefore, there is a need to develop tailored professional development training in digital health, to foster skilled interprofessional learning communities in the health care workforce in Australia. Objective: This study aimed to explore participants’ experiences and perspectives of participating in an interprofessional education program over 13 weeks. The evaluation also aimed to assess the benefits, barriers, and opportunities for improvements and identify future applications of the course materials. Methods: We developed a wholly online short course open to interdisciplinary professionals working in digital health in the health care sector. In a flipped classroom model, participants (n=400) undertook 2 hours of preclass learning online and then attended 2.5 hours of live synchronous learning in interactive weekly Zoom workshops for 13 weeks. Throughout the course, they collaborated in small, simulated learning communities (n=5 to 8), engaging in various activities and problem-solving exercises, contributing their unique perspectives and diverse expertise. The course covered a number of topics including background on LHS, establishing learning communities, the design thinking process, data preparation and machine learning analysis, process modeling, clinical decision support, remote patient monitoring, evaluation, implementation, and digital transformation. To evaluate the purpose of the program, we undertook a mixed methods evaluation consisting of pre- and postsurveys rating scales for usefulness, engagement, value, and applicability for various aspects of the course. Participants also completed identical measures of self-efficacy before and after (n=200), with scales mapped to specific skills and tasks that should have been achievable following each of the topics covered. Further, they undertook voluntary weekly surveys to provide feedback on which aspects to continue and recommendations for improvements, via free-text responses. Results: From the evaluation, it was evident that participants found the teaching model engaging, useful, valuable, and applicable to their work. In the self-efficacy component, we observed a significant increase (P<.001) in perceived confidence for all topics, when comparing pre- and postcourse ratings. Overall, it was evident that the program gave participants a framework to organize their knowledge and a common understanding and shared language to converse with other disciplines, changed the way they perceived their role and the possibilities of data and technologies, and provided a toolkit through the LHS framework that they could apply in their workplaces. Conclusions: We present a program to educate the health workforce on integrating the LHS model into standard practice. Interprofessional collaborative learning was a major component of the value of the program. This evaluation shed light on the multifaceted challenges and expectations of individuals embarking on a digital health program. Understanding the barriers and facilitators of the audience is crucial for creating an inclusive and supportive learning environment. Addressing these challenges will not only enhance participant engagement but also contribute to the overall success of the program and, by extension, the broader integration of digital health solutions into health care practice and, ultimately, patient outcomes. %R 10.2196/54152 %U https://mededu.jmir.org/2025/1/e54152 %U https://doi.org/10.2196/54152 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64871 %T Impact of Psychosocial and Palliative Care Training on Nurses’ Competences and Care of Patients With Cancer in Cameroon: Protocol for Quasi-Experimental Study %A Bassah,Nahyeni %A Tendongfor,Nicholas %A Ebob-Anya,Bachi-Ayukokang %A Eta,Vivian A E %A Esembeson,Malika %A Ngah,Ndzi Eric %A Abdul-Rahim,Salisu Ango %+ Department of Nursing, University of Buea, Molyko, Buea, P.O Box 63, Cameroon, 237 677358661, nahyenibassah@yahoo.com %K palliative care %K psychosocial nursing %K oncology nursing %K nurses %K quality improvement %K training %K competencies %D 2025 %7 3.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer is a leading cause of global mortality, accounting for nearly 10 million deaths in 2020. This is projected to increase by more than 60% by 2040, particularly in low- and middle-income countries. Yet, palliative and psychosocial oncology care is very limited in these countries. Objective: This study describes a protocol for the development, implementation, and evaluation of a psychosocial oncology and palliative care course on Cameroonian practicing nurses’ knowledge, self-perceived competence, and confidence in palliative and psychosocial oncology care provision for patients with cancer. Methods: A single group pre-posttest design, incorporating both quantitative and qualitative methods will be used. First, a psychosocial oncology and palliative care course for practicing nurses in Cameroon will be developed. This course will then be implemented with 50 practicing nurses purposefully selected from 2 oncology units in the Littoral region and 4 hospitals in the Southwest region of Cameroon. Finally, to assess the impact of the training program we will undertake a pre and posttest survey of nurses’ palliative and psychosocial oncology competences, a pre and post training audit of patients’ nursing records to examine nurses’ practice of palliative and psychosocial oncology care and undertake a critical-incident interview of nurses’ transfer of learning to practice. Descriptive and inferential statistics will be used to analysis quantitative data, while qualitative data will be analyzed using the framework approach. Results: This study was funded in September 2023. The training program development was initiated in March 2024 and completed in June 2024. Baseline data collection commenced in May 2024 and as of September 2024, we had collected data from 300 patient record. Training implementation is planned for October-December 2024, and post intervention data will be started in October 2024 and continue till April 2025. Data analysis will commence in October 2024 and we aim to publish study findings in peer review journals by November 2025. Conclusions: This study will improve our understanding of Cameroonian nurses’ palliative and psychosocial oncology competency gaps. It will result in the development of a palliative care and psychosocial oncology course and in the training of 50 nurses in psychosocial oncology and palliative care in Cameroon. This study will inform strategies for future psychosocial oncology and palliative care training initiatives in Cameroon and other low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/64871 %M 39752719 %R 10.2196/64871 %U https://www.researchprotocols.org/2025/1/e64871 %U https://doi.org/10.2196/64871 %U http://www.ncbi.nlm.nih.gov/pubmed/39752719 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e49895 %T Evaluation of the Effectiveness of Advanced Technology Clinical Simulation Manikins in Improving the Capability of Australian Paramedics to Deliver High-Quality Cardiopulmonary Resuscitation: Pre- and Postintervention Study %A Zucca,Alison %A Bryant,Jamie %A Purse,Jeffrey %A Szwec,Stuart %A Sanson-Fisher,Robert %A Leigh,Lucy %A Richer,Mike %A Morrison,Alan %K paramedicine %K cardiopulmonary resuscitation %K clinical simulation %K professional development %K manikins %K effectiveness %K technology %K paramedics %K patient care %K simulation-based training %K deployment %D 2024 %7 24.12.2024 %9 %J JMIR Cardio %G English %X Background: Emergency medical services attend out-of-hospital cardiac arrests all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. Consequently, for paramedics working in areas with low out-of-hospital cardiac arrest case volumes, ambulance services and professional bodies recognize the importance of alternative ways to maintain resuscitation skills. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills. Objective: The aim of the study is to examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high-quality patient care, as measured by external cardiac compression (ECC) performance. Methods: A pre- and postintervention study design without a control group was used. Data were collected at the start of the manikin training forum (baseline), immediately following the training forum (time 2), and 6 to 11 months after the training forum (time 3). The study was conducted with paramedics from 95 NSW Ambulance locations (75 regional locations and 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (N=106; 100% consent rate). As part of the intervention, paramedics attended a training session on the use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measure was an overall compression score that was automatically recorded and calculated by the simulator manikin in 2-minute cycles. This score was derived from compressions that were fully released and with the correct hand position, adequate depth, and adequate rate. Results: A total of 106 (100% consent rate) paramedics participated, primarily representing regional ambulance locations (n= 75, 78.9%). ECC compression scores were on average 95% or above at all time points, suggesting high performance. No significant differences over time (P>.05) were identified for the overall ECC performance score, compressions fully released, compressions with adequate depth, or compressions with the correct hand position. However, paramedics had significantly lower odds (odds ratio 0.30, 95% CI 0.12-0.78) of achieving compressions with adequate rate at time 3 compared to time 2 (P=.01). Compressions were of a slower rate, with an average difference of 2.1 fewer compressions every minute. Conclusions: Despite this difference in compression rate over time, this did not cause significant detriment to overall ECC performance. Training and deployment of simulator manikins did not significantly change paramedics’ overall ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance. %R 10.2196/49895 %U https://cardio.jmir.org/2024/1/e49895 %U https://doi.org/10.2196/49895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57327 %T Nurses’ Knowledge and Skills After Use of an Augmented Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial %A Sun,Wan-Na %A Hsieh,Min-Chai %A Wang,Wei-Fang %+ Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 704, Taiwan, 886 62353535 ext 4676, 820hosp@gmail.com %K augmented reality %K technology intervention %K randomized controlled trial %K advanced cardiac life support %K nursing education %D 2024 %7 5.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. Objective: This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. Methods: This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. Results: All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). Conclusions: AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. Trial Registration: ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285 %M 39636667 %R 10.2196/57327 %U https://www.jmir.org/2024/1/e57327 %U https://doi.org/10.2196/57327 %U http://www.ncbi.nlm.nih.gov/pubmed/39636667 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62887 %T Competence and Training Needs in Infectious Disease Emergency Response Among Chinese Nurses: Cross-Sectional Study %A Zhang,Dandan %A Chen,Yong-Jun %A Cui,Tianxin %A Zhang,Jianzhong %A Chen,Si-Ying %A Zhang,Yin-Ping %K competence %K preparedness %K infectious disease emergency %K Chinese %K nurse %K cross-sectional study %K COVID-19 %K pandemic %K public health %K health crises %K emergency response %K emergency preparedness %K medical institution %K health care worker %K linear regression %D 2024 %7 18.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In recent years, the frequent outbreaks of infectious diseases and insufficient emergency response capabilities, particularly issues exposed during the COVID-19 pandemic, have underscored the critical role of nurses in addressing public health crises. It is currently necessary to investigate the emergency preparedness of nursing personnel following the COVID-19 pandemic completely liberalized, aiming to identify weaknesses and optimize response strategies. Objective: This study aimed to assess the emergency response competence of nurses, identify their specific training needs, and explore the various elements that impact their emergency response competence. Methods: Using a multistage stratified sampling method, 5 provinces from different geographical locations nationwide were initially randomly selected using random number tables. Subsequently, within each province, 2 tertiary hospitals, 4 secondary hospitals, and 10 primary hospitals were randomly selected for the survey. The random selection and stratification of the hospitals took into account various aspects such as geographical locations, different levels, scale, and number of nurses. This study involved 80 hospitals (including 10 tertiary hospitals, 20 secondary hospitals, and 50 primary hospitals), where nurses from different departments, specialties, and age groups anonymously completed a questionnaire on infectious disease emergency response capabilities. Results: This study involved 2055 participants representing various health care institutions. The nurses’ mean score in infectious disease emergency response competence was 141.75 (SD 20.09), indicating a moderate to above-average level. Nearly one-fifth (n=397, 19.32%) of nurses have experience in responding to infectious disease emergencies; however, they acknowledge a lack of insufficient drills (n=615,29.93%) and training (n=502,24.43%). Notably, 1874 (91.19%) nurses expressed a willingness to undergo further training. Multiple linear regression analysis indicated that significant factors affecting infectious disease emergency response competence included the highest degree, frequency of drills and training, and the willingness to undertake further training (B=−11.455, 7.344, 11.639, 14.432, 10.255, 7.364, and −11.216; all P<.05). Notably, a higher frequency of participation in drills and training sessions correlated with better outcomes (P<.001 or P<.05). Nurses holding a master degree or higher demonstrated significantly lower competence scores in responding to infectious diseases compared with nurses with a diploma or associate degree (P=.001). Approximately 1644 (80%) of the nurses preferred training lasting from 3 days to 1 week, with scenario simulations and emergency drills considered the most popular training methods. Conclusions: These findings highlight the potential and need for nurses with infectious disease emergency response competence. Frequent drills and training will significantly enhance response competence; however, a lack of practical experience in higher education may have a negative impact on emergency performance. The study emphasizes the critical need for personalized training to boost nurses’ abilities, especially through short-term, intensive methods and simulation drills. Further training and tailored plans are essential to improve nurses’ overall proficiency and ensure effective responses to infectious disease emergencies. %R 10.2196/62887 %U https://publichealth.jmir.org/2024/1/e62887 %U https://doi.org/10.2196/62887 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54112 %T Transforming the Future of Digital Health Education: Redesign of a Graduate Program Using Competency Mapping %A Mun,Michelle %A Chanchlani,Sonia %A Lyons,Kayley %A Gray,Kathleen %K digital health %K digital transformation %K health care %K clinical informatics %K competencies %K graduate education %D 2024 %7 31.10.2024 %9 %J JMIR Med Educ %G English %X Digital transformation has disrupted many industries but is yet to revolutionize health care. Educational programs must be aligned with the reality that goes beyond developing individuals in their own professions, professionals wishing to make an impact in digital health will need a multidisciplinary understanding of how business models, organizational processes, stakeholder relationships, and workforce dynamics across the health care ecosystem may be disrupted by digital health technology. This paper describes the redesign of an existing postgraduate program, ensuring that core digital health content is relevant, pedagogically sound, and evidence-based, and that the program provides learning and practical application of concepts of the digital transformation of health. Existing subjects were mapped to the American Medical Informatics Association Clinical Informatics Core Competencies, followed by consultation with leadership to further identify gaps or opportunities to revise the course structure. New additions of core and elective subjects were proposed to align with the competencies. Suitable electives were chosen based on stakeholder feedback and a review of subjects in fields relevant to digital transformation of health. The program was revised with a new title, course overview, course intended learning outcomes, reorganizing of core subjects, and approval of new electives, adding to a suite of professional development offerings and forming a structured pathway to further qualification. Programs in digital health must move beyond purely informatics-based competencies toward enabling transformational change. Postgraduate program development in this field is possible within a short time frame with the use of established competency frameworks and expert and student consultation. %R 10.2196/54112 %U https://mededu.jmir.org/2024/1/e54112 %U https://doi.org/10.2196/54112 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e53151 %T Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study %A Sahyouni,Amal %A Zoukar,Imad %A Dashash,Mayssoon %K effectiveness %K online course %K pediatric %K malnutrition %K essential competencies %K e-learning %K health professional %K Syria %K pilot study %K acquisition knowledge %D 2024 %7 28.10.2024 %9 %J JMIR Med Educ %G English %X Background: There is a shortage of competent health professionals in managing malnutrition. Online education may be a practical and flexible approach to address this gap. Objective: This study aimed to identify essential competencies and assess the effectiveness of an online course on pediatric malnutrition in improving the knowledge of pediatricians and health professionals. Methods: A focus group (n=5) and Delphi technique (n=21 health professionals) were used to identify 68 essential competencies. An online course consisting of 4 educational modules in Microsoft PowerPoint (Microsoft Corp) slide form with visual aids (photos and videos) was designed and published on the Syrian Virtual University platform website using an asynchronous e-learning system. The course covered definition, classification, epidemiology, anthropometrics, treatment, and consequences. Participants (n=10) completed a pretest of 40 multiple-choice questions, accessed the course, completed a posttest after a specified period, and filled out a questionnaire to measure their attitude and assess their satisfaction. Results: A total of 68 essential competencies were identified, categorized into 3 domains: knowledge (24 competencies), skills (29 competencies), and attitudes (15 competencies). These competencies were further classified based on their focus area: etiology (10 competencies), assessment and diagnosis (21 competencies), and management (37 competencies). Further, 10 volunteers, consisting of 5 pediatricians and 5 health professionals, participated in this study over a 2-week period. A statistically significant increase in knowledge was observed among participants following completion of the online course (pretest mean 24.2, SD 6.1, and posttest mean 35.2, SD 3.3; P<.001). Pediatricians demonstrated higher pre- and posttest scores compared to other health care professionals (all P values were <.05). Prior malnutrition training within the past year positively impacted pretest scores (P=.03). Participants highly rated the course (mean satisfaction score >3.0 on a 5-point Likert scale), with 60% (6/10) favoring a blended learning approach. Conclusions: In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment. %R 10.2196/53151 %U https://mededu.jmir.org/2024/1/e53151 %U https://doi.org/10.2196/53151 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e56432 %T Capabilities for Using Telemonitoring in Physiotherapy Treatment: Exploratory Qualitative Study %A van Westerhuis,Charlotte %A Sanders,Astrid F %A Aarden,Jesse J %A Major,Mel E %A de Leeuwerk,Marijke E %A Florisson,Nadine %A Wijbenga,Miriam H %A van der Schaaf,Marike %A van der Leeden,Marike %A van Egmond,Maarten A %K telemedicine %K telemonitoring %K technology %K physical therapy modalities %K education %K physiotherapist %K physiotherapy %K telehealth %D 2024 %7 24.10.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Telemonitoring (TM), as part of telehealth, allows physiotherapists to monitor and coach their patients using remotely collected data. The use of TM requires a different approach compared with face-to-face treatment. Although a telehealth capability framework exists for health care professionals, it remains unclear what specific capabilities are required to use TM during physiotherapy treatments. Objective: This study aims to identify the capabilities required to use TM in physiotherapy treatment. Methods: An exploratory qualitative study was conducted following a constructivist semistructured grounded theory approach. Three heterogeneous focus groups were conducted with 15 lecturers of the School of Physiotherapy (Bachelor of Science Physiotherapy program) from the Amsterdam University of Applied Sciences. Focus group discussions were audiotaped and transcribed verbatim. Capabilities for using TM in physiotherapy treatment were identified during an iterative process of data collection and analysis, based on an existing framework with 4 different domains. Team discussions supported further conceptualization of the findings. Results: Sixteen capabilities for the use of TM in physiotherapy treatment were found addressing 3 different domains. Four capabilities were identified in the “digital health technologies, systems, and policies” domain, 7 capabilities in the “clinical practice and application” domain, and 5 capabilities in the “data analysis and knowledge creation” domain. No capabilities were identified in the “system and technology implementation” domain. Conclusions: The use of TM in physiotherapy treatment requires specific skills from physiotherapists. To best use TM in physiotherapy treatment, it is important to integrate these capabilities into the education of current and future physiotherapists. %R 10.2196/56432 %U https://rehab.jmir.org/2024/1/e56432 %U https://doi.org/10.2196/56432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58030 %T Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study %A Gimenes,Fernanda Raphael Escobar %A Stabile,Angelita Maria %A Bernardes,Rodrigo Magri %A Santos,Vinicius Batista %A Menegueti,Mayra Gonçalves %A do Prado,Patricia Rezende %A Ribeiro,Mauricio Serra %A Camerini,Flavia Giron %A Rabeh,Soraia Assad Nasbine %+ Ribeirão Preto College of Nursing, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, 14095020, Brazil, 55 1633153420, fregimenes@eerp.usp.br %K ultrasound %K bedside ultrasound %K patient safety %K advanced practice nursing %K digital technology in education %K empowerment %K nurses %K Point-of-Care Ultrasound %K PoCUS %K quality care %K decision-making %K nursing assessment %D 2024 %7 23.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals’ and students’ knowledge, image interpretation skills, and clinical acumen. Objective: This study aimed to (1) establish an assessment instrument gauging nurses’ competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses’ PoCUS training needs and evaluate its content and appearance validity. Methods: We will conduct a methodological study of technological production guided by Rogers’ diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses’ competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Results: Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Conclusions: Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/58030 %M 39441654 %R 10.2196/58030 %U https://www.researchprotocols.org/2024/1/e58030 %U https://doi.org/10.2196/58030 %U http://www.ncbi.nlm.nih.gov/pubmed/39441654 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54105 %T Challenges and Needs in Digital Health Practice and Nursing Education Curricula: Gap Analysis Study %A Livesay,Karen %A Walter,Ruby %A Petersen,Sacha %A Abdolkhani,Robab %A Zhao,Lin %A Butler-Henderson,Kerryn %K nursing %K digital health %K capability %K workforce %K framework %K nursing education %K education %K digital health practice %K clinicians %K nurse %K nurse graduates %K clinical nurses %K nurses %K nurse educators %K teach %K teaching %K learning %K nursing students %K student %K students %D 2024 %7 13.9.2024 %9 %J JMIR Med Educ %G English %X Background: Australian nursing programs aim to introduce students to digital health requirements for practice. However, innovation in digital health is more dynamic than education providers’ ability to respond. It is uncertain whether what is taught and demonstrated in nursing programs meets the needs and expectations of clinicians with regard to the capability of the nurse graduates. Objective: This study aims to identify gaps in the National Nursing and Midwifery Digital Health Capability Framework , based on the perspectives of clinical nurses, and in nurse educators’ confidence and knowledge to teach. The findings will direct a future co-design process. Methods: This study triangulated the findings from 2 studies of the Digital Awareness in Simulated Health project and the National Nursing and Midwifery Digital Capability Framework. The first was a qualitative study that considered the experiences of nurses with digital health technologies during the COVID-19 pandemic, and the second was a survey of nurse educators who identified their confidence and knowledge to teach and demonstrate digital health concepts. Results: The results were categorized by and presented from the perspectives of nurse clinicians, nurse graduates, and nurse educators. Findings were listed against each of the framework capabilities, and omissions from the framework were identified. A series of statements and questions were formulated from the gap analysis to direct a future co-design process with nursing stakeholders to develop a digital health capability curriculum for nurse educators. Conclusions: Further work to evaluate nursing digital health opportunities for nurse educators is indicated by the gaps identified in this study. %R 10.2196/54105 %U https://mededu.jmir.org/2024/1/e54105 %U https://doi.org/10.2196/54105 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57343 %T Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study %A Moyce,Sally %A Crawford,Cassidy %+ College of Health and Human Development, Montana State University, PO Box 173560, Bozeman, MT, 59717, United States, 1 970 846 8424, cassacrawford8@gmail.com %K behavioral activation %K community health workers %K implementation science %K Latino %K mental health provider shortage area %K pilot study %K evidence-based treatments %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. Objective: The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. Methods: We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. Results: Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. Conclusions: Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. International Registered Report Identifier (IRRID): DERR1-10.2196/57343 %M 39264699 %R 10.2196/57343 %U https://www.researchprotocols.org/2024/1/e57343 %U https://doi.org/10.2196/57343 %U http://www.ncbi.nlm.nih.gov/pubmed/39264699 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52798 %T Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations %A Ramachandran,Swathi %A Chang,Hsiu-Ju %A Worthington,Catherine %A Kushniruk,Andre %A Ibáñez-Carrasco,Francisco %A Davies,Hugh %A McKee,Geoffrey %A Brown,Adalsteinn %A Gilbert,Mark %A Iyamu,Ihoghosa %K digital public health %K digital transformation %K digital transformations %K rapid review %K rapid reviews %K synthesis %K review methods %K review methodology %K competencies %K competency %K training and practice recommendations %K public health workforce %K workforce %K worker %K workers %K practitioner %K practitioners %K public health %K digital health %K training %K continuing education %K skills %K skill %K recommendation %K recommendations %K best practice %K guideline %K guidelines %D 2024 %7 9.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic highlighted gaps in the public health workforce’s capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners’ capacity to support the digital transformation of public health. Methods: Following the World Health Organization’s (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development. %R 10.2196/52798 %U https://publichealth.jmir.org/2024/1/e52798 %U https://doi.org/10.2196/52798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57860 %T Evaluation of the Continuing Education Training “Beratende für Digitale Gesundheitsversorgung” (“Consultant for Digital Healthcare”): Protocol for an Effectiveness Study %A Kraft,Bernhard %A Kuscher,Thomas %A Zawatzki,Susann %A Hofstetter,Sebastian %A Jahn,Patrick %+ Health Service Research Working Group | Acute Care, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-str. 40, Halle (Saale), 06120, Germany, 49 345 557 4149, Bernhard.Kraft@uk-halle.de %K digitization %K digital-assistive technologies %K nursing and health care professionals %K further training program %K digital competence %K digital healthcare %K digital health %K effectiveness study %K training program %K nursing %K nursings %K health professional %K health professionals %K transfer of learning %K satisfaction %K mixed-method %K self-assessment %K Teaching Analysis Poll %K technology %K technologies %K innovation %K exploratory %K intervention %D 2024 %7 4.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The digital transformation in health care requires training nursing and health professionals in the digitally competent use of digital assistive technologies (DAT). The continuing education training “Beratende für digitale Gesundheitsversorgung” (“Consultant for Digital Healthcare”) was developed to fill this gap. The effectiveness of the training program will be assessed in this study. Objective: The primary objective is to record and measure the participants’ learning success. We will assess whether the previously defined teaching intentions, learning objectives, competencies, and participants’ expectations have been achieved and whether a transfer of learning occurred. The secondary objective is participant satisfaction and feasibility of the training. The tertiary objective is the successful transfer of DAT by participants in their institutions. Methods: Approximately 65 nursing and health care professionals will participate in the pilot phase of the further training and evaluation process, which is planned in a mixed methods design in a nonsequential manner. The different methods will be combined in the interpretation of the results to achieve a synaptic view of the training program. We plan to conduct pre-post surveys in the form of participant self-assessments about dealing with DAT and content-related knowledge levels. Exploratory individual interviews will also be conducted to build theory, to examine whether and to what extent competence (cognition) has increased, and whether dealing (affect) with DAT has changed. Furthermore, an interim evaluation within the framework of the Teaching Analysis Poll (TAP) will occur. The knowledge thereby gained will be used to revise and adapt the modules for future courses. To assess the transfer success, the participants create a practical project, which is carried out within the training framework, observed by the lecturers, and subsequently evaluated and adapted. Results: We expect that the learning objectives for the continuing education training will be met. The attendees are expected to increase their level of digital competence in different skills areas: (1) theoretical knowledge, (2) hands-on skills for planning the application and practical use of DAT, (3) reflective skills and applying ethical and legal considerations in their use, (4) applying all that in a structured process of technology implementation within their practical sphere of work. Conclusions: The aim of this study and appropriate further training program are to educate nursing and health care professionals in the use of DAT, thereby empowering them for a structured change process toward digitally aided care. This focus gives rise to the following research questions: First, how should further training programs be developed, and which focus is appropriate for addressee-appropriate learning goals, course structure, and general curriculum? Second, how should a training program with this specific content and area be evaluated? Third, what are the conditions to offer a continued program? International Registered Report Identifier (IRRID): PRR1-10.2196/57860 %M 39231424 %R 10.2196/57860 %U https://www.researchprotocols.org/2024/1/e57860 %U https://doi.org/10.2196/57860 %U http://www.ncbi.nlm.nih.gov/pubmed/39231424 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48594 %T Reforming China’s Secondary Vocational Medical Education: Adapting to the Challenges and Opportunities of the AI Era %A Tong,Wenting %A Zhang,Xiaowen %A Zeng,Haiping %A Pan,Jianping %A Gong,Chao %A Zhang,Hui %K secondary vocational medical education %K artificial intelligence %K practical skills %K critical thinking %K AI %D 2024 %7 15.8.2024 %9 %J JMIR Med Educ %G English %X China’s secondary vocational medical education is essential for training primary health care personnel and enhancing public health responses. This education system currently faces challenges, primarily due to its emphasis on knowledge acquisition that overshadows the development and application of skills, especially in the context of emerging artificial intelligence (AI) technologies. This article delves into the impact of AI on medical practices and uses this analysis to suggest reforms for the vocational medical education system in China. AI is found to significantly enhance diagnostic capabilities, therapeutic decision-making, and patient management. However, it also brings about concerns such as potential job losses and necessitates the adaptation of medical professionals to new technologies. Proposed reforms include a greater focus on critical thinking, hands-on experiences, skill development, medical ethics, and integrating humanities and AI into the curriculum. These reforms require ongoing evaluation and sustained research to effectively prepare medical students for future challenges in the field. %R 10.2196/48594 %U https://mededu.jmir.org/2024/1/e48594 %U https://doi.org/10.2196/48594 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e47127 %T Using the Kirkpatrick Model to Evaluate the Effect of a Primary Trauma Care Course on Health Care Workers’ Knowledge, Attitude, and Practice in Two Vietnamese Local Hospitals: Prospective Intervention Study %A Nguyen,Ba Tuan %A Nguyen,Van Anh %A Blizzard,Christopher Leigh %A Palmer,Andrew %A Nguyen,Huu Tu %A Quyet,Thang Cong %A Tran,Viet %A Skinner,Marcus %A Perndt,Haydn %A Nelson,Mark R %K trauma care %K emergency medicine %K primary trauma care course %K short course %K medical education %K trauma %K emergency %K urgent %K professional development %K workshop %K injury %K injured %K injuries %K primary care %D 2024 %7 23.7.2024 %9 %J JMIR Med Educ %G English %X Background: The Primary Trauma Care (PTC) course was originally developed to instruct health care workers in the management of patients with severe injuries in low- and middle-income countries (LMICs) with limited medical resources. PTC has now been taught for more than 25 years. Many studies have demonstrated that the 2-day PTC workshop is useful and informative to frontline health staff and has helped improve knowledge and confidence in trauma management; however, there is little evidence of the effect of the course on changes in clinical practice. The Kirkpatrick model (KM) and the knowledge, attitude, and practice (KAP) model are effective methods to evaluate this question. Objective: The aim of this study was to investigate how the 2-day PTC course impacts the satisfaction, knowledge, and skills of health care workers in 2 Vietnamese hospitals using a conceptual framework incorporating the KAP model and the 4-level KM as evaluation tools. Methods: The PTC course was delivered over 2 days in the emergency departments (EDs) of Thanh Hoa and Ninh Binh hospitals in February and March 2022, respectively. This study followed a prospective pre- and postintervention design. We used validated instruments to assess the participants’ satisfaction, knowledge, and skills before, immediately after, and 6 months after course delivery. The Fisher exact test and the Wilcoxon matched-pairs signed rank test were used to compare the percentages and mean scores at the pretest, posttest, and 6-month postcourse follow-up time points among course participants. Results: A total of 80 health care staff members attended the 2-day PTC course and nearly 100% of the participants were satisfied with the course. At level 2 of the KM (knowledge), the scores on multiple-choice questions and the confidence matrix improved significantly from 60% to 77% and from 59% to 71%, respectively (P<.001), and these improvements were seen in both subgroups (nurses and doctors). The focus of level 3 was on practice, demonstrating a significant incremental change, with scenarios checklist points increasing from a mean of 5.9 (SD 1.9) to 9.0 (SD 0.9) and bedside clinical checklist points increasing from a mean of 5 (SD 1.5) to 8.3 (SD 0.8) (both P<.001). At the 6-month follow-up, the scores for multiple-choice questions, the confidence matrix, and scenarios checklist all remained unchanged, except for the multiple-choice question score in the nurse subgroup (P=.005). Conclusions: The PTC course undertaken in 2 local hospitals in Vietnam was successful in demonstrating improvements at 3 levels of the KM for ED health care staff. The improvements in the confidence matrix and scenarios checklist were maintained for at least 6 months after the course. PTC courses should be effective in providing and sustaining improvement in knowledge and trauma care practice in other LMICs such as Vietnam. Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN 12621000371897; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380970 %R 10.2196/47127 %U https://mededu.jmir.org/2024/1/e47127 %U https://doi.org/10.2196/47127 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55680 %T Using Twitter (X) to Mobilize Knowledge for First Contact Physiotherapists: Qualitative Study %A Campbell,Laura %A Quicke,Jonathan %A Stevenson,Kay %A Paskins,Zoe %A Dziedzic,Krysia %A Swaithes,Laura %+ Impact Accelerator Unit, School of Medicine, Keele University, David Weatherall Building, Staffordshire, ST5 5BG, United Kingdom, 44 01782734727, l.campbell@keele.ac.uk %K Twitter %K X %K social media %K first contact physiotherapy %K musculoskeletal %K knowledge mobilisation %K primary care %K mindlines %K qualitative %K physiotherapy %K implementation %D 2024 %7 8.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Twitter (now X) is a digital social network commonly used by health care professionals. Little is known about whether it helps health care professionals to share, mobilize, and cocreate knowledge or reduce the time between research knowledge being created and used in clinical practice (the evidence-to-practice gap). Musculoskeletal first contact physiotherapists (FCPs) are primary care specialists who diagnose and treat people with musculoskeletal conditions without needing to see their general practitioner (family physician) first. They often work as a sole FCP in practice; hence, they are an ideal health care professional group with whom to explore knowledge mobilization using Twitter. Objective: We aimed to explore how Twitter is and can be used to mobilize knowledge, including research findings, to inform FCPs’ clinical practice. Methods: Semistructured interviews of FCPs with experience of working in English primary care were conducted. FCPs were purposively sampled based on employment arrangements and Twitter use. Recruitment was accomplished via known FCP networks and Twitter, supplemented by snowball sampling. Interviews were conducted digitally and used a topic guide exploring FCP's perceptions and experiences of accessing knowledge, via Twitter, for clinical practice. Data were analyzed thematically and informed by the knowledge mobilization mindlines model. Public contributors were involved throughout. Results: In total, 19 FCPs consented to the interview (Twitter users, n=14 and female, n=9). Three themes were identified: (1) How Twitter meets the needs of FCPs, (2) Twitter and a journey of knowledge to support clinical practice, and (3) factors impeding knowledge sharing on Twitter. FCPs described needs relating to isolated working practices, time demands, and role uncertainty. Twitter provided rapid access to succinct knowledge, the opportunity to network, and peer reassurance regarding clinical cases, evidence, and policy. FCPs took a journey of knowledge exchange on Twitter, including scrolling for knowledge, filtering for credibility and adapting knowledge for in-service training and clinical practice. Participants engaged best with images and infographics. FCPs described misinformation, bias, echo chambers, unprofessionalism, hostility, privacy concerns and blurred personal boundaries as factors impeding knowledge sharing on Twitter. Consequently, many did not feel confident enough to actively participate on Twitter. Conclusions: This study explores how Twitter is and can be used to mobilize knowledge to inform FCP clinical practice. Twitter can meet the knowledge needs of FCPs through rapid access to succinct knowledge, networking opportunities, and professional reassurance. The journey of knowledge exchange from Twitter to clinical practice can be explained by considering the mindlines model, which describes how FCPs exchange knowledge in digital and offline contexts. Findings demonstrate that Twitter can be a useful adjunct to FCP practice, although several factors impede knowledge sharing on the platform. We recommend social media training and enhanced governance guidance from professional bodies to support the use of Twitter for knowledge mobilization. %M 38742615 %R 10.2196/55680 %U https://www.jmir.org/2024/1/e55680 %U https://doi.org/10.2196/55680 %U http://www.ncbi.nlm.nih.gov/pubmed/38742615 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e51915 %T Health Care Workers’ Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis %A Jones,Jennifer %A Johnston,Jamie Sewan %A Ndiaye,Ngouille Yabsa %A Tokar,Anna %A Singla,Saumya %A Skinner,Nadine Ann %A Strehlow,Matthew %A Utunen,Heini %K massive open online course %K MOOC %K online learning %K online courses %K online course %K health care education %K medical education %K education %K training %K professional development %K continuing education %K COVID-19 training %K infectious disease outbreak response %K emergency %K public health %K crisis %K crises %K outbreak %K pandemic %K COVID-19 %K SARS-CoV-2 %K coronavirus %K humanitarian emergency response %K health care workers %K nurse %K nurses %K practitioner %K practitioners %K clinician %K clinicians %K health care worker %K medic %K low-income %K lower-middle income %K LIC %K LMIC %K developing country %K developing countries %K developing nation %K developing nations %K case study %K survey %K surveys %K descriptive analysis %K descriptive analyses %K motivation %K motivations %K lower-middle–income country %K low-income country %D 2024 %7 19.6.2024 %9 %J JMIR Med Educ %G English %X Background: Massive open online courses (MOOCs) are increasingly used to educate health care workers during public health emergencies. In early 2020, the World Health Organization (WHO) developed a series of MOOCs for COVID-19, introducing the disease and strategies to control its outbreak, with 6 courses specifically targeting health care workers as learners. In 2020, Stanford University also launched a MOOC designed to deliver accurate and timely education on COVID-19, equipping health care workers across the globe to provide health care safely and effectively to patients with the novel infectious disease. Although the use of MOOCs for just-in-time training has expanded during the pandemic, evidence is limited regarding the factors motivating health care workers to enroll in and complete courses, particularly in low-income countries (LICs) and lower-middle–income countries (LMICs). Objective: This study seeks to gain insights on the characteristics and motivations of learners turning to MOOCs for just-in-time training, to provide evidence that can better inform MOOC design to meet the needs of health care workers. We examine data from learners in 1 Stanford University and 6 WHO COVID-19 courses to identify (1) the characteristics of health care workers completing the courses and (2) the factors motivating them to enroll. Methods: We analyze (1) course registration data of the 49,098 health care workers who completed the 7 focal courses and (2) survey responses from 6272 course completers. The survey asked respondents to rank their motivations for enrollment and share feedback about their learning experience. We use descriptive statistics to compare responses by health care profession and by World Bank country income classification. Results: Health care workers completed the focal courses from all regions of the world, with nearly one-third (14,159/49,098, 28.84%) practicing in LICs and LMICs. Survey data revealed a diverse range of professional roles among the learners, including physicians (2171/6272, 34.61%); nurses (1599/6272, 25.49%); and other health care professionals such as allied health professionals, community health workers, paramedics, and pharmacists (2502/6272, 39.89%). Across all health care professions, the primary motivation to enroll was for personal learning to improve clinical practice. Continuing education credit was also an important motivator, particularly for nonphysicians and learners in LICs and LMICs. Course cost (3423/6272, 54.58%) and certification (4238/6272, 67.57%) were also important to a majority of learners. Conclusions: Our results demonstrate that a diverse range of health care professionals accessed MOOCs for just-in-time training during a public health emergency. Although all health care workers were motivated to improve their clinical practice, different factors were influential across professions and locations. These factors should be considered in MOOC design to meet the needs of health care workers, particularly those in lower-resource settings where alternative avenues for training may be limited. %R 10.2196/51915 %U https://mededu.jmir.org/2024/1/e51915 %U https://doi.org/10.2196/51915 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e52290 %T A Call for a Health Data–Informed Workforce Among Clinicians %A Doll,Joy %A Anzalone,A Jerrod %A Clarke,Martina %A Cooper,Kathryn %A Polich,Ann %A Siedlik,Jacob %K health data–informed workforce %K health data %K health informaticist %K data literacy %K workforce development %D 2024 %7 17.6.2024 %9 %J JMIR Med Educ %G English %X A momentous amount of health data has been and is being collected. Across all levels of health care, data are driving decision-making and impacting patient care. A new field of knowledge and role for those in health care is emerging—the need for a health data–informed workforce. In this viewpoint, we describe the approaches needed to build a health data–informed workforce, a new and critical skill for the health care ecosystem. %R 10.2196/52290 %U https://mededu.jmir.org/2024/1/e52290 %U https://doi.org/10.2196/52290 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51418 %T Examining the Effectiveness of Social Media for the Dissemination of Research Evidence for Health and Social Care Practitioners: Systematic Review and Meta-Analysis %A Roberts-Lewis,Sarah %A Baxter,Helen %A Mein,Gill %A Quirke-McFarlane,Sophia %A Leggat,Fiona J %A Garner,Hannah %A Powell,Martha %A White,Sarah %A Bearne,Lindsay %+ Population Health Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom, 44 20 8725 0368, sroberts@sgul.ac.uk %K social media %K dissemination %K health care %K social care %K research evidence %K practitioners %K effectiveness %K meta-analysis %K systematic review %K randomized controlled trial %K RCT %D 2024 %7 5.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners. Objective: This study aims to quantitatively synthesize evidence of the between- and within-group effectiveness of social media for dissemination of research evidence to health and social care practitioners. It also compared effectiveness between different social media platforms, formats, and strategies. Methods: We searched electronic databases for articles in English that were published between January 1, 2010, and January 10, 2023, and that evaluated social media interventions for disseminating research evidence to qualified, postregistration health and social care practitioners in measures of reach, engagement, direct dissemination, or impact. Screening, data extraction, and risk of bias assessments were carried out by at least 2 independent reviewers. Meta-analyses of standardized pooled effects were carried out for between- and within-group effectiveness of social media and comparisons between platforms, formats, and strategies. Certainty of evidence for outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. Results: In total, 50 mixed-quality articles that were heterogeneous in design and outcome were included (n=9, 18% were randomized controlled trials [RCTs]). Reach (measured in number of practitioners, impressions, or post views) was reported in 26 studies. Engagement (measured in likes or post interactions) was evaluated in 21 studies. Direct dissemination (measured in link clicks, article views, downloads, or altmetric attention score) was analyzed in 23 studies (8 RCTs). Impact (measured in citations or measures of thinking and practice) was reported in 13 studies. Included studies almost universally indicated effects in favor of social media interventions, although effect sizes varied. Cumulative evidence indicated moderate certainty of large and moderate between-group effects of social media interventions on direct dissemination (standardized mean difference [SMD] 0.88; P=.02) and impact (SMD 0.76; P<.001). After social media interventions, cumulative evidence showed moderate certainty of large within-group effects on reach (SMD 1.99; P<.001), engagement (SMD 3.74; P<.001), and direct dissemination (SMD 0.82; P=.004) and low certainty of a small within-group effect on impacting thinking or practice (SMD 0.45; P=.02). There was also evidence for the effectiveness of using multiple social media platforms (including Twitter, subsequently rebranded X; and Facebook), images (particularly infographics), and intensive social media strategies with frequent, daily posts and involving influential others. No included studies tested the dissemination of research evidence to social care practitioners. Conclusions: Social media was effective for disseminating research evidence to health care practitioners. More intense social media campaigns using specific platforms, formats, and strategies may be more effective than less intense interventions. Implications include recommendations for effective dissemination of research evidence to health care practitioners and further RCTs in this field, particularly investigating the dissemination of social care research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022378793; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378793 International Registered Report Identifier (IRRID): RR2-10.2196/45684 %M 38838330 %R 10.2196/51418 %U https://www.jmir.org/2024/1/e51418 %U https://doi.org/10.2196/51418 %U http://www.ncbi.nlm.nih.gov/pubmed/38838330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56138 %T An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study %A Tourrette,Cédric %A Tostain,Jean-Baptiste %A Kozub,Eva %A Badreddine,Maha %A James,Julia %A Noraz,Aurore %A De Choudens,Charlotte %A Moulis,Lionel %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Montpellier University, INSERM, Campus Sante, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France, 33 684014834, francois.carbonnel@umontpellier.fr %K planetary health %K One Health %K medical education %K environmental health %K education %K e-learning %K general practitioner %K pilot study %K climate change %K training %K environmental %K e-learning module %K behavior change %K ecosystem %K questionnaire %K behavior %K self-assessment %K e-learning intervention %K environment %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ≥65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. Objective: The objective of this study was to assess the impact of the e-learning module on participants’ knowledge and behavior change. Methods: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. Results: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants’ pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). Conclusions: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice. %M 38743463 %R 10.2196/56138 %U https://formative.jmir.org/2024/1/e56138 %U https://doi.org/10.2196/56138 %U http://www.ncbi.nlm.nih.gov/pubmed/38743463 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55297 %T Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident–Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial %A Lule,Herman %A Mugerwa,Micheal %A Ssebuufu,Robinson %A Kyamanywa,Patrick %A Bärnighausen,Till %A Posti,Jussi P %A Wilson,Michael Lowery %+ Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turun Yliopisto, Turku, FI-20014, Finland, 358 465699821, helule@utu.fi %K randomized controlled trial %K medical education %K trauma team %K trauma registry %K rural health %K global health %K team development %K Africa %K rural %K trauma %K motorcycle injury %K multicenter cluster randomized controlled clinical trial %K injury %K accident %K low- and middle-income countries %K patient outcomes %K education program %D 2024 %7 7.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. Objective: This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident–related injuries in an African low-resource setting. Methods: This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident–related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. Results: The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. Conclusions: This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. Trial Registration: Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763 International Registered Report Identifier (IRRID): DERR1-10.2196/55297 %M 38713507 %R 10.2196/55297 %U https://www.researchprotocols.org/2024/1/e55297 %U https://doi.org/10.2196/55297 %U http://www.ncbi.nlm.nih.gov/pubmed/38713507 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e58743 %T Digital Skills to Improve Levels of Care and Renew Health Care Professions %A De Martinis,Massimo %A Ginaldi,Lia %K digital competence %K telehealth %K nursing %K health care workforce %K health care professionals %K informatics %K education %K curriculum %K interdisciplinary education %K health care education %D 2024 %7 1.5.2024 %9 %J JMIR Med Educ %G English %X %R 10.2196/58743 %U https://mededu.jmir.org/2024/1/e58743 %U https://doi.org/10.2196/58743 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e53997 %T Digital Health Education for the Future: The SaNuRN (Santé Numérique Rouen-Nice) Consortium’s Journey %A Grosjean,Julien %A Dufour,Frank %A Benis,Arriel %A Januel,Jean-Marie %A Staccini,Pascal %A Darmoni,Stéfan Jacques %K digital health %K medical informatics %K education %K health education %K curriculum %K students %K teaching materials %K hybrid learning %K program development %K capacity building %K access to information %K e-learning %K open access %K open data %K skills framework %K competency-based learning %K telemedicine training %K medical simulation %K objective structured clinical examination %K OSCE %K script concordance test %K SCT %K virtual patient %D 2024 %7 30.4.2024 %9 %J JMIR Med Educ %G English %X Santé Numérique Rouen-Nice (SaNuRN; “Digital Health Rouen-Nice” in English) is a 5-year project by the University of Rouen Normandy (URN) and Côte d’Azur University (CAU) consortium to optimize digital health education for medical and paramedical students, professionals, and administrators. The project includes a skills framework, training modules, and teaching resources. In 2027, SaNuRN is expected to train a significant portion of the 400,000 health and paramedical students at the French national level. Our purpose is to give a synopsis of the SaNuRN initiative, emphasizing its novel educational methods and how they will enhance the delivery of digital health education. Our goals include showcasing SaNuRN as a comprehensive program consisting of a proficiency framework, instructional modules, and educational materials and explaining how SaNuRN is implemented in the participating academic institutions. SaNuRN is aimed at educating and training health and paramedical students in digital health. The project is a cooperative effort between URN and CAU, covering 4 French departments. It is based on the French National Referential on Digital Health (FNRDH), which defines the skills and competencies to be acquired and validated by every student in the health, paramedical, and social professions curricula. The SaNuRN team is currently adapting the existing URN and CAU syllabi to FNRDH and developing short-duration video capsules of 20-30 minutes to teach all the relevant material. The project aims to ensure that the largest student population earns the necessary skills, and it has developed a 2-tier system involving facilitators who will enable the efficient expansion of the project’s educational outreach and support the students in learning the needed material efficiently. With a focus on real-world scenarios and innovative teaching activities integrating telemedicine devices and virtual professionals, SaNuRN is committed to enabling continuous learning for health care professionals in clinical practice. The SaNuRN team introduced new ways of evaluating health care professionals by shifting from a knowledge-based to a competencies-based evaluation, aligning with the Miller teaching pyramid and using the Objective Structured Clinical Examination and Script Concordance Test in digital health education. Drawing on the expertise of URN, CAU, and their public health and digital research laboratories and partners, SaNuRN represents a platform for continuous innovation, including telemedicine training and living labs with virtual and interactive professional activities. SaNuRN provides a comprehensive, personalized, 30-hour training package for health and paramedical students, addressing all 70 FNRDH competencies. The project is enhanced using artificial intelligence and natural language processing to create virtual patients and professionals for digital health care simulation. SaNuRN teaching materials are open access. It collaborates with academic institutions worldwide to develop educational material on digital health in English and multilingual formats. SaNuRN offers a practical and persuasive training approach to meet the current digital health education requirements. %R 10.2196/53997 %U https://mededu.jmir.org/2024/1/e53997 %U https://doi.org/10.2196/53997 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e52230 %T Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study %A Chien,Cheng-Yu %A Tsai,Shang-Li %A Huang,Chien-Hsiung %A Wang,Ming-Fang %A Lin,Chi-Chun %A Chen,Chen-Bin %A Tsai,Li-Heng %A Tseng,Hsiao-Jung %A Huang,Yan-Bo %A Ng,Chip-Jin %+ Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, No 5 Fushing Street, Gueishan District, Taoyuan, 33305, Taiwan, 886 3 3281200 ext 2505, ngowl@ms3.hinet.net %K cardiopulmonary resuscitation %K blended method %K blended %K hybrid %K refresher %K refreshers %K teaching %K instruction %K observational %K training %K professional development %K continuing education %K retraining %K traditional method %K self-directed learning %K resuscitation %K CPR %K emergency %K resuscitation %K rescue %K life support %K cardiac %K cardiopulmonary %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method. Objective: This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators. Methods: This study recruited participants aged ≥18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators. Results: This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3% female), with 332 (28.5%), 270 (23.2%), 258 (22.2%), and 303 (26.1%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80%); however, a higher proportion (98/303, 32.3%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training. Conclusions: Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach. Trial Registration: IGOGO NCT05659108; https://www.cgmh-igogo.tw %M 38683663 %R 10.2196/52230 %U https://mededu.jmir.org/2024/1/e52230 %U https://doi.org/10.2196/52230 %U http://www.ncbi.nlm.nih.gov/pubmed/38683663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50968 %T Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study %A O'Brien,Niki %A Fernandez Crespo,Roberto %A O'Driscoll,Fiona %A Prendergast,Mabel %A Chana,Deeph %A Darzi,Ara %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary’s Campus, London, W21NY, United Kingdom, 44 (0)20 3312 1310, n.obrien@imperial.ac.uk %K acceptability %K cross sectional %K cybersecurity %K digital health %K digital transformation %K education %K feasibility %K framework %K frameworks %K global health %K health systems %K implementation %K organization %K organizational %K organizations %K patient safety %K SWOT %K TAM %K usability %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care–specific resources to help organizations at different levels of maturity develop their cybersecurity practices. Objective: This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. Methods: A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams’ networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. Results: A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. Conclusions: The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone’s responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed. %M 38603777 %R 10.2196/50968 %U https://formative.jmir.org/2024/1/e50968 %U https://doi.org/10.2196/50968 %U http://www.ncbi.nlm.nih.gov/pubmed/38603777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54656 %T Evaluation of an e-Learning Program for Community Pharmacists for Dispensing Emicizumab (Hemlibra) in France: Nationwide Cross-Sectional Study %A Chamouard,Valérie %A Freyssenge,Julie %A Clairaz-Mahiou,Béatrice %A Ferrera Bibas,Felicia %A Fraticelli,Laurie %+ Laboratory P2S (Health Systemic Process), UR 4129, University Claude Bernard Lyon 1, 7-11 rue Guillaume Paradin, Lyon, 69372, France, 33 04 78 78 57 45, laurie.fraticelli@univ-lyon1.fr %K hemophilia %K care pathway %K emicizumab %K Kirkpatrick model %K pharmacy %K survey %K Hemlibra %K France %K e-learning program %K pharmacists %K pharmacist %K hemophilia A %K hospital %K HEMOPHAR %K methodology %K community %K engagement %K pharmaceutical %K rare disease %K digital health %K intervention %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since June 2021, patients with hemophilia A with antifactor VIII inhibitors and those with severe hemophilia A without antifactor VIII inhibitors treated with Hemlibra have had to choose between a community or hospital pharmacy. The French reference center for hemophilia developed the HEMOPHAR e-learning program for community pharmacists for dispensing emicizumab.  Objective: This study aims to evaluate the efficiency and safety of this new care pathway by assessing the HEMOPHAR e-learning program.  Methods: The methodology is based on Kirkpatrick’s model for evaluating the immediate reaction of trained community pharmacists (level 1), their level of acquired knowledge (level 2), and their professional practice after 3 months of dispensation (level 3).  Results: The HEMOPHAR e-learning program reached a large audience, with 67% (337/502) of the eligible community pharmacists following it. The immediate reaction was overall satisfying. High rates of engagement were reported with 63.5% (214/337) to 73.3% (247/337) of completed training modules, along with high rates of success with quizzes of 61.5% (174/337) to 95.7% (244/337). We observed that 83.9% (193/230) of the community pharmacists needed less than 2 attempts to pass the quiz of the module related to professional practice, while the other quizzes required more attempts. Advice on compliance and drug interactions were most frequently provided to patients by the community pharmacists.  Conclusions: This study suggests ways to improve the training of community pharmacists and to optimize coordination with treatment centers. This study also reports on the feasibility of switching to a community pharmacy in a secure pharmaceutical circuit, including in the context of a rare bleeding disease.  Trial Registration: ClinicalTrials.gov NCT05449197; https://clinicaltrials.gov/study/NCT05449197 International Registered Report Identifier (IRRID): RR2-10.2196/43091 %M 38574351 %R 10.2196/54656 %U https://formative.jmir.org/2024/1/e54656 %U https://doi.org/10.2196/54656 %U http://www.ncbi.nlm.nih.gov/pubmed/38574351 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50864 %T Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials %A Kimber,Melissa %A Baker-Sullivan,Elizabeth %A Stewart,Donna E %A Vanstone,Meredith %+ Offord Centre for Child Studies, Department of Psychiatry & Behavioural Neurosciences, McMaster University, WHC 120, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 27220, kimberms@mcmaster.ca %K medical education %K health professions education %K child maltreatment %K intimate partner violence %K mixed methods %K pilot trial %K qualitative description %K family violence %D 2024 %7 21.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence. Objective: Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters. Methods: The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct service capacity. Participants complete quantitative assessments at baseline, after intervention, and at 3-month follow-up. A subset of participants from each arm also undergoes a qualitative semistructured interview with the aim of describing participants’ perceptions of the value and impact of each VEGA modality, as well as research burden. Scores on potential outcome measures will be mapped to excerpts of qualitative data via a mixed methods joint display to aid in the interpretation of findings. Results: We consented 71 individuals to participate in the RISE with Residents study. Data collection was completed on August 31, 2023, and data are currently being cleaned and prepared for analysis. As of January 15, 2024, we consented 34 individuals in the RISE with Veterans study; data collection will be completed in March 2024. For both studies, no data analysis had taken place at the time of manuscript submission. Results will be disseminated through peer-reviewed publications; academic conferences; and posting and sharing of study summaries and infographics on social media, the project website, and via professional network listserves. Conclusions: Reducing the impacts of family violence remains a pressing public health challenge. Both research studies will provide a valuable methodological contribution about the feasibility of trial methods in health professions education focused on family violence. They will also contribute to education science about the differences in the effectiveness of self-directed versus facilitator-led learning strategies. Trial Registration: ClinicalTrials.gov NCT05490121, https://clinicaltrials.gov/study/NCT05490121; ClinicalTrials.gov NCT05490004, https://clinicaltrials.gov/study/NCT05490004 International Registered Report Identifier (IRRID): DERR1-10.2196/50864 %M 38512307 %R 10.2196/50864 %U https://www.researchprotocols.org/2024/1/e50864 %U https://doi.org/10.2196/50864 %U http://www.ncbi.nlm.nih.gov/pubmed/38512307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51141 %T The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study %A Al-Sbei,Rasha %A Ataya,Jawdat %A Jamous,Issam %A Dashash,Mayssoon %+ Medical Education Program, Syrian Virtual University, Al-Mazzeh Street, Damascus, 35329, Syrian Arab Republic, 963 992287487, dr.jawdat.ataya@gmail.com %K restorative dentistry %K online learning %K dental education %K dental graduates %K Syria %K education %K dental %K dentistry %K dental practice %K effectiveness %K educational program %K survey %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. Objective: This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. Methods: This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants’ knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. Results: The results showed a significant improvement in the participants’ knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. Conclusions: The findings indicated a notable enhancement in the participants’ understanding of restorative dentistry. The participants’ high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field. %M 38441921 %R 10.2196/51141 %U https://formative.jmir.org/2024/1/e51141 %U https://doi.org/10.2196/51141 %U http://www.ncbi.nlm.nih.gov/pubmed/38441921 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e46740 %T Evaluating the Impact of the National Health Service Digital Academy on Participants’ Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study %A Acharya,Amish %A Black,Ruth Claire %A Smithies,Alisdair %A Darzi,Ara %+ Institute of Global Health Innovation, Imperial College London, 10th Floor, St Mary's Hospital, Paddington, London, W2 1NY, United Kingdom, 44 207 886 2125, aa2107@ic.ac.uk %K digital leadership %K professional identity %K dissertation of practice %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership. Objective: This study aims to examine the impact of the NHSDA program on participants’ perceptions of themselves as digital health leaders. Methods: We recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals’ perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework. Results: Of the 41 participants, 42% (17/41) were in clinical roles, 34% (14/41) were in program delivery or management roles, 20% (8/41) were in data science roles, and 5% (2/41) were in “other” roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants’ values and direction within the wider digital health community. According to the questionnaire, after graduation, 59% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46% (11/24) reporting that the course was a strong determinant of this change. Conclusions: A digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development. %M 38381477 %R 10.2196/46740 %U https://mededu.jmir.org/2024/1/e46740 %U https://doi.org/10.2196/46740 %U http://www.ncbi.nlm.nih.gov/pubmed/38381477 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e49551 %T Unpacking the Experiences of Health Care Professionals About the Web-Based Building Resilience At Work Program During the COVID-19 Pandemic: Framework Analysis %A Ang,Wei How Darryl %A Lim,Zhi Qi Grace %A Lau,Siew Tiang %A Dong,Jie %A Lau,Ying %+ The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 829, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China (Hong Kong), 852 39436222, yinglau@cuhk.edu.hk %K resilience %K intent to stay %K employability %K health care professionals %K process evaluation %K framework analysis %K framework %K resilience %K stress %K mental health disorder %K prevention %K training %K qualitative study %K web-based tool %K tool %K sustainability %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has resulted in a greater workload in the health care system. Therefore, health care professionals (HCPs) continue to experience high levels of stress, resulting in mental health disorders. From a preventive perspective, building resilience has been associated with reduced stress and mental health disorders and promotes HCPs’ intent to stay. Despite the benefits of resilience training, few studies provided an in-depth understanding of the contextual factors, implementation, and mechanisms of impact that influences the sustainability of resilience programs. Therefore, examining target users’ experiences of the resilience program is important. This will provide meaningful information to refine and improve future resilience programs. Objective: This qualitative study aims to explore HCPs’ experiences of participating in the web-based Building Resilience At Work (BRAW) program. In particular, this study aims to explore the contextual and implementational factors that would influence participants’ interaction and outcome from the program. Methods: A descriptive qualitative approach using individual semistructured Zoom interviews was conducted with participants of the web-based resilience program. A framework analysis was conducted, and it is guided by the process evaluation framework. Results: A total of 33 HCPs participated in this qualitative study. Three themes depicting participants’ experiences, interactions, and impacts from the BRAW program were elucidated from the framework analysis: learning from web-based tools, interacting with the BRAW program, and promoting participants’ workforce readiness. Conclusions: Findings show that a web-based asynchronous and self-paced resilience program is an acceptable and feasible approach for HCPs. The program also led to encouraging findings on participants’ resilience, intent to stay, and employability. However, continued refinements in the components of the web-based resilience program should be carried out to ensure the sustainability of this intervention. Trial Registration: ClinicalTrials.gov NCT05130879; https://clinicaltrials.gov/ct2/show/NCT05130879 %M 38294866 %R 10.2196/49551 %U https://mededu.jmir.org/2024/1/e49551 %U https://doi.org/10.2196/49551 %U http://www.ncbi.nlm.nih.gov/pubmed/38294866 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54213 %T Model for Doctor of Nursing Practice Projects Based on Cross-Fertilization Between Improvement and Implementation Sciences: Protocol for Quality Improvement and Program Evaluation Studies %A Sowan,Azizeh %A Chinman,Matthew %+ School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 7975, United States, 1 210 567 5799, sowan@uthscsa.edu %K quality improvement %K implementation %K Doctor of Nursing Practice %K model %K methodology %K Nursing %K Doctor of Nursing %K hybrid approach %K implementation sciences %K scholarship %K scholars %K Nursing Practice Program %K nursing program %D 2024 %7 31.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hundreds of nursing professionals graduate each year from Doctor of Nursing Practice (DNP) programs, entrusted with roles as practice scholars and leaders. Graduates are tasked to lead multidisciplinary knowledge implementation projects to improve safety, quality, and key performance metrics. Nevertheless, there is a continued lack of agreement and faculty dissatisfaction with the format, focus, and results of the DNP graduation projects. The use of a wide range of models and methodologies from different sciences for knowledge implementation introduces challenges to DNP students; affects the scientific rigor of the projects; and results in the overuse, superficial use, or misuse of the models. Quality improvement (QI) and program evaluation studies are substantial investments that may lead to waste and even harm if not well conducted. Traditional QI methodologies, commonly used in DNP projects, were found to be uncertain in improving health care outcomes. The complexity of health care systems calls for cross-fertilization between improvement and implementation sciences to improve health care outcomes. Objective: This study describes the development, implementation, and evaluation of a hybrid model for QI and program evaluation studies to guide scholarship in the DNP program. Methods: The hybrid model was based on cross-fertilization between improvement and implementation sciences. The model adapted the Getting to Outcome (GTO) and Knowledge to Action (KTA) models as the overarching process models for knowledge implementation. Within each phase of the GTO and KTA models, expected barriers and facilitators for the implementation and adoption of innovation were identified based on the CFIR (Consolidated Framework for Implementation Research). Accordingly, strategies to facilitate the implementation and adoption of innovations were identified based on a refined list of implementation strategies and QI tools. The choice of these models was based on the top 5 criteria for selecting implementation science theories and frameworks. Seven DNP students used the hybrid model to conduct QI projects. Students evaluated their experiences by responding to a Qualtrics survey. Results: The hybrid model encouraged a comprehensive systematic way of thinking, provided tools essential to implementation success, emphasized the need for adaptability in implementation, maintained rigor in QI, and guided the sustainability of change initiatives. Some of the challenges faced by students included finding reliable and valid measures, attaining and maintaining staff buy-in, and competing organizational priorities. Conclusions: Cross-fertilization between improvement and implementation sciences provided a roadmap and systematic thinking for successful QI projects in the DNP program. The integration of the CFIR with the GTO or KTA process models, enforced by the use of evidence-based implementation strategies and QI tools, reflected the complexity of health care systems and emphasized the need for adaptability in implementation. International Registered Report Identifier (IRRID): RR1-10.2196/54213 %M 38294860 %R 10.2196/54213 %U https://www.researchprotocols.org/2024/1/e54213 %U https://doi.org/10.2196/54213 %U http://www.ncbi.nlm.nih.gov/pubmed/38294860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44653 %T Virtual and Interprofessional Objective Structured Clinical Examination in Dentistry and Dental Technology: Development and User Evaluations %A Pang,MengWei %A Dong,YanLing %A Zhao,XiaoHan %A Wan,JiaWu %A Jiang,Li %A Song,JinLin %A Ji,Ping %A Jiang,Lin %+ Stomatological Hospital of Chongqing Medical University, 426# Songshibei Road, Yubei District, Chongqing, 401147, China, 86 15922650133, jianglin@hospital.cqmu.edu.cn %K dentist %K dental technician %K objective structured clinical examination %K OSCE %K interprofessional education %K interprofessional collaborative practice %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Interprofessional education (IPE) facilitates interprofessional collaborative practice (IPCP) to encourage teamwork among dental care professionals and is increasingly becoming a part of training programs for dental and dental technology students. However, the focus of previous IPE and IPCP studies has largely been on subjective student and instructor perceptions without including objective assessments of collaborative practice as an outcome measure. Objective: The purposes of this study were to develop the framework for a novel virtual and interprofessional objective structured clinical examination (viOSCE) applicable to dental and dental technology students, to assess the effectiveness of the framework as a tool for measuring the outcomes of IPE, and to promote IPCP among dental and dental technology students. Methods: The framework of the proposed novel viOSCE was developed using the modified Delphi method and then piloted. The lead researcher and a group of experts determined the content and scoring system. Subjective data were collected using the Readiness for Interprofessional Learning Scale and a self-made scale, and objective data were collected using examiner ratings. Data were analyzed using nonparametric tests. Results: We successfully developed a viOSCE framework applicable to dental and dental technology students. Of 50 students, 32 (64%) participated in the pilot study and completed the questionnaires. On the basis of the Readiness for Interprofessional Learning Scale, the subjective evaluation indicated that teamwork skills were improved, and the only statistically significant difference in participant motivation between the 2 professional groups was in the mutual evaluation scale (P=.004). For the viOSCE evaluation scale, the difference between the professional groups in removable prosthodontics was statistically significant, and a trend for negative correlation between subjective and objective scores was noted, but it was not statistically significant. Conclusions: The results confirm that viOSCE can be used as an objective evaluation tool to assess the outcomes of IPE and IPCP. This study also revealed an interesting relationship between mutual evaluation and IPCP results, further demonstrating that the IPE and IPCP results urgently need to be supplemented with objective evaluation tools. Therefore, the implementation of viOSCE as part of a large and more complete objective structured clinical examination to test the ability of students to meet undergraduate graduation requirements will be the focus of our future studies. %M 38231556 %R 10.2196/44653 %U https://formative.jmir.org/2024/1/e44653 %U https://doi.org/10.2196/44653 %U http://www.ncbi.nlm.nih.gov/pubmed/38231556 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e52279 %T A Service-Learning Project Based on a Community-Oriented Intelligent Health Promotion System for Postgraduate Nursing Students: Mixed Methods Study %A Sun,Ting %A Xu,Xuejie %A Zhu,Ningning %A Zhang,Jing %A Ma,Zuchang %A Xie,Hui %+ School of Nursing, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233030, China, 86 0552 3178522, hui2122@hotmail.com %K service learning %K intelligent health promotion system %K scientific awareness %K research innovation ability %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Service learning (SL) is a pedagogical approach that combines community service with cognitive learning for professionals. Its efficacy in promoting community health has gained broad recognition in nursing education. The application of postgraduate nursing SL programs in community-based intelligent health remains underexplored. Thus, additional investigation is necessary to assess the influence of the SL project based on a community-oriented intelligent health promotion system (SLP-COIHPS) on postgraduate nursing students and health service recipients. Objective: This study aims to assess how SLP-COIHPS influences the scientific awareness and research innovation abilities of postgraduate nursing students. In addition, the study sought to examine the experiences of both participating students and health service recipients. Methods: We conducted a mixed methods investigation by using web-based surveys and conducting interviews. The web-based surveys aimed to explore the differences in scientific awareness and research innovation capabilities between 2 distinct groups: an experimental group of 23 postgraduate nursing students actively participated in SLP-COIHPS, while 23 postgraduate students (matched one-to-one with the experimental group in terms of grade, sex, and research methods) served as control participants. Semistructured interviews were conducted with 65% (15/23) of postgraduate students and 3% (12/405) of community residents who received health services, aiming to assess the project’s impact on them. The community-based intelligent health promotion system installed in intelligent health cabins can be conceptualized as an expert system providing valuable references for student health education. It has the capability to generate comprehensive assessments and personalized health guidance plans. Following training, students were involved in offering health assessments, health education, and related services. Subsequently, after the web-based surveys and semistructured interviews, quantitative data were analyzed using the SPSS (IBM Corp) software package, using 2-tailed t tests and Mann-Whitney U tests; qualitative data underwent analysis using the constructivist grounded theory approach. Results: Postgraduate nursing students participating in this program scored 12.83 (Cohen d>0.8; P<.001) and 10.56 (Cohen d>0.8; P=.004) points higher than postgraduate students in the control group in research awareness and research innovation capability, respectively. On the basis of the qualitative results, postgraduate students reported improvement in this program. Analysis of the interviews revealed a total of 12 subcategories across three primary domains: (1) specialized skills, (2) scientific research ability, and (3) comprehensive qualities. Community residents reported high satisfaction and positive experiences. Analysis of the interviews with community residents identified two primary categories: (1) satisfaction and (2) perceived benefits. Conclusions: SLP-COIHPS had a positive impact on students’ development of scientific awareness and research innovation ability. Qualitative study findings also support the further development of practical programs that integrate intelligent health and SL theories in the field of medical education. This includes exploring the potential factors influencing postgraduate nursing students’ research capabilities or investigating the long-term effects of the project. %M 38100207 %R 10.2196/52279 %U https://mededu.jmir.org/2023/1/e52279 %U https://doi.org/10.2196/52279 %U http://www.ncbi.nlm.nih.gov/pubmed/38100207 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47603 %T Implementation of Competency-Based Education for Quality Midwifery Programs in Africa: Protocol for a Scoping Review %A Ige,Waleola Bukola %A Ngcobo,Winnie Baphumelele %A Afolabi,Opeyemi %+ School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 238 Masizi Kunene Road, Glenwood, Durban, South Africa, 4041, Nigeria, 234 8034626570, 218088046@stu.ukzn.ac.za %K Africa %K competency-based education %K implementation %K midwifery programme %K protocol %K scoping review %K sustainability %D 2023 %7 4.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Competency-based education (CBE) for midwifery programs is a system of academic instruction and evaluation that aims to achieve proficiency in midwifery student learning outcomes, which is based on students’ ability to demonstrate the knowledge, attitudes, self-perceptions, and skills of a predetermined set of educational activities in theory and practice. CBE focuses on ensuring that midwifery students can develop critical thinking abilities, values, and the clinical decision-making abilities needed for the delivery of safe care in future practice. Objective: The objective of this scoping review is to map and synthesize existing literature on the implementation of CBE for midwifery programs and its sustainability in Africa. Methods: We will use the Arksey and O’Malley approach for scoping reviews for the research methodology. The 3-stage search process, proposed by the Joanna Briggs Institute, will be used to determine the eligibility of published and unpublished studies. PubMed, Science Direct, Web of Science, CINAHL, PsycINFO, and Scopus will be searched to screen published articles. ProQuest Dissertations and Theses and Google Scholar will be used to search for unpublished studies. Findings will only apply to studies conducted in Africa from 2010 to the present year in English. The 2 reviewers will work independently to carefully screen and compare the full text of the selected citations to the inclusion criteria. In the event of any disagreements between the 2 reviewers at any stage of the selection process regarding the inclusion of an article, this will be settled by discussion or consultation with a third reviewer. The extracted data will be presented using a PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review) flow diagram with an attached narrative summary. The review will summarize and disseminate findings on the implementation of the CBE for midwifery programs and its sustainability in Africa. Results: It is intended that this scoping review will be completed within 6 months following the publication of this protocol. Conclusions: The conclusions from this scoping review will inform midwifery educators, institutions, policy makers, and other stakeholders on the strategies to implement and sustain CBE for midwifery programs in Africa. International Registered Report Identifier (IRRID): PRR1-10.2196/47603 %M 38048157 %R 10.2196/47603 %U https://www.researchprotocols.org/2023/1/e47603 %U https://doi.org/10.2196/47603 %U http://www.ncbi.nlm.nih.gov/pubmed/38048157 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e48804 %T Supporting Clinical Competencies in Men’s Mental Health Using the Men in Mind Practitioner Training Program: User Experience Study %A Seidler,Zac E %A Benakovic,Ruben %A Wilson,Michael J %A Fletcher,Justine %A Oliffe,John L %A Owen,Jesse %A Rice,Simon M %+ Orygen, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 0432 438 254, zac.seidler@orygen.org.au %K e-learning %K mental health services %K psychotherapy %K men’s mental health %K masculinity %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Engaging men in psychotherapy is essential in male suicide prevention efforts, yet to date, efforts to upskill mental health practitioners in delivering gender-sensitized therapy for men have been lacking. To address this, we developed Men in Mind, an e-learning training program designed to upskill mental health practitioners in engaging men in therapy. Objective: This study involves an in-depth analysis of the user experience of the Men in Mind intervention, assessed as part of a randomized controlled trial of the efficacy of the intervention. Methods: Following completion of the intervention, participants provided qualitative (n=392) and quantitative (n=395) user experience feedback, focused on successes and suggested improvements to the intervention and improvements to their confidence in delivering therapy with specific subpopulations of male clients. We also assessed practitioner learning goals (n=242) and explored the extent to which participants had achieved these goals at follow-up. Results: Participants valued the inclusion of video demonstrations of skills in action alongside the range of evidence-based content dedicated to improving their insight into the engagement of men in therapy. Suggested improvements most commonly reflected the desire for more or more diverse content, alongside the necessary adaptations to improve the learning and user experience. Participants also commonly reported improved confidence in assisting men with difficulty articulating their emotions in therapy and suicidal men. Conclusions: The evidence obtained from this study aids in plans to scale Men in Mind and informs the future development of practitioner training interventions in men’s mental health. International Registered Report Identifier (IRRID): RR2-10.1186/s40359-022-00875-9 %M 37934579 %R 10.2196/48804 %U https://mededu.jmir.org/2023/1/e48804 %U https://doi.org/10.2196/48804 %U http://www.ncbi.nlm.nih.gov/pubmed/37934579 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47293 %T Nursing Training for Early Clinical Deterioration Risk Assessment: Protocol for an Implementation Study %A Lourenço,Laura Bacelar de Araujo %A Meszaros,Mariana de Jesus %A Silva,Michele de Freitas Neves %A São-João,Thaís Moreira %+ School of Nursing, University of Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, 13083-887, Brazil, 55 19974082753, laurabalourenco@gmail.com %K nursing %K hospitalization %K clinical deterioration %K patient safety %K early warning score %K education %D 2023 %7 17.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the hospitalization period, it is possible to observe considerable changes in the vital parameters of patients, which may require emergency interventions or intensive treatment. The alteration of signs and symptoms that lead to physiological instability that can worsen the clinical picture with progression to shock, respiratory failure, or cardiorespiratory arrest is currently defined as clinical deterioration. Identifying signs of clinical deterioration at an early stage can lead to substantial decreases in mortality rates, the need for emergency interventions, and unscheduled treatments in intensive care units. Identifying and appropriately referring patients who show signs of clinical deterioration can be facilitated by applying early warning systems that provide rapid responses. The nursing team is usually the first to identify clinical changes in patients. Although the literature demonstrates that early recognition of clinical deterioration is the key to early intervention and leads to better outcomes, we only sometimes pursue the most appropriate intervention. Objective: This study aims to implement and evaluate an evidence-based professional training program designed for nurses and coordinated by a nurse using the “just-in-time” methodology and the National Early Warning Score 2 (NEWS2) to assess the risk of early clinical deterioration and appropriate referral in inpatient units of a public university hospital in southeastern Brazil. Methods: This intervention protocol is structured according to the recommendations of the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Declaration 2013. The type of training to be offered, “Just-in-Time Training,” consists of a teaching modality that facilitates the delivery of a time-based and work-based education, with greater emphasis on providing on-the-job learning as needed. A qualitative stage will also be conducted through focus groups and interviews with nurses to verify the factors that influence the professional practice related to the early evaluation of the clinic. A script of previously tested questions will guide and standardize the different groups. The data will define the intervention’s elements: the strategy, the type of training, the location, the teaching methodology, and the teaching material. Results: The study has received authorization from the ethics committee, and participants will be recruited in July 2023. Data collection should be completed in October of the same year. The results obtained at the end of this research will be shared with the participating nursing team through the presentation of reports. In addition, the research results will be submitted to scientific journals and presented at international scientific conferences. Conclusions: This study will support nurses and possibly other clinicians to improve their approach to early recognition of clinical deterioration in patients. Trial Registration: Brazilian Registry of Clinical Trials RBR-5hq9y3k; https://ensaiosclinicos.gov.br/rg/RBR-5hq9y3k International Registered Report Identifier (IRRID): PRR1-10.2196/47293 %M 37847547 %R 10.2196/47293 %U https://www.researchprotocols.org/2023/1/e47293 %U https://doi.org/10.2196/47293 %U http://www.ncbi.nlm.nih.gov/pubmed/37847547 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42862 %T Virtual Worlds Technology to Enhance Training for Primary Care Providers in Assessment and Management of Posttraumatic Stress Disorder Using Motivational Interviewing: Pilot Randomized Controlled Trial %A Manuel,Jennifer K %A Purcell,Natalie %A Abadjian,Linda %A Cardoos,Stephanie %A Yalch,Matthew %A Hill,Coleen %A McCarthy,Brittan %A Bertenthal,Daniel %A McGrath,Sarah %A Seal,Karen %+ San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA, 94121, United States, 1 415 221 4810 ext 25206, jennifer.manuel@va.gov %K primary care %K posttraumatic stress disorder %K PTSD %K motivational interviewing %K virtual training %K training %K virtual %K stress %K disorder %K treatment %K patient %K assessment %K communication %K feasibility %K acceptability %K efficacy %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Many individuals with posttraumatic stress disorder (PTSD) first present to primary care rather than specialty mental health care. Primary care providers often lack the training required to assess and treat patients with PTSD. Virtual trainings have emerged as a convenient and effective way of training primary care providers in PTSD assessment and communication methods (ie, motivational interviewing [MI]). Objective: The aim of this study was to conduct a pilot randomized controlled trial of a synchronous Virtual Worlds (VW; a virtual world where learners were immersed as avatars) training versus an asynchronous web-based training on PTSD and MI, comparing the feasibility, acceptability, usability, and preliminary efficacy of 2 different training platforms among primary care providers. Methods: Participating primary care providers were randomized to a VW and a web-based PTSD training. Outcomes were collected at baseline, posttraining, and 90-days follow-up. Standardized patient interviews measured participants’ communication skills in assessing and managing patients with PTSD symptoms. Results: Compared to the web-based training, the VW training platform achieved larger learning gains in MI (ie, partnership and empathy) and in discussing pharmacotherapy and psychotherapy for PTSD. Both VW and web-based trainings led to increases in PTSD knowledge and primary care providers’ self-confidence. Conclusions: The asynchronous web-based PTSD training improved PTSD-related knowledge and self-confidence but was not as effective as the VW immersive experience in teaching MI or clinical management. Because VW training is synchronous and new for many learners, it required more time, facilitation, and technical support. As computer technology improves, VW educational interventions may become more feasible, particularly in teaching clinical skills. Trial Registration: ClinicalTrials.gov NCT03898271; https://tinyurl.com/mu479es5 %M 37639299 %R 10.2196/42862 %U https://mededu.jmir.org/2023/1/e42862 %U https://doi.org/10.2196/42862 %U http://www.ncbi.nlm.nih.gov/pubmed/37639299 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e45587 %T Web-Based Learning for General Practitioners and Practice Nurses Regarding Behavior Change: Qualitative Descriptive Study %A Raumer-Monteith,Lauren %A Kennedy,Madonna %A Ball,Lauren %+ Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, 1 Parkslands Drive, Gold Coast, 4215, Australia, 61 411747083, lauren.raumer-monteith@outlook.com %K continuing professional development %K continuing medical education %K web-based %K e-learning %K behavior change %K general practitioner %K practice nurse %K nurse %K medical education %K professional development %K general practice %K web-based learning %K remote learning %K adoption %K perspective %K health care professional %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Supporting patients to live well by optimizing behavior is a core tenet of primary health care. General practitioners and practice nurses experience barriers in providing behavior change interventions to patients for lifestyle behaviors, including low self-efficacy in their ability to enact change. Web-based learning technologies are readily available for general practitioners and practice nurses; however, opportunities to upskill in behavior change are still limited. Understanding what influences general practitioners’ and practice nurses’ adoption of web-based learning is crucial to enhancing the quality and impact of behavior change interventions in primary health care. Objective: This study aimed to explore general practitioners’ and practice nurses’ perceptions regarding web-based learning to support patients with behavior change. Methods: A qualitative, cross-sectional design was used involving web-based, semistructured interviews with general practitioners and practice nurses in Queensland, Australia. The interviews were recorded and transcribed using the built-in Microsoft Teams transcription software. Inductive coding was used to generate codes from the interview data for thematic analysis. Results: In total, there were 11 participants in this study, including general practitioners (n=4) and practice nurses (n=7). Three themes emerged from the data analysis: (1) reflecting on the provider of the Healthy Lifestyles suite; (2) valuing the web-based learning content and presentation; and (3) experiencing barriers and facilitators to using the Healthy Lifestyles suite. Conclusions: Provider reputation, awareness of availability, resources, content quality, usability, cost, and time influence adoption of web-based learning. Perceived quality is associated with culturally tailored information, resources, a balance of information and interactivity, plain language, user-friendly navigation, appealing visual presentation, communication examples, and simple models. Free web-based learning that features progress saving and module lengths of less than 2 hours alleviate perceived time and cost barriers. Learning providers may benefit by including these features in their future behavior change web-based learning for general practitioners and practice nurses. %M 37498657 %R 10.2196/45587 %U https://mededu.jmir.org/2023/1/e45587 %U https://doi.org/10.2196/45587 %U http://www.ncbi.nlm.nih.gov/pubmed/37498657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48392 %T The ChatGPT (Generative Artificial Intelligence) Revolution Has Made Artificial Intelligence Approachable for Medical Professionals %A Mesko,Bertalan %+ The Medical Futurist Institute, Povl Bang-Jensen u 2/B1 4/1, Budapest, 1118, Hungary, 36 703807260, berci@medicalfuturist.com %K artificial intelligence %K digital health %K future %K technology %K ChatGPT %K medical practice %K large language model %K language model %K generative %K conversational agent %K conversation agents %K chatbot %K generated text %K computer generated %K medical education %K continuing education %K professional development %K curriculum %K curricula %D 2023 %7 22.6.2023 %9 Viewpoint %J J Med Internet Res %G English %X In November 2022, OpenAI publicly launched its large language model (LLM), ChatGPT, and reached the milestone of having over 100 million users in only 2 months. LLMs have been shown to be useful in a myriad of health care–related tasks and processes. In this paper, I argue that attention to, public access to, and debate about LLMs have initiated a wave of products and services using generative artificial intelligence (AI), which had previously found it hard to attract physicians. This paper describes what AI tools have become available since the beginning of the ChatGPT revolution and contemplates how it they might change physicians’ perceptions about this breakthrough technology. %M 37347508 %R 10.2196/48392 %U https://www.jmir.org/2023/1/e48392 %U https://doi.org/10.2196/48392 %U http://www.ncbi.nlm.nih.gov/pubmed/37347508 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46601 %T Enhancing Nonverbal Communication Through Virtual Human Technology: Protocol for a Mixed Methods Study %A Perez,Analay %A Fetters,Michael D %A Creswell,John W %A Scerbo,Mark %A Kron,Frederick W %A Gonzalez,Richard %A An,Lawrence %A Jimbo,Masahito %A Klasnja,Predrag %A Guetterman,Timothy C %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7124, tguetter@umich.edu %K human technology %K MPathic-VR %K nonverbal communication behavior %K patient-provider communication %K virtual human %D 2023 %7 6.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. Objective: The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. Methods: This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic–virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. Results: Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. Conclusions: The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers. International Registered Report Identifier (IRRID): DERR1-10.2196/46601 %M 37279041 %R 10.2196/46601 %U https://www.researchprotocols.org/2023/1/e46601 %U https://doi.org/10.2196/46601 %U http://www.ncbi.nlm.nih.gov/pubmed/37279041 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e46673 %T Usefulness of a Digitally Assisted Person-Centered Care Intervention: Qualitative Study of Patients’ and Nurses’ Experiences in a Long-term Perspective %A Olesen,Mette Linnet %A Rossen,Sine %A Jørgensen,Rikke %A Langballe Udbjørg,Line %A Hansson,Helena %+ Department of Gynecology, The Interdisciplinary Research Unit of Women’s, Children’s and Families’ Health, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 35456850, mette.linnet.olesen@regionh.dk %K digital technology %K digital nursing %K digitally assisted guided self-determination %K empowerment %K self-management %K person-centered care %K qualitative %K service design %K patient care %K nurse %K quality of life %K interview %K web-based questionnaire %K functionality %K support %K training %K implementation %K self-determination %K autonomy %K agency %K person centered %K patient centered %K client focus %K gynecology %K oncology %K health knowledge %K health care professional %K health care provider %K HCP %K mobile phone %D 2023 %7 18.5.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with the increasingly mature technology. The first theme was the different experiences and perspectives of nurses and patients concerning barriers to using DA-GSD and comprised 4 subthemes: conflicting perspectives on the ability of patients to engage with DA-GSD and how to provide it, conflicting perspectives on DA-GSD as a threat to the nurse-patient relationship, functionality of DA-GSD and available technical equipment, and data security. The other theme was what influenced the increased acceptability of DA-GSD among the nurses over time and comprised 3 subthemes: a re-evaluation of the nurse-patient relationship; improved functionality of DA-GSD; and supervision, experience, patient feedback, and a global pandemic. Conclusions: The nurses experienced more barriers to DA-GSD than the patients did. Acceptance of the intervention increased over time among the nurses in keeping with the intervention’s improved functionality, additional guidance, and positive experiences, combined with patients finding it useful. Our findings emphasize the importance of supporting and training nurses if new technologies are to be implemented successfully. %M 37200076 %R 10.2196/46673 %U https://nursing.jmir.org/2023/1/e46673 %U https://doi.org/10.2196/46673 %U http://www.ncbi.nlm.nih.gov/pubmed/37200076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43300 %T A Technology-Supported Guidance Model to Support the Development of Critical Thinking Among Undergraduate Nursing Students in Clinical Practice: Concurrent, Exploratory, Flexible, and Multimethod Feasibility Study %A Zlamal,Jaroslav %A Roth Gjevjon,Edith %A Fossum,Mariann %A Steindal,Simen A %A Nes,Andréa Aparecida Gonçalves %+ Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway, 47 95963522, Jaroslav.Zlamal@ldh.no %K technology %K guidance model %K critical thinking %K feasibility %K nursing %K nursing education %K medical education %K nursing student %K digital intervention %K mobile app %K clinical practice %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education. Objective: The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention. Methods: This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence. Results: Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention. Conclusions: The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed. International Registered Report Identifier (IRRID): RR2-10.2196/31646 %M 37099377 %R 10.2196/43300 %U https://formative.jmir.org/2023/1/e43300 %U https://doi.org/10.2196/43300 %U http://www.ncbi.nlm.nih.gov/pubmed/37099377 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e46428 %T Artificial Intelligence Teaching as Part of Medical Education: Qualitative Analysis of Expert Interviews %A Weidener,Lukas %A Fischer,Michael %+ Research Unit for Quality and Ethics in Health Care, UMIT TIROL – Private University for Health Sciences and Health Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria, 43 17670491594, lukas.weidener@edu.umit-tirol.at %K AI technology %K artificial intelligence %K clinical context %K expert interviews %K health care %K medical curriculum %K medical education %K medical school %K medical student %K medicine %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The use of artificial intelligence (AI) in medicine is expected to increase significantly in the upcoming years. Advancements in AI technology have the potential to revolutionize health care, from aiding in the diagnosis of certain diseases to helping with treatment decisions. Current literature suggests the integration of the subject of AI in medicine as part of the medical curriculum to prepare medical students for the opportunities and challenges related to the use of the technology within the clinical context. Objective: We aimed to explore the relevant knowledge and understanding of the subject of AI in medicine and specify curricula teaching content within medical education. Methods: For this research, we conducted 12 guideline-based expert interviews. Experts were defined as individuals who have been engaged in full-time academic research, development, or teaching in the field of AI in medicine for at least 5 years. As part of the data analysis, we recorded, transcribed, and analyzed the interviews using qualitative content analysis. We used the software QCAmap and inductive category formation to analyze the data. Results: The qualitative content analysis led to the formation of three main categories (“Knowledge,” “Interpretation,” and “Application”) with a total of 9 associated subcategories. The experts interviewed cited knowledge and an understanding of the fundamentals of AI, statistics, ethics, and privacy and regulation as necessary basic knowledge that should be part of medical education. The analysis also showed that medical students need to be able to interpret as well as critically reflect on the results provided by AI, taking into account the associated risks and data basis. To enable the application of AI in medicine, medical education should promote the acquisition of practical skills, including the need for basic technological skills, as well as the development of confidence in the technology and one’s related competencies. Conclusions: The analyzed expert interviews’ results suggest that medical curricula should include the topic of AI in medicine to develop the knowledge, understanding, and confidence needed to use AI in the clinical context. The results further imply an imminent need for standardization of the definition of AI as the foundation to identify, define, and teach respective content on AI within medical curricula. %M 36946094 %R 10.2196/46428 %U https://mededu.jmir.org/2023/1/e46428 %U https://doi.org/10.2196/46428 %U http://www.ncbi.nlm.nih.gov/pubmed/36946094 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e36380 %T Supporting Midwifery Students During Clinical Practice: Results of a Systematic Scoping Review %A Amod,Hafaza %A Mkhize,Sipho Wellington %+ School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 238 Masizi Kunene Road, Umbilo, Durban, 4041, South Africa, 27 31 260 4000 ext 3037, amodh@ukzn.ac.za %K clinical support %K mentorship training program %K midwifery clinical education %K midwife %K midwifery %K mentor %K mentorship %K clinical education training %K clinical support %K midwifery student %K South Africa %K Africa %K framework %K medical education %D 2023 %7 21.4.2023 %9 Review %J Interact J Med Res %G English %X Background: Midwifery educators are highly concerned about the quality of clinical support offered to midwifery students during clinical placement. The unpreparedness of midwifery practitioners in mentorship roles and responsibilities affects the competence levels of the next-generation midwives being produced. Objective: The aim of this paper is to highlight various clinical support interventions to support midwifery students globally and propose a framework to guide mentorship training in South Africa. Methods: This paper adopts a mixed methodology approach guided by the Arksey and O’Malley framework. Keywords such as midwifery students, clinical support, mentorship, preceptorship, and midwifery clinical practice were used during the literature search. The review included primary quantitative, qualitative, and mixed methods design papers published between 2010 and 2020, and studies on clinical support interventions available to midwifery students during clinical placement. The search strategy followed a 3-stage system of title, abstract, and full-text screening using inclusion and exclusion criteria. All included papers were quality appraised with a mixed methods appraisal tool. Extracted data were analyzed and presented in themes following a thematic content analysis approach. Results: The screening results attained 10 papers for data extraction. In total, 7 of the 10 (70%) studies implemented a mentorship training program, 2 (20%) used a training workshop, and 1 (10%) used an intervention guide to support midwifery students in clinical practice. Of these 10 papers, 5 were qualitative, 4 mixed methods, and 1 quantitative in approach. In total, 9 of the 10 (90%) studies were conducted in high-income countries with only 1 study done in Uganda but supported by the United Kingdom. The quality of included papers ranged between 50% and 100%, showing moderate to high appraisal results. Significant findings highlighted that the responsibility of mentorship is shared between key role players (midwifery practitioners, students, and educators) and thus a 3-fold approach to mentorship. Mentorship training and support are essential to strengthen the clinical support of midwifery students during placement. The main findings produced 2 main themes and 2 subthemes each. The main themes included strengthening partnerships and consultation; and providing mentor support through training. The 4 subthemes were: establishing stronger partnerships between nursing education institutions and clinical facilities; improving consultation between midwifery educators, practitioners, and students; the quality of clinical support depends on the training content; and the training duration and structure. Hence, the researchers proposed these subthemes in a framework to guide mentorship training. Conclusions: Mentorship training and support for midwifery practitioners will likely strengthen the quality of midwifery clinical support. A framework to guide mentorship training will encourage midwifery educators to develop and conduct mentorship training with ease. More studies using quantitative approaches in research and related to midwifery clinical support are required in African countries. International Registered Report Identifier (IRRID): RR2-10.2196/29707 %M 37083750 %R 10.2196/36380 %U https://www.i-jmr.org/2023/1/e36380 %U https://doi.org/10.2196/36380 %U http://www.ncbi.nlm.nih.gov/pubmed/37083750 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e44246 %T A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study %A Kobak,Kenneth %A Shear,M Katherine %A Skritskaya,Natalia A %A Bloom,Colleen %A Bottex,Gaelle %+ Center for Telepsychology, 22 North Harwood Circle, Madison, WI, 53717, United States, 1 608 406 2621, kobak@charter.net %K grief %K prolonged grief disorder %K evidence-based practice %K mental health training %K therapist training %K new technology %K web-based training %K dissemination %K e-learning %D 2023 %7 27.3.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Prolonged grief disorder (PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural or social expectations and interferes with functioning. The COVID-19 epidemic has resulted in increased rates of PGD, and few clinicians feel confident in treating this condition. PGD therapy (PGDT) is a simple, short-term, and evidence-based treatment developed in tandem with the validation of the PGD diagnosis. To facilitate the dissemination of PGDT training, we developed a web-based therapist tutorial that includes didactic training on PGDT concepts and principles as well as web-based multimedia patient scenarios and examples of clinical implementation of PGDT. Objective: We aimed to evaluate user satisfaction with the tutorial and whether the tutorial increased trainees’ knowledge of PGDT principles and procedures. Moreover, we included a small number of pilot questions to evaluate the PGDT-related clinical skills. Methods: This study evaluated tutorial learning using a pre- and poststudy design. Participants were recruited from professional organization mailing lists, announcements to graduates of the Columbia School of Social Work, and through word of mouth. After signing consent, participants completed a brief demographic survey, a 55-item multiple-choice prestudy test on the concepts and principles of PGD and PGDT covered in the tutorial, and a 4-item pilot web-based prestudy test to gauge PGD clinical implementation skills. The link to the course content was then activated, and participants were given 8 weeks to complete the 11-module tutorial containing information, web-based exercises, simulated patient and video examples, and self-tests. Results: Overall, 406 clinicians signed consent, and 236 (58.1%) started the tutorial. Of these, 83.1% (196/236) completed all 11 modules. Trainee scores on our PDGT assessment improved substantially from pretraining to the postmodule assessment, with the total number of correct answers increasing from a mean of 29 (SD 5.5; 52.7% correct) to 36.7 (SD 5.2; 66.7% correct; t195=18.93; P<.001). In addition, the trainee’s implementation scores on 4 clinical vignettes increased from 2.6 (SD 0.7) correct out of 4 to 3.1 (SD 0.4) out of 4 (t188=7.02; P<.001). Effect sizes (Cohen d) were 1.44 (95% CI 1.23-1.65) for PDGT assessment and 1.06 (95% CI 0.84-1.29) for implementation. Trainees found the tutorial interesting, enjoyable, clearly presented, and useful for professional development. They endorsed a mean score of 3.7 (SD 0.47) on a 1 to 4 scale of agreement with recommending the course to others and feeling satisfied with the tutorial, and a mean of 3.3 (SD 0.57) with feeling able to apply the skills with clients. Conclusions: This pilot study provides support for the usefulness of this web-based training for teaching clinicians how to administer PGDT. The addition of patient scenarios for clinical implementation strategies holds promise for increasing the effectiveness of PGDT training and other evidence-based treatments. Trial Registration: ClinicalTrials.gov NCT05121792; https://www.clinicaltrials.gov/ct2/show/NCT05121792 %M 36972105 %R 10.2196/44246 %U https://mededu.jmir.org/2023/1/e44246 %U https://doi.org/10.2196/44246 %U http://www.ncbi.nlm.nih.gov/pubmed/36972105 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42512 %T Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students %A Solberg,Marianne Trygg %A Sørensen,Anne Lene %A Clarke,Sara %A Nes,Andrea Aparecida Goncalves %+ Lovisenberg Diaconal University College, Lovisenberggata 15 b, Oslo, 0456, Norway, 47 47097070, marianne.trygg.solberg@ldh.no %K advanced practice nurse %K nursing education %K virtual reflection group %K teaching design %K critical care %K active learning approach %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master’s degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs’ competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students’ achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs’ development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. Objective: This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students’ development of the required competence to become APNs in critical care. Methods: This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. Results: The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. Conclusions: Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs’ required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education. %M 36951919 %R 10.2196/42512 %U https://mededu.jmir.org/2023/1/e42512 %U https://doi.org/10.2196/42512 %U http://www.ncbi.nlm.nih.gov/pubmed/36951919 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40677 %T Developing the Next Generation of Nursing Disciplinary Leaders in Higher Education: Protocol for a Sequential Mixed Methods Study %A Slattery,Melissa %A Grech,Carol %A Vernon,Rachael %+ Department of Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 433672741, slamj010@mymail.unisa.edu.au %K academic %K attributes %K behaviors %K characteristics %K higher education %K leadership %K nursing %K qualities %D 2023 %7 16.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Leading nurse education and research in the higher education (HE) sector has become increasingly challenging over the last decade with many universities in Australia and New Zealand having undergone academic restructuring. The future of HE faces many challenges including recruitment of suitably qualified staff to lead teaching and research and advance professional disciplines. Increasing cultural diversity of the Nursing workforce and the communities’ nurses serve, and the identification of cultural attributes in the context of racial inequities exposed by the pandemic and the climate emergency suggest different forms of leadership may be required in the future by those leading nurse education in the HE sector. Currently, there is a dearth of research evidence that identifies the qualities, behaviors, and characteristics (collectively identified as core attributes) required by nurse academic leaders. Objective: This research aims to identify an evidenced based set of core attributes that are required to lead the discipline of Nursing in the Australian and New Zealand HE sectors. Methods: This research is using a 2-phase sequential mixed methods design incorporating a scoping review; and Delphi technique. In phase 1, a scoping review will be undertaken to identify the qualities, behaviors, and characteristics that can influence the evolution of the next generation of academic nurse leaders. A set of draft statements and questions will be prepared based on analysis of findings from the review. Phase 2 uses Delphi technique consisting of e-survey rounds with experts in leading nursing faculties in Australia and New Zealand. An Expert Advisory Group will consider the initial set of draft statements and questions from phase 1. Consistent with Delphi technique, a series of “rounds” will then occur using an e-survey method. Established leaders (Professors and Associate Professors who are members of the Council of Deans Australia and New Zealand) will rate their level of agreement to statements on the qualities, behaviors, and characteristics required to lead the discipline of nursing in the HE sector in Australia and New Zealand. Results: The findings of the scoping review will identify what is currently known about the qualities, behaviors, and characteristics of academic nurse leaders. Quantitative and qualitative results from the Delphi study will initially be reported in separate manuscripts for publication. It is projected that a final paper will be prepared from aggregated research data and outline how the findings can inform the preparation of future academic nurse leaders. Conclusions: The generation of an evidenced-based set of core attributes will serve to inform the next generation of academic nurse leaders including informing recruitment processes and postgraduate nurse leadership programs. It is anticipated that the data sets and findings will be transferrable to other disciplines within HE to aid in future-proofing discipline-based expertise and leadership in the context of academic restructure. International Registered Report Identifier (IRRID): PRR1-10.2196/40677 %M 36758578 %R 10.2196/40677 %U https://www.researchprotocols.org/2023/1/e40677 %U https://doi.org/10.2196/40677 %U http://www.ncbi.nlm.nih.gov/pubmed/36758578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42340 %T Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study %A Martín-Carbonell,Marta %A Espejo,Begoña %A Castro-Melo,Greys Patricia %A Sequeira-Daza,Doris %A Checa,Irene %+ Universitat de València, Av. Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963864503, bespejo@uv.es %K psychometric properties %K structural equation modeling %K older adulthood %K geriatric %K gerontology %K health care college students %K health care professionals %K questionnaire %K stereotype %K agism %D 2023 %7 9.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. Objective: The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. Methods: A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. Results: The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. Conclusions: The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism. %M 36892936 %R 10.2196/42340 %U https://www.jmir.org/2023/1/e42340 %U https://doi.org/10.2196/42340 %U http://www.ncbi.nlm.nih.gov/pubmed/36892936 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42281 %T Readiness of Health Care Professionals in Singapore to Teach Online and Their Technology-Related Teaching Needs: Quantitative Cross-sectional Pilot Study %A Lee,Jason Wen Yau %A Bello,Fernando %+ Technology Enhanced Learning and Innovation Department, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore, 65 66016357, Jason.Lee@duke-nus.edu.sg %K online readiness in teaching %K technology for learning %K faculty development %K training need %K technology-enhanced learning %K readiness %K teaching %K medical education %K health care education %K teacher %K teaching %K online environment %K online teaching %K teaching skill %K educator %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: With the increasing acceptance of face-to-face classes transitioning to web-based learning due to COVID-19, there is an increasing need to have educators trained and equipped to teach online. The ability to teach in-person may not necessarily mean that one is ready teach in a web-based environment. Objective: The objective of our study was to investigate the readiness of health care professionals in Singapore to teach online and their technology-related teaching needs. Methods: This was a quantitative cross-sectional pilot study conducted among health care administrative staff and professionals in medicine, nursing, allied health, and dentistry. Participants were recruited via an open invitation email to all staff members of Singapore’s largest group of health care institutions. Data were collected using a web-based questionnaire. Differences in the readiness of the professionals to teach online were analyzed using analysis of variance, and a 1-sided independent sample t test was performed to analyze the differences between respondents younger than 40 years and those older than 41 years. Results: A total of 169 responses was analyzed. Full-time academic faculty members scored the highest for readiness to teach online (2.97), followed by nursing professionals (2.91), medicine professionals (2.88), administrative staff members (2.83), and allied health professionals (2.76). However, there was no statistically significant difference (P=.77) among all the respondents in their readiness to teach online. There was an agreement among all professionals in their need for software tools to teach; in particular, there was a significant difference in the software needs among the professionals for streaming videos (P=.01). There was no statistically significant difference in the readiness to teach online between those younger than 40 years and those older than 41 years (P=.48). Conclusions: Our study shows that there are still some gaps in terms of readiness to teach online among health care professionals. Our findings can be used by policy makers and faculty developers to identify opportunities for development among their educators so that they are ready to teach online with the appropriate software tools. %M 36877546 %R 10.2196/42281 %U https://mededu.jmir.org/2023/1/e42281 %U https://doi.org/10.2196/42281 %U http://www.ncbi.nlm.nih.gov/pubmed/36877546 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44101 %T A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype %A Nes,Andréa Aparecida Gonçalves %A Zlamal,Jaroslav %A Linnerud,Silje Christin Wang %A Steindal,Simen A %A Solberg,Marianne Trygg %+ Lovisenberg Diaconal University College, Lovisenberggt 15B, Oslo, 0456, Norway, 47 90703168, andrea.nes@ldh.no %K clinical practice %K guidance application model %K nursing students %K constructive alignment %K metacognition %K technological tool %K nursing %K nursing profession %K application %K mobile health, eHealth %K educator %K communication %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students’ clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice. Objective: We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice. Methods: This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing. Results: This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application’s name and logo, technical architecture, guidance and assessment module, and security and privacy. Conclusions: This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies. %M 36735289 %R 10.2196/44101 %U https://humanfactors.jmir.org/2023/1/e44101 %U https://doi.org/10.2196/44101 %U http://www.ncbi.nlm.nih.gov/pubmed/36735289 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e41589 %T Implementation of Virtual Reality in Health Professions Education: Scoping Review %A Lie,Silje Stangeland %A Helle,Nikolina %A Sletteland,Nina Vahl %A Vikman,Miriam Dubland %A Bonsaksen,Tore %+ Department of Health, Faculty of Health Studies, VID Specialized University, Misjonsmarka 12, Stavanger, 4024, Norway, siljes.lie@vid.no %K implementation %K virtual reality %K higher education %K medical education %K health professions education %K continuing education %K scoping review %K health professional %K technology %D 2023 %7 24.1.2023 %9 Review %J JMIR Med Educ %G English %X Background: Virtual reality has been gaining ground in health professions education and may offer students a platform to experience and master situations without endangering patients or themselves. When implemented effectively, virtual reality technologies may enable highly engaging learning activities and interactive simulations. However, implementation processes present challenges, and the key to successful implementation is identifying barriers and facilitators as well as finding strategies to address them. Objective: This scoping review aimed to identify the literature on virtual reality implementation in health professions education, identify barriers to and facilitators of implementation, and highlight gaps in the literature in this area. Methods: The scoping review was conducted based on the Joanna Briggs Institute Evidence Synthesis methodologies. Electronic searches were conducted in the Academic Search Elite, Education Source, and CINAHL databases on January 5, 2022, in Google Scholar on February 2 and November 18, 2022, and in PubMed database on November 18, 2022. We conducted hand searches of key items, reference tracking, and citation tracking and searches on government webpages on February 2, 2022. At least 2 reviewers screened the identified literature. Eligible studies were considered based on predefined inclusion criteria. The results of the identified items were analyzed and synthesized using qualitative content analysis. Results: We included 7 papers and identified 7 categories related to facilitators of and barriers to implementation—collaborative participation, availability, expenses, guidelines, technology, careful design and evaluation, and training—and developed a model that links the categories to the 4 constructs from Carl May’s general theory of implementation. All the included reports provided recommendations for implementation, including recommendations for careful design and evaluation, training of faculty and students, and faculty presence during use. Conclusions: Virtual reality implementation in health professions education appears to be a new and underexplored research field. This scoping review has several limitations, including definitions and search words, language, and that we did not assess the included papers’ quality. Important implications from our findings are that ensuring faculty’s and students’ competence in using virtual reality technology is necessary for the implementation processes. Collaborative participation by including end users in the development process is another factor that may ensure successful implementation in higher education contexts. To ensure stakeholders’ motivation and potential to use virtual reality, faculty and students could be invited to participate in the development process to ensure that the educational content is valued. Moreover, technological challenges and usability issues should be resolved before implementation to ensure that pedagogical content is the focus. This accentuates the importance of piloting, sufficient time resources, basic testing, and sharing of experiences before implementation. International Registered Report Identifier (IRRID): RR2-10.2196/37222 %M 36692934 %R 10.2196/41589 %U https://mededu.jmir.org/2023/1/e41589 %U https://doi.org/10.2196/41589 %U http://www.ncbi.nlm.nih.gov/pubmed/36692934 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e38329 %T Incorporating Paid Caregivers Into Medical Education to Enhance Medical Student Exposure to This Essential Workforce %A Kamat,Samir %A Danias,George %A Agarwal,Aneesh %A Chennareddy,Sumanth %A Han,Joseph %A Lee,Samuel %+ Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY, 10029, United States, 1 2122416096, samir.kamat@icahn.mssm.edu %K medical education %K education %K student %K communication %K perspective %K medical student %K paid caregiver %K caregiver %K health care model %K home-based health care %K patient care %K health care provider %K medical student %K student experience %K training %K care team %K integration %K clinical decision %D 2022 %7 9.12.2022 %9 Viewpoint %J JMIR Med Educ %G English %X The implications of the COVID-19 pandemic underscored the utility of home-based health care due in part to social distancing requirements, curtailment of elective hospital procedures, and patient apprehension of the health care setting. The pandemic particularly accentuated the integral role of paid caregivers (eg, home health aides, personal care attendants, and other home care workers) in caring for patients with chronic health conditions. Given the paradigm shift toward community- and value-based health care models, paid caregivers are likely to play an even greater role as care team members. Despite the increasingly prominent role paid caregivers are assuming in health care, especially for patients who are chronically ill, in our experience as medical students, we have very little exposure to these care team members, with most interactions occurring in brief, chance encounters. Specifically, we advocate for increased medical student exposure to paid caregivers to facilitate their recognition as valuable care team members. We propose to achieve this through (1) classroom-based module learning with live paid caregivers and (2) plain language communication training to enhance reciprocal engagement. %M 36485028 %R 10.2196/38329 %U https://mededu.jmir.org/2022/4/e38329 %U https://doi.org/10.2196/38329 %U http://www.ncbi.nlm.nih.gov/pubmed/36485028 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e42033 %T Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review %A Diouf,Ndeye Thiab %A Musabyimana,Angèle %A Blanchette,Virginie %A Lépine,Johanie %A Guay-Bélanger,Sabrina %A Tremblay,Marie-Claude %A Dogba,Maman Joyce %A Légaré,France %+ VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, 2480 chemin de la canardière, Quebec, QC, G1G 2G1, Canada, 1 418 663 5313, france.legare@fmed.ulaval.ca %K shared decision-making %K reflexivity %K training %K health care professionals %K implementation %D 2022 %7 7.12.2022 %9 Review %J JMIR Med Educ %G English %X Background: Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. Objective: In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. Methods: From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. Results: Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. Conclusions: Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training. %M 36318726 %R 10.2196/42033 %U https://mededu.jmir.org/2022/4/e42033 %U https://doi.org/10.2196/42033 %U http://www.ncbi.nlm.nih.gov/pubmed/36318726 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e23783 %T Using Normalization Process Theory to Evaluate an End-of-Life Pediatric Palliative Care Web-Based Training Program for Nurses: Protocol for a Randomized Controlled Trial %A Al-Shammari,Moustafa A %A Yasir,Amean %A Aldoori,Nuhad %A Mohammad,Hussein %+ Nursing Department, Al-Mustaqbal University College, Najaf Street, In front of the University of Babylon, PO Box 100, Hillah, 51001, Iraq, 964 07816706378, moustafa.ali@uomus.edu.iq %K End-of-Life Nursing Education Consortium for pediatric palliative care %K implementation %K Iraq %K life-limiting illness %K pediatric palliative care %K pragmatic trial %K web-based training %D 2022 %7 11.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Palliative care (PC) is a new concept in Iraq, and there is no training for health care specialists or the public. The lack of education and training programs is the most important barrier for PC. Intermediate training is needed for nurses who regularly manage patients with life-threatening diseases. The End-of-Life Nursing Education Consortium for pediatric palliative care (PPC) program is intended for nurses who are interested in providing care to children with life-limiting diseases or providing support in the event of an accident or unexpected death. Objective: Our trial aims to evaluate the effect of a web-based training course, using the Normalization Process Theory. It focuses on how complex interventions become routinely embedded in practice and on training of a sample of academic nurses in the application of PPC in routine daily practice. It hypothesizes that nurses will be able to provide PC for the pediatric population after completing the training. Methods: This is a multicenter, parallel, pragmatic trial in 5 health care settings spread across a single city in Babylon Province, Iraq. Participants will be recruited and stratified into 2 categories (critical care units and noncritical care units). In the experimental condition, 86 nurses will be trained in the application of PPC for 2 weeks through a web-based training course powered by the Relais Platform. The nurses will be invited to participate via email or instant messaging (WhatsApp, Telegram, or Viber). They will provide end-of-life care in addition to usual care to children and adolescents with life-limiting conditions. In the control condition, 86 nurses will continue usual care. The program’s effectiveness will be assessed at the level of nurses only. We will compare baseline findings (before the intervention) with postintervention findings (after completing the training course). A further assessment will be performed 3 months after the course. As numerous unidentified factors can influence the effect of the training, we will perform a progressive evaluation to assess sample selection, application, and intervention value, as well as implementation difficulties. The nursing staff will not be blinded to the intervention, but will be blinded to the results. Results: The study trial recruitment opened in July 2020. The first outcomes became available in December 2020. Conclusions: The trial attempts to clarify the delivery of PC at the end of life through the implementation of a web-based training course among Iraqi nurses in the pediatric field. The study strengths include the usual practice setting, staff training, readiness of staff to participate in the study, and random allocation to the intervention. However, participants may drop out after being transferred to another department during the study period. Trial Registration: ClinicalTrials.gov NCT04461561; https://clinicaltrials.gov/ct2/show/NCT04461561 International Registered Report Identifier (IRRID): PRR1-10.2196/23783 %M 36367759 %R 10.2196/23783 %U https://www.researchprotocols.org/2022/11/e23783 %U https://doi.org/10.2196/23783 %U http://www.ncbi.nlm.nih.gov/pubmed/36367759 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38759 %T American Anesthesiology Residency Programs: Website Usability Analysis %A Seto,Noah %A Beach,Jeffrey %A Calvano,Joshua %A Lu,Shu %A He,Shuhan %+ College of Osteopathic Medicine, Rocky Vista University, 8401 S Chambers Rd, Parker, CO, 80134, United States, 1 303 373 2008, nlseto@salud.unm.edu %K medical student education %K education in anesthesia %K technology in education %K quality improvement %K communication %D 2022 %7 20.10.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: The Association of American Medical Colleges has recently issued recommendations for the upcoming 2022-2023 application cycle that residency programs should conduct all interviews for this upcoming application cycle over the web. In light of these recommendations, many students will have limited exposure to anesthesiology programs and will rely on information gleaned digitally. This change means that the aspects of program websites used to provide information, such as size, structure, location, requirements, and contact information, will be crucial in helping prospective residents decide where and how to apply in the future. An evaluation of website usability, which includes initial appearance along with factors that influence its ease of navigation and convenience of use, can thus be applied to anesthesiology residency websites. Areas of need can be targeted to increase web presence and provide effective pathways to exhibit the different attributes of their programs to future applicants. Objective: This study aimed to compile a list of US anesthesiology residency programs and their websites while objectively analyzing the websites using a formally published usability scoring system, as well as to identify positive and negative trends to offer areas of improvement among anesthesiology residency websites. Methods: We included only 114 US anesthesiology residency program websites in our sample set, since some websites we analyzed showed errors or inconclusive. Website usability was separated into 4 distinct categories for analysis based on methodology outlined in previous literature on both health care website usability and residency website usability. The 4 categories were Accessibility, Marketing, Content Quality, and Technology. Each website was then analyzed and scored based on key components highlighted within the 4 categories. The multiple factors were then graded using a percentage system to create a comprehensive score for each program. Results: The highest scoring category was Content Quality (mean 4.7, SD 2.48, SE 0.23). The lowest scoring category was Technology (mean 0.9, SD 0.38, SE 0.04). Conclusions: Through the application of a health care website usability framework, multiple anesthesiology residency programs were analyzed and scored in the areas of Accessibility, Marketing, Content Quality, and Technology, which allowed us to determine the effectiveness of the usability of these websites to convey information to their end user. Websites must communicate vital information, with usability at the forefront, to continue to grow, especially as the United States faces challenges due to the COVID-19 pandemic. Our recommendation is that anesthesiology programs should strive to improve website usability to increase the ease by which applicants can collect vital information about anesthesiology programs. A few proposed solutions include making changes such as decreasing error pages on websites, migrating away from using in-line cascading style sheets, and improving web page loading speeds to improve the Technology category. %M 36264625 %R 10.2196/38759 %U https://www.i-jmr.org/2022/2/e38759 %U https://doi.org/10.2196/38759 %U http://www.ncbi.nlm.nih.gov/pubmed/36264625 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e40520 %T The Educational Impact of Web-Based, Faculty-Led Continuing Medical Education Programs in Type 2 Diabetes: A Survey Study to Analyze Changes in Knowledge, Competence, and Performance of Health Care Professionals %A Harris,Stewart B %A Idzik,Shannon %A Boasso,Adriano %A Neunie,Sola Quasheba %A Noble,Alexander Daniel %A Such,Helen Elaine %A Van,Joanna %+ University Clinical Investigators (d.b.a. Diabetes Research Center), 2492 Walnut Avenue, Suite 130, Tustin, CA, 92780, United States, 1 410 706 8129, jvan@uciinc.net %K clinical case %K competence %K continuing medical education %K knowledge %K multidisciplinary team %K web-based education %K performance %K type 2 diabetes %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited. Objective: This study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence, and performance following short, case-based, multidisciplinary web-based CME activities; and identify the remaining educational gaps. Methods: Two faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5). Results: Each activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P<.001), with the proportion of learners answering at least six of 7 questions correctly, increasing from 22% (11/50) to 60% (30/50). A nonsignificant improvement in knowledge and competence was observed following participation in touch MultiDisciplinary Team (mean score, SD 4.36, 1.24 vs 4.58, 1.07; P=.35); however, baseline knowledge and competence were relatively high, where 80% of the respondents (40/50) answered at least four of 6 questions correctly. A significant improvement in HCP self-reported performance was observed in a combined analysis of both activities (mean score, SD 2.65, 1.32 vs 3.15, 1.26; P=.03), with the proportion of learners selecting the answer representing the best clinical option for all 4 questions increasing from 32% (11/34) to 59% (20/34) after the activity. Several unmet educational needs were self-reported or identified from the analysis of incorrectly answered questions, including setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. Conclusions: Short, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. %M 36102282 %R 10.2196/40520 %U https://mededu.jmir.org/2022/4/e40520 %U https://doi.org/10.2196/40520 %U http://www.ncbi.nlm.nih.gov/pubmed/36102282 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e40758 %T Effects of Practicing With and Obtaining Crowdsourced Feedback From the Video-Based Communication Assessment App on Resident Physicians’ Adverse Event Communication Skills: Pre-post Trial %A White,Andrew A %A King,Ann M %A D’Addario,Angelo E %A Brigham,Karen Berg %A Dintzis,Suzanne %A Fay,Emily E %A Gallagher,Thomas H %A Mazor,Kathleen M %+ Department of Medicine, University of Washington School of Medicine, Box 356429, 1959 Pacific St, Seattle, WA, 98195, United States, 1 2066161447, andwhite@uw.edu %K medical error disclosure %K simulation studies %K communication assessment %K graduate medical education %K crowdsourcing %K patient-centered care %K medical education %K virtual education %K virtual communication %K physician communication %K resident %K virtual learning %K digital learning %K video communication %K medical error %K digital response %D 2022 %7 3.10.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: US residents require practice and feedback to meet Accreditation Council for Graduate Medical Education mandates and patient expectations for effective communication after harmful errors. Current instructional approaches rely heavily on lectures, rarely provide individualized feedback to residents about communication skills, and may not assure that residents acquire the skills desired by patients. The Video-based Communication Assessment (VCA) app is a novel tool for simulating communication scenarios for practice and obtaining crowdsourced assessments and feedback on physicians’ communication skills. We previously established that crowdsourced laypeople can reliably assess residents’ error disclosure skills with the VCA app. However, its efficacy for error disclosure training has not been tested. Objective: We aimed to evaluate the efficacy of using VCA practice and feedback as a stand-alone intervention for the development of residents’ error disclosure skills. Methods: We conducted a pre-post study in 2020 with pathology, obstetrics and gynecology, and internal medicine residents at an academic medical center in the United States. At baseline, residents each completed 2 specialty-specific VCA cases depicting medical errors. Audio responses were rated by at least 8 crowdsourced laypeople using 6 items on a 5-point scale. At 4 weeks, residents received numerical and written feedback derived from layperson ratings and then completed 2 additional cases. Residents were randomly assigned cases at baseline and after feedback assessments to avoid ordinal effects. Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2×3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings. Results: In total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents’ communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents’ communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6%). Conclusions: Residents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum. %M 36190751 %R 10.2196/40758 %U https://mededu.jmir.org/2022/4/e40758 %U https://doi.org/10.2196/40758 %U http://www.ncbi.nlm.nih.gov/pubmed/36190751 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e34905 %T Practices, Perceived Benefits, and Barriers Among Medical Students and Health Care Professionals Regarding the Adoption of eHealth in Clinical Settings: Cross-sectional Survey Study %A Nguyen,Long Hoang %A Nguyen,Lien Thi Khanh %A Nguyen,Tham Thi %A Trong Dam,Vu Anh %A Vu,Thuc Minh Thi %A Nguyen,Hao Anh Si %A Vu,Giang Thu %A Latkin,Carl A %A Ho,Roger C M %A Ho,Cyrus S H %+ Institute for Global Health Innovations, Duy Tan University, 254 Nguyen Van Linh, Da Nang, 550000, Vietnam, 84 941890199, damtanhvu@duytan.edu.vn %K eHealth %K literacy %K perception %K practices %K health care professional %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: eHealth is increasingly becoming an indispensable part of health practice and policy-making strategies. However, the use of eHealth tools in clinical practice and the perceptions of eHealth among medical students and health care professionals in Vietnam are not well understood. Objective: This study aims to investigate perceptions and practices regarding eHealth and their associated factors among medical students and health care professionals. Methods: A web-based cross-sectional study was conducted on 523 medical students and health care professionals. Information about the practices for, perceived barriers to, and benefits of eHealth application in clinical practices was collected. Multivariate Tobit and logistic regression models were used to determine factors associated with perceptions and practices. Results: In total, 61.6% (322/523) of participants used eHealth tools in clinical practices, with moderate levels of eHealth literacy. The score for the perceived benefits of eHealth tools was low. The most common barrier for eHealth utilization was human resources for IT (240/523, 45.9%), followed by security and risk control capacity (226/523, 43.2%) and no training in eHealth application (223/523, 42.6%). Age, eHealth literacy, and the use of the internet for updating medical knowledge were positively associated with using eHealth tools in clinical practices. Conclusions: eHealth tools were moderately used in clinical practices, and the benefits of eHealth were underestimated among health care professionals and medical students in Vietnam. Renovating the current medical education curriculum to integrate eHealth principles should be required to equip health care professionals and medical students with essential skills for rapid digital transformation. %M 36098992 %R 10.2196/34905 %U https://mededu.jmir.org/2022/3/e34905 %U https://doi.org/10.2196/34905 %U http://www.ncbi.nlm.nih.gov/pubmed/36098992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35319 %T Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis %A Lobchuk,Michelle %A Bathi,Prachotan Reddy %A Ademeyo,Adedotun %A Livingston,Aislinn %+ College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Room 315 - 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada, 1 204 474 7135, Michelle.Lobchuk@umanitoba.ca %K web browser %K user-centered design %K qualitative research %K internet %K empathy %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions severely curtailed empirical endeavors that involved in-person interaction, such as usability testing sessions for technology development. Researchers and developers found themselves using web-based moderation for usability testing. Skilled remote moderators and observers are fundamental in this approach. However, to date, more empirical work is needed that captures the perceptions and support needs of moderators and observers in testing situations. Objective: The aim of this paper was to identify remote moderator and observer participant experiences and their use of certain tools to capture feedback of users as they interact with the web browser application. Methods: This research is part of a broader study on an educational web browser application for nursing students to learn perspective taking and enhance their perceptual understanding of a dialogue partner’s thoughts and feelings. The broader study used a quantitative and think-aloud qualitative problem-discovery usability study design. This case study explored written accounts of the remote moderator and observer participants regarding their roles, experiences, and reactions to the testing protocol and their suggestions for improved techniques and strategies for conducting remote usability testing. Content analysis was used to analyze participants’ experiences in the usability testing sessions. Results: We collected data from 1 remote moderator and 2 remote observers. Five themes were identified: dealing with personal stressors, dealing with user anxiety, maintaining social presence, ethical response to the study protocol, and communication during sessions. The participants offered recommendations for the design of future remote testing activities as well as evidence-informed training materials for usability project personnel. Conclusions: This study’s findings contribute to a growing body of endeavors to understand human-computer interaction and its impact on remote moderator and observer roles. As technology rapidly advances, more remote usability testing will occur where the knowledge gleaned in this study can have an impact. Recommendations based on moderator and observer participant perspectives identify the need for more evidence-informed training materials for their roles that focus on web-based interpersonal communication skills, execution of user testing protocols, troubleshooting technology and test user issues, proficiency in web conferencing platforms, behavior analysis and feedback technologies, and time management. %M 35921138 %R 10.2196/35319 %U https://formative.jmir.org/2022/8/e35319 %U https://doi.org/10.2196/35319 %U http://www.ncbi.nlm.nih.gov/pubmed/35921138 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e37015 %T Resilience Enhancement Online Training for Nurses (REsOluTioN): Protocol for a Pilot Randomized Controlled Trial %A Srikesavan,Cynthia %A Davey,Zoe %A Cipriani,Andrea %A Henshall,Catherine %+ Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Headington, Oxford, OX3 0BP, United Kingdom, 44 07768 918298, chenshall@brookes.ac.uk %K online training %K nurses %K resilience %K mental well-being %K pilot trial %K COVID-19 %K nursing %K mental health %K health care staff %K psychological health %K online health %K resilience training %K health care setting %D 2022 %7 3.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, nurses are facing increased pressure to provide high-quality complex patient care within environments with scarce resources in terms of staffing, infrastructure, or financial reward. The strain and demand on the psychological health and well-being of nurses during COVID-19 has been substantial, with many experiencing burnout; as such, interventions to enhance resilience within the workplace are required. A face-to-face resilience enhancement training program for nurses that was effective in improving resilience levels was translated into a 4-week online training program, Resilience Enhancement Online Training for Nurses (REsOluTioN), to enable greater accessibility for nurses. Objective: This study aims to compare levels of resilience, psychological health, and well-being in nurses before and after the online resilience training compared to a wait list control group. It will also explore participants’ engagement with the trial and their acceptability of the online training. Methods: This is a two-arm, parallel, randomized controlled trial with a 6-week follow-up period. Up to 100 registered nonagency nurses working at a National Health Service hospital trust in South England will be recruited. Four cohorts will run, and participants will be randomized into a wait list control group or to REsOluTioN. Pre- and postonline surveys will collect study outcome measure data. In the REsOluTioN arm, data will be collected on the perceived usefulness of the online training via an online survey. Institutional and health research authority approvals have been obtained. Results: REsOluTioN will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training will be interactive with input from mentors, health care leaders, and peers to promote engagement and enhanced communication, and will create a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them. This can increase self-knowledge and learning around workplace resilience coping strategies and provide a safe space to validate feelings through mentorship and peer support. Findings will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial is now finished and was conducted between August 2021 and May 2022. Conclusions: The REsOluTioN trial will enable preliminary data to be gathered to indicate the online training’s effectiveness in enhancing nurses’ resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): DERR1-10.2196/37015 %M 35862692 %R 10.2196/37015 %U https://www.researchprotocols.org/2022/8/e37015 %U https://doi.org/10.2196/37015 %U http://www.ncbi.nlm.nih.gov/pubmed/35862692 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e33767 %T An Innovative Use of Twitter to Disseminate and Promote Medical Student Scholarship During the COVID-19 Pandemic: Usability Study %A Allen,Gary %A Garris,Jenna %A Lawson,Luan %A Reeder,Timothy %A Crotty,Jennifer %A Hannan,Johanna %A Brewer,Kori %+ Department of Emergency Medicine, Brody School of Medicine, East Carolina University, 600 Moye Blvd, MS #625, Greenville, NC, 27834, United States, 1 252 744 2159, brewerk@ecu.edu %K medical education %K social media %K web-based learning %K innovation %K Twitter %K dissemination %K scholarship %K medical student %K platform %K academic promotion %K COVID-19 %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Due to the emergence of the COVID-19 pandemic in March 2020, the cancellation of in-person learning activities forced every aspect of medical education and student engagement to pivot to a web-based format, including activities supporting the performance and dissemination of scholarly work. At that time, social media had been used to augment in-person conference learning, but it had not been used as the sole platform for scholarly abstract presentations. Objective: Our aim was to assess the feasibility of using Twitter to provide a completely web-based forum for real-time dissemination of and engagement with student scholarly work as an alternative to a traditional in-person poster presentation session. Methods: The Brody School of Medicine at East Carolina University launched an online Medical Student Scholarship Forum, using Twitter as a platform for students to present scholarly work and prepare for future web-based presentations. A single student forum participant created posts using a standardized template that incorporated student research descriptions, uniform promotional hashtags, and individual poster presentations. Tweets were released over 5 days and analytic data were collected from the Twitter platform. Outcome measures included impressions, engagements, retweets, likes, media engagements, and average daily engagement rate. Results: During the conference, the student leader published 63 tweets promoting the work of 58 students (55 medical and 3 dental students) over 5 days. During the forum and the following week, tweets from the @BrodyDistinctly Twitter account received 63,142 impressions and 7487 engagements, including 187 retweets, 1427 likes, and 2082 media engagements. During the 5 days of the forum, the average daily engagement rate was 12.72%. Conclusions: Using Twitter as a means of scholarly dissemination resulted in a larger viewing community compared to a traditional in-person event. Early evidence suggests that social media platforms may be an alternative to traditional scholarly presentations. Presenting via Twitter allowed students to receive instantaneous feedback and effectively network with wider academic communities. Additional research is needed to evaluate the effectiveness of knowledge uptake, feedback, and networking. %M 35759753 %R 10.2196/33767 %U https://mededu.jmir.org/2022/3/e33767 %U https://doi.org/10.2196/33767 %U http://www.ncbi.nlm.nih.gov/pubmed/35759753 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e38004 %T Aligning the American Health Information Management Association Entry-level Curricula Competencies and Career Map With Industry Job Postings: Cross-sectional Study %A Fenton,Susan H %A Marc,David T %A Kennedy,Angela %A Hamada,Debra %A Hoyt,Robert %A Lalani,Karima %A Renda,Connie %A Reynolds,Rebecca B %+ Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), 200 E. Randolph St., Suite 5100, Chicago, IL, 60601, United States, 1 312 978 0383, angela.kennedy@cahiim.org %K health information management %K health workforce %K healthcare industry %K natural language processing %K medical education %K professional education %K job recruitment %K job website %K web scraping %K data mining %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The field of health information management (HIM) focuses on the protection and management of health information from a variety of sources. The American Health Information Management Association (AHIMA) Council for Excellence in Education (CEE) determines the needed skills and competencies for this field. AHIMA’s HIM curricula competencies are divided into several domains among the associate, undergraduate, and graduate levels. Moreover, AHIMA’s career map displays career paths for HIM professionals. What is not known is whether these competencies and the career map align with industry demands. Objective: The primary aim of this study is to analyze HIM job postings on a US national job recruiting website to determine whether the job postings align with recognized HIM domains, while the secondary aim is to evaluate the AHIMA career map to determine whether it aligns with the job postings. Methods: A national job recruitment website was mined electronically (web scraping) using the search term “health information management.” This cross-sectional inquiry evaluated job advertisements during a 2-week period in 2021. After the exclusion criteria, 691 job postings were analyzed. Data were evaluated with descriptive statistics and natural language processing (NLP). Soft cosine measures (SCM) were used to determine correlations between job postings and the AHIMA career map, curricular competencies, and curricular considerations. ANOVA was used to determine statistical significance. Results: Of all the job postings, 29% (140/691) were in the Southeast, followed by the Midwest (140/691, 20%), West (131/691,19%), Northeast (94/691, 14%), and Southwest (73/691, 11%). The educational levels requested were evenly distributed between high school diploma (219/691, 31.7%), associate degree (269/691, 38.6%), or bachelor’s degree (225/691, 32.5%). A master’s degree was requested in only 8% (52/691) of the postings, with 72% (42/58) preferring one and 28% (16/58) requiring one. A Registered Health Information Technologist (RHIT) credential was the most commonly requested (207/691, 29.9%) in job postings, followed by Registered Health Information Administrator (RHIA; 180/691, 26%) credential. SCM scores were significantly higher in the informatics category compared to the coding and revenue cycle (P=.006) and data analytics categories (P<.001) but not significantly different from the information governance category (P=.85). The coding and revenue cycle category had a significantly higher SCM score compared to the data analytics category (P<.001). Additionally, the information governance category was significantly higher than the data analytics category (P<.001). SCM scores were significantly different between each competency category, except there were no differences in the average SCM score between the information protection and revenue cycle management categories (P=.96) and the information protection and data structure, content, and information governance categories (P=.31). Conclusions: Industry job postings primarily sought degrees, with a master’s degree a distant fourth. NLP analysis of job postings suggested that the correlation between the informatics category and job postings was higher than that of the coding, revenue cycle, and data analytics categories. %M 35584188 %R 10.2196/38004 %U https://mededu.jmir.org/2022/3/e38004 %U https://doi.org/10.2196/38004 %U http://www.ncbi.nlm.nih.gov/pubmed/35584188 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e38050 %T Anesthesiologists With Advanced Degrees in Education: Qualitative Study of a Changing Paradigm %A Aggarwal,Anuj %A Hess,Olivia %A Lockman,Justin L %A Smith,Lauren %A Stevens,Mitchell %A Bruce,Janine %A Caruso,Thomas %+ Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 N Pasteur Dr, Stanford, CA, 94305, United States, 1 650 723 6415, akaggarw@stanford.edu %K academic medical centers %K trends %K medical education %K medical %K faculty %K anesthesiologists %K medical professionals %K learning %K institute %K clinician %K educator %K experience %K decision-making %K training %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Anesthesiology education has undergone profound changes over the past century, from a pure clinical apprenticeship to novel comprehensive curricula based on andragogic learning theories. Combined with institutional and regulatory requirements, these new curricula have propagated professionalization of the clinician-educator role. A significant number of clinician-educator anesthesiologists, often with support from department chairs, pursue formal health professions education (HPE) training, yet there are no published data demonstrating the benefits or costs of these degrees to educational leaders. Objective: This study aims to collect the experiences of anesthesiologists who have pursued HPE degrees to understand the advantages and costs of HPE degrees to anesthesiologists. Methods: Investigators performed a qualitative study of anesthesiologists with HPE degrees working at academic medical centers. Interviews were thematically analyzed via an iterative process. They were coded using a team-based approach, and representative themes and exemplary quotations were identified. Results: Seven anesthesiologists were interviewed, representing diverse geographic regions, subspecialties, and medical institutions. Analyses of interview transcripts resulted in the following 6 core themes: outcomes, extrinsic motivators, intrinsic motivators, investment, experience, and recommendations. The interviewees noted the advantages of HPE training for those wishing to pursue leadership or scholarship in medical education; however, they also noted the costs and investment of time in addition to preexisting commitments. The interviewees also highlighted the issues faculty and chairs might consider for the optimal timing of HPE training. Conclusions: There are numerous professional and personal benefits to pursuing HPE degrees for faculty interested in education leadership or scholarship. Making an informed decision to pursue HPE training can be challenging when considering the competing pressures of clinical work and personal obligations. The experiences of the interviewed anesthesiologists offer direction to future anesthesiologists and chairs in their decision-making process of whether and when to pursue HPE training. %M 35771619 %R 10.2196/38050 %U https://mededu.jmir.org/2022/2/e38050 %U https://doi.org/10.2196/38050 %U http://www.ncbi.nlm.nih.gov/pubmed/35771619 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e32614 %T Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review %A Guillaume,Dominique %A Troncoso,Erica %A Duroseau,Brenice %A Bluestone,Julia %A Fullerton,Judith %+ Jhpiego, 1615 Thames St # 200, Baltimore, MD, 21231, United States, 1 410 537 1800, dominique.guillaume@jhpiego.org %K digital learning %K continuing medical education %K mHealth %K peer learning %K mentorship %K health systems %K global health %K mobile phone %D 2022 %7 7.6.2022 %9 Review %J JMIR Med Educ %G English %X Background: Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. Objective: The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. Methods: A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. Results: A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. Conclusions: The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital. %M 35671080 %R 10.2196/32614 %U https://mededu.jmir.org/2022/2/e32614 %U https://doi.org/10.2196/32614 %U http://www.ncbi.nlm.nih.gov/pubmed/35671080 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e34687 %T The Opportunities and Challenges of Digital Anatomy for Medical Sciences: Narrative Review %A Wickramasinghe,Nilmini %A Thompson,Bruce R %A Xiao,Junhua %+ School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Victoria, 3022, Australia, 61 3 92145042, jxiao@swin.edu.au %K digital anatomy %K digital health %K virtual reality %K augmented reality %K medical education %D 2022 %7 20.5.2022 %9 Review %J JMIR Med Educ %G English %X Background: Anatomy has been the cornerstone of medical education for centuries. However, given the advances in the Internet of Things, this landscape has been augmented in the past decade, shifting toward a greater focus on adopting digital technologies. Digital anatomy is emerging as a new discipline that represents an opportunity to embrace advances in digital health technologies and apply them to the domain of modern medical sciences. Notably, the use of augmented or mixed and virtual reality as well as mobile and platforms and 3D printing in modern anatomy has dramatically increased in the last 5 years. Objective: This review aims to outline the emerging area of digital anatomy and summarize opportunities and challenges for incorporating digital anatomy in medical science education and practices. Methods: Literature searches were performed using the PubMed, Embase, and MEDLINE bibliographic databases for research articles published between January 2005 and June 2021 (inclusive). Out of the 4650 articles, 651 (14%) were advanced to full-text screening and 77 (1.7%) were eligible for inclusion in the narrative review. We performed a Strength, Weakness, Opportunity, and Threat (SWOT) analysis to evaluate the role that digital anatomy plays in both the learning and teaching of medicine and health sciences as well as its practice. Results: Digital anatomy has not only revolutionized undergraduate anatomy education via 3D reconstruction of the human body but is shifting the paradigm of pre- and vocational training for medical professionals via digital simulation, advancing health care. Importantly, it was noted that digital anatomy not only benefits in situ real time clinical practice but also has many advantages for learning and teaching clinicians at multiple levels. Using the SWOT analysis, we described strengths and opportunities that together serve to underscore the benefits of embracing digital anatomy, in particular the areas for collaboration and medical advances. The SWOT analysis also identified a few weaknesses associated with digital anatomy, which are primarily related to the fact that the current reach and range of applications for digital anatomy are very limited owing to its nascent nature. Furthermore, threats are limited to technical aspects such as hardware and software issues. Conclusions: This review highlights the advances in digital health and Health 4.0 in key areas of digital anatomy analytics. The continuous evolution of digital technologies will increase their ability to reinforce anatomy knowledge and advance clinical practice. However, digital anatomy education should not be viewed as a simple technical conversion and needs an explicit pedagogical framework. This review will be a valuable asset for educators and researchers to incorporate digital anatomy into the learning and teaching of medical sciences and their practice. %M 35594064 %R 10.2196/34687 %U https://mededu.jmir.org/2022/2/e34687 %U https://doi.org/10.2196/34687 %U http://www.ncbi.nlm.nih.gov/pubmed/35594064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34302 %T A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study %A Dunn,Sheila %A Munro,Sarah %A Devane,Courtney %A Guilbert,Edith %A Jeong,Dahn %A Stroulia,Eleni %A Soon,Judith A %A Norman,Wendy V %+ Department of Family and Community Medicine, University of Toronto, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 4977, sheila.dunn@wchospital.ca %K mifepristone %K abortion %K community of practice %K virtual community of practice %K diffusion of innovation %K learning community %D 2022 %7 5.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective: The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l’avortement (CAPS-CPCA) VCoP and explore physicians’ experience with CAPS-CPCA and their views on its value in supporting implementation. Methods: This was a mixed methods intrinsic case study of Canadian health care providers’ use and physicians’ perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians’ characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians’ experiences and perceptions of the VCoP. Results: From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6%) completed a baseline survey. Of these 222 respondents, 156 (70.3%) were family physicians, 170 (80.2%) were women, and 78 (35.1%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project’s knowledge translation activities with policy makers to mitigate these barriers. Conclusions: A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028443 %M 35511226 %R 10.2196/34302 %U https://www.jmir.org/2022/5/e34302 %U https://doi.org/10.2196/34302 %U http://www.ncbi.nlm.nih.gov/pubmed/35511226 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e36948 %T Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review %A Ayivi-Vinz,Gloria %A Bakwa Kanyinga,Felly %A Bergeron,Lysa %A Décary,Simon %A Adisso,Évèhouénou Lionel %A Zomahoun,Hervé Tchala Vignon %A Daniel,Sam J %A Tremblay,Martin %A Plourde,Karine V %A Guay-Bélanger,Sabrina %A Légaré,France %+ VITAM – Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, 2480 Chemin de la Canardière, Quebec, QC, G1J 2G1, Canada, 1 418 663 5919, France.Legare@mfa.ulaval.ca %K CPD-REACTION %K behavior %K intention %K education medical %K continuing %K health care professionals %K questionnaire %K web-based %K continuing professional development %D 2022 %7 2.5.2022 %9 Review %J JMIR Med Educ %G English %X Background: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory–informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory–informed tool that evaluates the impact of CPD activities on clinicians’ behavioral intentions. Objective: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals’ intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. Methods: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants’ completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%). Conclusions: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. Trial Registration: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492 %M 35318188 %R 10.2196/36948 %U https://mededu.jmir.org/2022/2/e36948 %U https://doi.org/10.2196/36948 %U http://www.ncbi.nlm.nih.gov/pubmed/35318188 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e32657 %T Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals %A Beverly,Elizabeth %A Rigot,Brooke %A Love,Carrie %A Love,Matt %+ Ohio University Heritage College of Osteopathic Medicine, 1 Ohio University, Irvine Hall 307, Athens, OH, 45701, United States, 1 740 593 4616, beverle1@ohio.edu %K virtual reality %K qualitative %K medical education %K health care %K digital learning %K learning platform %K health care providers %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals’ experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67%, women; n=22, 92%, White; and n=4, 17%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character’s frustrations and disappointments; perceived ease of use of cine-VR: 96% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. %M 35486427 %R 10.2196/32657 %U https://mededu.jmir.org/2022/2/e32657 %U https://doi.org/10.2196/32657 %U http://www.ncbi.nlm.nih.gov/pubmed/35486427 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e34042 %T Digital Health and Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Survey Study for Designing a Digital Learning Toolbox App %A Lin,Yuchen %A Lemos,Martin %A Neuschaefer-Rube,Christiane %+ Clinic for Phoniatrics, Pedaudiology & Communication Disorders, University Hospital and Medical Faculty, Rheinisch-Westfaelische Technische Hochschule Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany, 49 241 80 88954, yuchen.lin@rwth-aachen.de %K digital learning %K mLearning %K mHealth %K speech-language pathology %K phoniatrics %K otolaryngology %K communication disorders %K mobile phone %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The digital age has introduced opportunities and challenges for clinical education and practice caused by infinite incoming information and novel technologies for health. In the interdisciplinary field of communication sciences and disorders (CSD), engagement with digital topics has emerged slower than in other health fields, and effective strategies for accessing, managing, and focusing on digital resources are greatly needed. Objective: We aimed to conceptualize and investigate preferences of stakeholders regarding a digital learning toolbox, an app containing a library of current resources for CSD. This cross-sectional survey study conducted in German-speaking countries investigated professional and student perceptions and preferences regarding such an app’s features, functions, content, and associated concerns. Methods: An open web-based survey was disseminated to professionals and students in the field of CSD, including speech-language pathologists (SLPs; German: Logopäd*innen), speech-language pathology students, phoniatricians, otolaryngologists, and medical students. Insights into preferences and perceptions across professions, generations, and years of experience regarding a proposed app were investigated. Results: Of the 164 participants, an overwhelming majority (n=162, 98.8%) indicated readiness to use such an app, and most participants (n=159, 96.9%) perceived the proposed app to be helpful. Participants positively rated app functions that would increase utility (eg, tutorial, quality rating function, filters based on content or topic, and digital format); however, they had varied opinions regarding an app community feature. Regarding app settings, most participants rated the option to share digital resources through social media links (144/164, 87.8%), receive and manage push notifications (130/164, 79.3%), and report technical issues (160/164, 97.6%) positively. However, significant variance was noted across professions (H3=8.006; P=.046) and generations (H3=9.309; P=.03) regarding a username-password function, with SLPs indicating greater perceived usefulness in comparison to speech-language pathology students (P=.045), as was demonstrated by Generation X versus Generation Z (P=.04). Participants perceived a range of clinical topics to be important; however, significant variance was observed across professions, between physicians and SLPs regarding the topic of diagnostics (H3=9.098; P=.03) and therapy (H3=21.236; P<.001). Concerns included technical challenges, data protection, quality of the included resources, and sustainability of the proposed app. Conclusions: This investigation demonstrated that professionals and students show initial readiness to engage in the co-design and use of an interdisciplinary digital learning toolbox app. Specifically, this app could support effective access, sharing, evaluation, and knowledge management in a digital age of rapid change. Formalized digital skills education in the field of CSD is just a part of the solution. It will be crucial to explore flexible, adaptive strategies collaboratively for managing digital resources and tools to optimize targeted selection and use of relevant, high-quality evidence in a world of bewildering data. %M 35475980 %R 10.2196/34042 %U https://mededu.jmir.org/2022/2/e34042 %U https://doi.org/10.2196/34042 %U http://www.ncbi.nlm.nih.gov/pubmed/35475980 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35083 %T Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial %A Ewais,Tatjana %A Hunt,Georgia %A Munro,Jonathan %A Pun,Paul %A Hogan,Christy %A William,Leeroy %A Teodorczuk,Andrew %+ Mater Young Adult Health Centre, Mater Health, Mater Misericordiae Ltd, Level 4, Salmon Building, Raymond Terrace, South Brisbane, 4101, Australia, 61 731638521, Tatjana.Ewais@mater.org.au %K Schwartz Rounds %K compassionate care %K health care staff well-being %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective: Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods: This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory–Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results: The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions: The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/35083 %M 35475785 %R 10.2196/35083 %U https://www.researchprotocols.org/2022/4/e35083 %U https://doi.org/10.2196/35083 %U http://www.ncbi.nlm.nih.gov/pubmed/35475785 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e33360 %T Learning Agility of Learning and Development Professionals in the Life Sciences Field During the COVID-19 Pandemic: Empirical Study %A Peng,XinYun %A Wang-Trexler,Nicole %A Magagna,William %A Land,Susan %A Peck,Kyle %+ Department of Learning and Performance Systems, Pennsylvania State University, 301 Keller Building, University Park, PA, 16802, United States, 1 4154201314, xypeng@psu.edu %K COVID-19 %K learning agility %K learning and development professionals %K life sciences professionals %K training and development %K mixed methods %D 2022 %7 26.4.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic has impacted the life sciences field worldwide. Life sciences organizations (eg, pharmaceutical and med-tech companies) faced a rapidly increasing need for vital medical products, patient support, and vaccine development. Learning and development (L&D) departments play a crucial role in life sciences organizations as they apply learning initiatives to organizational strategy within a constantly evolving sector. During the COVID-19 pandemic, the work of L&D professionals in life sciences organizations changed profoundly during the abrupt shift to remote work, since learning and training normally occur in a face-to-face environment. Given the complex and dynamic situation of the pandemic, both individuals and organizations needed to learn quickly and apply what they learned to solve new, unprecedented problems. This situation presents an opportunity to study how characteristics of learning agility were evidenced by life sciences organizations and individual employees in the remote working mode. Objective: In collaboration with Life Sciences Trainers & Educators Networks (LTEN), this study investigated the responses and learning agility of L&D professionals and their organizational leadership within the life sciences sector to the work changes due to the pandemic. The study answered the following questions: (1) How did L&D professionals in the life sciences sector respond to the changes in their work environment during the COVID-19 pandemic? (2) How did L&D professionals in the life sciences sector demonstrate learning agility during remote working? Methods: We adopted a mixed methods approach that included a semistructured interview and a survey. Participants who were life sciences or health care L&D practitioners and in relevant positions were recruited via email through the LTEN and its partner pharmaceutical, biotech, or medical devices organizations. Interviews with 12 L&D professionals were conducted between June and August 2020 through phone or online conferencing, covering 22 open-ended questions to stimulate ideas that could be explored further in the survey. The semistructured interview questions were grounded in theory on learning agility. In total, 4 themes were developed from the interviews, which formed the basis for developing the survey items. The subsequent survey regarding 4 specific themes was conducted from August to October 2020 using Qualtrics. Both interview and survey data were analyzed based on a learning agility framework. Results: Findings revealed generally positive organizational and individual responses toward the changes brought about by the pandemic. Results also indicated that a disruptive crisis, such as the shift from working in the office to working from home (WFH), required professionals’ learning agility to both self-initiate their own learning and to support the learning agility of others in the organization. Conclusions: This study was designed to better understand education and training in the life sciences field, particularly during the unique circumstances of the global COVID-19 pandemic. We put forward several directions for future research on the learning agility of L&D professionals in life sciences organizations. %M 35417403 %R 10.2196/33360 %U https://www.i-jmr.org/2022/1/e33360 %U https://doi.org/10.2196/33360 %U http://www.ncbi.nlm.nih.gov/pubmed/35417403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e28625 %T Evidence for Continuing Professional Development and Recency of Practice Standards for Regulated Health Professionals in Australia: Protocol for a Systematic Review %A Main,Penelope %A Anderson,Sarah %+ Research and Evaluation Team, Australian Health Practitioner Regulation Agency, GPO Box 9958, Adelaide, 5001, Australia, 61 416367536, penelope.main@ahpra.gov.au %K protocol %K systematic review %K continuing professional development %K continuing education %K recency of practice %K regulatory standards %K health practitioners %D 2022 %7 13.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Continuing professional development (CPD) and recency of practice (ROP) standards are components of health practitioner regulation in Australia. The CPD and ROP standards are currently under review, and an evidence base to assist the development of consistent standards is required. Preliminary searching was unable to find a recent systematic review of the literature to provide an evidence base to underpin the standards review. Objective: This paper presents the protocol for a systematic review that aims to develop a current evidence base that will support the National Boards to develop more consistent, evidence-based, effective standards that are clear and easy to understand and operationalize. Methods: Research questions were developed to support the planned review of CPD and ROP registration standards. Major databases and relevant journals were searched for articles published in English between 2015 and 2021, using key search terms based on previous unpublished reviews of the CPD and ROP registration standards. The quality of the articles retrieved will be assessed using an instrument suitable for use in the development of public policy. The findings will be published in a peer-reviewed journal. Results: In September 2021, our search strategy identified 18,002 studies for the CPD-related research questions after removal of duplicates. Of these, 509 records were screened based on their title, and 66 full-text articles were assessed for eligibility based on their abstract, of which 31 met the inclusion criteria. A further 291 articles were identified as relevant to the ROP research questions. Of these, 87 records were screened based on their title, and 46 full-text articles were assessed for eligibility based on their abstract, of which 8 studies met our inclusion criteria. Conclusions: This protocol outlines the scope and methodology that will be used to conduct a systematic review of evidence for CPD and ROP and inform a review of the standards for regulated health professionals in Australia. Previous research has shown that while CPD improves practitioner knowledge, the link to public safety is unclear. While there has been a greater focus on maintenance of certification and other quality assurance activities over the past 10 years, there remains great variability in CPD requirements across both professions and jurisdictions. ROP was found to be a poorly researched area with most research concentrating on medical practitioners, nurses, and midwives and no clear consensus about the optimal time period after which retraining or an assessment of competence should be introduced. As the CPD and ROP standards are currently under review, it is timely that a review of current evidence be undertaken. International Registered Report Identifier (IRRID): DERR1-10.2196/28625 %M 35416788 %R 10.2196/28625 %U https://www.researchprotocols.org/2022/4/e28625 %U https://doi.org/10.2196/28625 %U http://www.ncbi.nlm.nih.gov/pubmed/35416788 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e35223 %T Artificial Intelligence Education for the Health Workforce: Expert Survey of Approaches and Needs %A Gray,Kathleen %A Slavotinek,John %A Dimaguila,Gerardo Luis %A Choo,Dawn %+ Centre for Digital Transformation of Health, The University of Melbourne, Level 13, VCCC Building, 305 Grattan St, Parkville, 3010, Australia, 61 3 8344 8936, kgray@unimelb.edu.au %K artificial intelligence %K curriculum %K ethics %K human-computer interaction %K interprofessional education %K machine learning %K natural language processing %K professional development %K robotics %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The preparation of the current and future health workforce for the possibility of using artificial intelligence (AI) in health care is a growing concern as AI applications emerge in various care settings and specializations. At present, there is no obvious consensus among educators about what needs to be learned or how this learning may be supported or assessed. Objective: Our study aims to explore health care education experts’ ideas and plans for preparing the health workforce to work with AI and identify critical gaps in curriculum and educational resources across a national health care system. Methods: A survey canvassed expert views on AI education for the health workforce in terms of educational strategies, subject matter priorities, meaningful learning activities, desired attitudes, and skills. A total of 39 senior people from different health workforce subgroups across Australia provided ratings and free-text responses in late 2020. Results: The responses highlighted the importance of education on ethical implications, suitability of large data sets for use in AI clinical applications, principles of machine learning, and specific diagnosis and treatment applications of AI as well as alterations to cognitive load during clinical work and the interaction between humans and machines in clinical settings. Respondents also outlined barriers to implementation, such as lack of governance structures and processes, resource constraints, and cultural adjustment. Conclusions: Further work around the world of the kind reported in this survey can assist educators and education authorities who are responsible for preparing the health workforce to minimize the risks and realize the benefits of implementing AI in health care. %M 35249885 %R 10.2196/35223 %U https://mededu.jmir.org/2022/2/e35223 %U https://doi.org/10.2196/35223 %U http://www.ncbi.nlm.nih.gov/pubmed/35249885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31977 %T Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda %A Tudor Car,Lorainne %A Poon,Selina %A Kyaw,Bhone Myint %A Cook,David A %A Ward,Victoria %A Atun,Rifat %A Majeed,Azeem %A Johnston,Jamie %A van der Kleij,Rianne M J J %A Molokhia,Mariam %A V Wangenheim,Florian %A Lupton,Martin %A Chavannes,Niels %A Ajuebor,Onyema %A Prober,Charles G %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Science Building, Novena, Singapore, 308232, Singapore, 65 69041258, josip.car@ntu.edu.sg %K digital education %K health professions education %K evidence map %K systematic review %K research questions %K conceptual framework %K mobile phone %D 2022 %7 17.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. Objective: This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. Methods: We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. Results: We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants’ skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). Conclusions: We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed. %M 35297767 %R 10.2196/31977 %U https://www.jmir.org/2022/3/e31977 %U https://doi.org/10.2196/31977 %U http://www.ncbi.nlm.nih.gov/pubmed/35297767 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e34036 %T Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing %A Son,Hyojin %A Ross,Alyson %A Mendoza-Tirado,Elizabeth %A Lee,Lena Jumin %+ Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, 20892, United States, 1 667 701 5768, hyojin.son@nih.gov %K virtual reality %K health care %K application %K nursing %D 2022 %7 16.3.2022 %9 Viewpoint %J JMIR Nursing %G English %X Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing. %M 35293870 %R 10.2196/34036 %U https://nursing.jmir.org/2022/1/e34036 %U https://doi.org/10.2196/34036 %U http://www.ncbi.nlm.nih.gov/pubmed/35293870 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30738 %T A Serious Game (Immunitates) About Immunization: Development and Validation Study %A Lima,Isabela Dantas de Araujo %A Ponce de Leon,Casandra Genoveva Rosales Martins %A Ribeiro,Laiane Medeiros %A Silva,Izabel Cristina Rodrigues da %A Vilela,Danielle Monteiro %A Fonseca,Luciana Mara Monti %A Góes,Fernanda dos Santos Nogueira de %A Funghetto,Silvana Schwerz %+ Graduate Program in Health Sciences and Technologies, Ceilândia College, University of Brasília, Campus Universitário - Centro Metropolitano, Ceilândia Sul, Brasília, 72220-275, Brazil, 55 61 3107 8418, isabeladantas.al@gmail.com %K educational technology %K immunization %K nursing education %K validation %K methodological study %K vaccination %K public health %K nursing students %K teaching %K education %K support tool %K continuing education %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Vaccination is a fundamental part of all levels—local to worldwide—of public health, and it can be considered one of humanity's greatest achievements in the control and elimination of infectious diseases. Teaching immunization and vaccination can be monotonous and tiring. It is necessary to develop new approaches for teaching these themes in nursing school. Objective: We aimed to develop and validate a serious game about immunization and vaccination for Brazilian nursing students. Methods: We developed a quiz-type game, Immunitates, using design and educational theoretical models and Brazilian National Health Guidelines. The game’s heuristics and content were evaluated with 2 different instruments by a team of experts. A sample of nursing students evaluated the validity of the game’s heuristics only. We calculated the content validity index (CVI) for each evaluation. Results: The study included 49 experts and 15 nursing students. All evaluations demonstrated high internal consistency (Cronbach α≥.86). The game’s heuristics (experts: CVI 0.75-1.0; students: CVI 0.67-1.0) and the game’s contents demonstrated validity (experts: CVI 0.73-1.0). Participants identified some specific areas for improvement in the next version. Conclusions: The serious game appears to be valid. It is intended as a support tool for nursing students in the teaching–learning process and as a tool for continuing education for nurses. %M 35179496 %R 10.2196/30738 %U https://games.jmir.org/2022/1/e30738 %U https://doi.org/10.2196/30738 %U http://www.ncbi.nlm.nih.gov/pubmed/35179496 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e31634 %T Comparing Web-Based and In-Person Educational Workshops for Canadian Occupational Therapists and Understanding Their Learning Experiences: Mixed Methods Study %A Kim,Sungha %A Bayer,Ilana %A Gewurtz,Rebecca %A Larivière,Nadine %A Letts,Lori %+ School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada, 1 289 659 7787, kims130@mcmaster.ca %K online education %K occupational therapy %K occupational therapist %K continuing education %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Do-Live-Well (DLW) framework is an occupation-focused health promotion approach. Occupational therapists (OTs) have been interested in training opportunities regarding this framework. Traditionally, in-person continuing educational interventions are the main way that OTs obtain knowledge, but web-based learning has become popular among health care professionals. However, its effectiveness and learners’ experience in web-based learning have not been well-studied in occupational therapy education. Objective: This study aims to evaluate the effectiveness of the web-based and in-person educational DLW workshops for Canadian OTs and to understand their experiences in both workshop types. Methods: An explanatory sequential mixed methods study design was used, where quantitative data were collected first, then qualitative data were used to explain the quantitative findings. A quasi-experimental design and interpretative description methodology were used in the quantitative and qualitative phases, respectively. Results: Quantitative results were as follows: a total of 43 OTs completed pre-, post-, and follow-up evaluations (in-person group: 21/43, 49%; web-based group: 22/43, 51%). Practice settings of the participants varied, including geriatric, hospital, long-term, mental health, pediatric, and primary settings. The primary outcome was as follows: there were no statistically significant differences in knowledge changes at the 3 time points (P=.57 to P=.99) between the groups. In the web-based group, the knowledge scores at follow-up were lower compared with the posttest results, meaning that knowledge gain was reduced over time (P=.001). The secondary outcomes were as follows: there were statistically significant differences between the groups in factors influencing DLW adoption at posttest (P=.001) and in satisfaction with the workshop (P<.001) at posttest in favor of the in-person group. Qualitative results were as follows: a total of 18 OTs (9/18, 50% from each group) participated in an individual interview. Five themes were identified regarding learners’ workshop experiences: relevance to their practices and interests may improve learning, a familiar learning environment may facilitate learning, synchronous in-person interaction is valuable in the learning process, ease of access to learning should be considered, and flexibility in web-based learning can be both beneficial and challenging. Conclusions: The quantitative results of this study reported no difference in knowledge acquisition between the in-person and web-based groups, indicating that web-based education is as effective as in-person workshops. However, participants’ satisfaction with the workshop was statistically significantly higher for the in-person workshop. The qualitative findings described the participants’ perceived benefits and challenges of each educational format. The participants in both the web-based and in-person workshop groups valued in-person interactions in learning, but the participants in the web-based workshop group expressed web-based learning lacked in-person-like interactions. Thus, adding synchronous in-person interactions to web-based learning may improve learners’ educational experiences in web-based occupational therapy and continuing education. %M 34982719 %R 10.2196/31634 %U https://mededu.jmir.org/2022/1/e31634 %U https://doi.org/10.2196/31634 %U http://www.ncbi.nlm.nih.gov/pubmed/34982719 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30440 %T Simulation-Based Teaching of Telemedicine for Future Users of Teleconsultation and Tele-Expertise: Feasibility Study %A Bouamra,Benjamin %A Chakroun,Karim %A Medeiros De Bustos,Elisabeth %A Dobson,Jennifer %A Rouge,Jeanne-Antide %A Moulin,Thierry %+ Department of Neurology, Besançon University Hospital, 3 boulevard Alexandre Fleming, Besançon, 25000, France, 33 0687434404, benjamin.bouamra@wanadoo.fr %K telemedicine %K teleconsultation %K simulation training %K health care %K training %K education %K digital training %K medical education %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Health care professionals worldwide are increasingly using telemedicine in their daily clinical practice. However, there is still a lack of dedicated education and training even though it is needed to improve the quality of the diverse range of telemedicine activities. Simulation-based training may be a useful tool in telemedicine education and training delivery. Objective: This study aims to assess the feasibility and acceptability of simulation-based telemedicine training. Methods: We assessed five telemedicine training sessions conducted in a simulation laboratory. The training was focused on video teleconsultations between a patient and a health care professional. The assessment included the participants’ satisfaction and attitudes toward the training. Results: We included 29 participants in total. Participant satisfaction was high (mean score 4.9 of 5), and those that took part stated the high applicability of the simulation-based training to their telemedicine practices (mean score 4.6 of 5). They also stated that they intended to use telemedicine in the future (mean score 4.5 of 5). Conclusions: Simulation-based training of telemedicine dedicated to video teleconsultation was feasible and showed high satisfaction from participants. However, it remains difficult to scale for a high number of health care professionals. %M 34941553 %R 10.2196/30440 %U https://mededu.jmir.org/2021/4/e30440 %U https://doi.org/10.2196/30440 %U http://www.ncbi.nlm.nih.gov/pubmed/34941553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33695 %T Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research %A Darnell,Doyanne %A Areán,Patricia A %A Dorsey,Shannon %A Atkins,David C %A Tanana,Michael J %A Hirsch,Tad %A Mooney,Sean D %A Boudreaux,Edwin D %A Comtois,Katherine Anne %+ Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, United States, 1 206 744 9108, darnelld@uw.edu %K suicide prevention %K hospital %K training %K e-learning %K artificial intelligence %K implementation science %K user-centered design %K task-shifting %K quality assessment %K fidelity %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence–based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/33695 %M 34914618 %R 10.2196/33695 %U https://www.researchprotocols.org/2021/12/e33695 %U https://doi.org/10.2196/33695 %U http://www.ncbi.nlm.nih.gov/pubmed/34914618 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e27854 %T Nursing Student Perceptions and Attitudes Toward Patients With Cancer After Education and Mentoring: Integrative Review %A Hedenstrom,Margot Lisa %A Sneha,Sweta %A Nalla,Anusha %A Wilson,Barbara %+ Wellstar School of Nursing, Wellstar College of Health Sciences, Kennesaw State University, 520 Parliament Garden Way, Rm 3114 MD 4102, Kennesaw, GA, 30144, United States, 1 470 578 7969, mhedenst@kennesaw.edu %K nursing students %K nurse %K cancer %K attitudes %K health care professionals %K nursing %K cancer patients %K oncology %K patient support %K continuing education %K mentoring %D 2021 %7 24.9.2021 %9 Review %J JMIR Cancer %G English %X Background: Knowledge about nursing student attitudes toward patients with cancer after an educational intervention and mentoring support is limited. This review examined the literature on this topic. Objective: This integrative review aims to explore the literature on the experiences of students who participate in an oncology elective or educational course on cancer and their attitudes toward cancer. Methods: A comprehensive search was conducted using PubMed, CINAHL, and MEDLINE databases. Each study was systematically assessed. An evidence table was completed to identify the key aspects of each study that was reviewed. Results: There is insufficient information on the impact of nursing student education on the attitudes and skills of nursing students caring for patients with cancer. An integrative review was completed on the impact of education and mentoring for nursing students on cancer care, which yielded 10 studies that were reviewed. These studies indicate that educational intervention and mentoring improve the confidence and ability of nursing students to care for patients with cancer. Conclusions: Student nurses need to be armed with knowledge, skills, and positive attitudes while caring for patients with cancer. Nursing students perform best when they have accurate information, positive role models, and mentoring by experienced oncology professionals, to support proficiency in caring for patients with cancer. The lack of knowledge of nursing students in the areas of cancer care, treatment, and patient support requires additional education and research to promote expertise and positive attitudes toward cancer and treating patients with cancer. This will support nursing students’ ability to care for patients with cancer as well as develop future educational interventions to shape nursing student attitude and knowledge. This integrative review also identifies the positive impact on the attitudes of other health care professionals who have received training or education on cancer. %M 34559056 %R 10.2196/27854 %U https://cancer.jmir.org/2021/3/e27854 %U https://doi.org/10.2196/27854 %U http://www.ncbi.nlm.nih.gov/pubmed/34559056 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e24182 %T Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study %A Hicks,Joseph Paul %A Allsop,Matthew John %A Akaba,Godwin O %A Yalma,Ramsey M %A Dirisu,Osasuyi %A Okusanya,Babasola %A Tukur,Jamilu %A Okunade,Kehinde %A Akeju,David %A Ajepe,Adegbenga %A Okuzu,Okey %A Mirzoev,Tolib %A Ebenso,Bassey %+ Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9LU, United Kingdom, 44 113434185, m.j.allsop@leeds.ac.uk %K primary health worker training %K digital health technology %K eHealth %K video-based training %K maternal and child health %K Nigeria %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers’ knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders’ experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention’s acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs’ workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372 %M 34528891 %R 10.2196/24182 %U https://mhealth.jmir.org/2021/9/e24182 %U https://doi.org/10.2196/24182 %U http://www.ncbi.nlm.nih.gov/pubmed/34528891 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e27901 %T Digital Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary and Exploratory Analysis of Content, Organizing Structures, and Formats %A Lin,Yuchen %A Neuschaefer-Rube,Christiane %+ Clinic for Phoniatrics, Pedaudiology & Communication Disorders, University Hospital and Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, Aachen, 52074, Germany, 49 241 80 88954, yuchen.lin@rwth-aachen.de %K digital learning %K e-learning %K speech-language pathology %K phoniatrics %K otolaryngology %K communication disorders %K mobile phone %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The digital revolution is rapidly transforming health care and clinical teaching and learning. Relative to other medical fields, the interdisciplinary fields of speech-language pathology (SLP), phoniatrics, and otolaryngology have been slower to take up digital tools for therapeutic, teaching, and learning purposes—a process that was recently expedited by the COVID-19 pandemic. Although many current teaching and learning tools have restricted or institution-only access, there are many openly accessible tools that have gone largely unexplored. To find, use, and evaluate such resources, it is important to be familiar with the structures, concepts, and formats of existing digital tools. Objective: This descriptive study aims to investigate digital learning tools and resources in SLP, phoniatrics, and otolaryngology. Differences in content, learning goals, and digital formats between academic-level learners and clinical-professional learners are explored. Methods: A systematic search of generic and academic search engines (eg, Google and PubMed); the App Store; Google Play Store; and websites of established SLP, phoniatrics, and otolaryngology organizations was conducted. By using specific search terms and detailed inclusion and exclusion criteria, relevant digital resources were identified. These were organized and analyzed according to learner groups, content matter, learning goals and architectures, and digital formats. Results: Within- and between-learner group differences among 125 identified tools were investigated. In terms of content, the largest proportion of tools for academic-level learners pertained to anatomy and physiology (60/214, 28%), and that for clinical-professional learners pertained to diagnostic evaluation (47/185, 25.4%). Between groups, the largest differences were observed for anatomy and physiology (academic-level learners: 60/86, 70%; clinical-professional learners: 26/86, 30%) and professional issues (8/28, 29% vs 20/28, 71%). With regard to learning goals, most tools for academic-level learners targeted the performance of procedural skills (50/98, 51%), and those for clinical-professional learners targeted receptive information acquisition (44/62, 71%). Academic-level learners had more tools for supporting higher-level learning goals than clinical-professional learners, specifically tools for performing procedural skills (50/66, 76% vs 16/66, 24%) and strategic skills (8/10, 80% vs 2/10, 20%). Visual formats (eg, pictures or diagrams) were dominant across both learner groups. The greatest between-group differences were observed for interactive formats (45/66, 68% vs 21/66, 32%). Conclusions: This investigation provides initial insights into openly accessible tools across SLP, phoniatrics, and otolaryngology and their organizing structures. Digital tools in these fields addressed diverse content, although the tools for academic-level learners were greater in number, targeted higher-level learning goals, and had more interactive formats than those for clinical-professional learners. The crucial next steps include investigating the actual use of such tools in practice and students’ and professionals’ attitudes to better improve upon such tools and incorporate them into current and future learning milieus. %M 34313592 %R 10.2196/27901 %U https://mededu.jmir.org/2021/3/e27901 %U https://doi.org/10.2196/27901 %U http://www.ncbi.nlm.nih.gov/pubmed/34313592 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e27736 %T Nursing Students’ Perceptions about Effective Pedagogy: Netnographic Analysis %A De Gagne,Jennie C %A Koppel,Paula D %A Park,Hyeyoung K %A Cadavero,Allen %A Cho,Eunji %A Rushton,Sharron %A Yamane,Sandra S %A Manturuk,Kim %A Jung,Dukyoo %+ College of Nursing, Ewha Womans University of Korea, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 10 4310 4522, dyjung@ewha.ac.kr %K discussion forums %K faculty behaviors %K health professions students %K learning environment %K learning experience %K netnography %K pedagogy %D 2021 %7 22.6.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Effective pedagogy that encourages high standards of excellence and commitment to lifelong learning is essential in health professions education to prepare students for real-life challenges such as health disparities and global health issues. Creative learning and innovative teaching strategies empower students with high-quality, practical, real-world knowledge and meaningful skills to reach their potential as future health care providers. Objective: The aim of this study was to explore health profession students’ perceptions of whether their learning experiences were associated with good or bad pedagogy during asynchronous discussion forums. The further objective of the study was to identify how perceptions of the best and worst pedagogical practices reflected the students’ values, beliefs, and understanding about factors that made a pedagogy good during their learning history. Methods: A netnographic qualitative design was employed in this study. The data were collected on February 3, 2020 by exporting archived data from multiple sessions of a graduate-level nursing course offered between the fall 2016 and spring 2020 semesters at a large private university in the southeast region of the United States. Each student was a data unit. As an immersive data operation, field notes were taken by all research members. Data management and analysis were performed with NVivo 12. Results: A total of 634 posts were generated by 153 students identified in the dataset. Most of these students were female (88.9%). From the 97 categories identified, four themes emerged: (T) teacher presence built through relationship and communication, (E) environment conducive to affective and cognitive learning, (A) assessment and feedback processes that yield a growth mindset, and (M) mobilization of pedagogy through learner- and community-centeredness. Conclusions: The themes that emerged from our analysis confirm findings from previous studies and provide new insights. Our study highlights the value of technology as a tool for effective pedagogy. A resourceful teacher can use various communication techniques to develop meaningful connections between the learner and teacher. Styles of communication will vary according to the unique expectations and needs of learners with different learning preferences; however, the aim is to fully engage each learner, establish a rapport between and among students, and nurture an environment characterized by freedom of expression in which ideas flow freely. We suggest that future research continue to explore the influence of differing course formats and pedagogical modalities on student learning experiences. %M 34156337 %R 10.2196/27736 %U https://mededu.jmir.org/2021/2/e27736 %U https://doi.org/10.2196/27736 %U http://www.ncbi.nlm.nih.gov/pubmed/34156337 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e20704 %T Shared Tobacco Cessation Curriculum Website for Health Professionals: Longitudinal Analysis of User and Utilization Data Over a Period of 15 Years %A Elkhadragy,Nervana %A Aviado,Jeremie %A Huang,Henry %A Corelli,Robin L %A Hudmon,Karen Suchanek %+ Department of Pharmacy Practice, College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN, United States, 1 317 880 5427, khudmon@purdue.edu %K health professional education %K interprofessional education %K shared curricula %K website %K end-user data %K tobacco cessation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Because tobacco use is a major cause of morbidity and mortality worldwide, it is essential to prepare health care providers to assist patients with quitting smoking. Created in 1999, the “Rx for Change” tobacco cessation curriculum was designed to fill an educational gap in cessation training of health professional students. In 2004, a website was launched to host teaching materials and tools to support the efforts of educators and clinicians. Objective: The objective of this study was to characterize users and utilization of a website hosting shared teaching materials over a period of 15 years. Methods: Data from the Rx for Change website have been collected prospectively since its inception. In this study, end-user data were analyzed to determine user characteristics, how they heard about the website, intended use of the materials, and numbers of logins and file downloads over time. Results: Total number of website registrants was 15,576, representing all 50 states in the United States and 94 countries. The most represented discipline was pharmacy (6393/15,505, 41.2%), and nearly half of users were students or residents. The most common source of referral to the website was a faculty member or colleague (33.4%, 2591/7758), and the purpose of enhancing personal knowledge and skills was the most commonly cited intended use of the curricular materials. A total of 259,835 file downloads occurred during the 15-year period, and the most commonly downloaded file type was ancillary handouts. Conclusions: The Rx for Change website demonstrated sustained use, providing immediate access to tobacco cessation teaching and practice tools for educators and clinicians over the first 15 years of its existence. The website has a broad interprofessional reach, and the consistent utilization over time and large number of downloads provide evidence for the feasibility and utility of a public-access website hosting teaching materials. The shared curriculum approach averts the need for educators to create their own materials for teaching tobacco cessation to students in the health professions. %M 34032582 %R 10.2196/20704 %U https://mededu.jmir.org/2021/2/e20704 %U https://doi.org/10.2196/20704 %U http://www.ncbi.nlm.nih.gov/pubmed/34032582 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 4 %N 2 %P e26944 %T Academic Electronic Health Records in Undergraduate Nursing Education: Mixed Methods Pilot Study %A Kleib,Manal %A Jackman,Deirdre %A Duarte Wisnesky,Uirá %A Ali,Shamsa %+ Faculty of Nursing, University of Alberta, 5-112 Edmonton Clinic Health Academy, Edmonton, AB, T6G1C9, Canada, 1 7802481422, manal.kleib@ualberta.ca %K academic electronic health record %K Lippincott DocuCare %K simulation %K nursing informatics education %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: Teaching students about electronic health records presents challenges for most nursing programs, primarily because of the limited training opportunities within clinical practice settings. A simulated electronic health record is an experiential, learner-centered strategy that enables students to acquire and apply the informatics knowledge needed for working with electronic records in a safe learning environment before the students have encounters with real patients. Objective: The aim of this study is to provide a preliminary evaluation of the Lippincott DocuCare simulated electronic health record and determine the feasibility issues associated with its implementation. Methods: We used one-group pretest-posttest, surveys, and focus group interviews with students and instructors to pilot the DocuCare simulated electronic health record within an undergraduate nursing program in Western Canada. Volunteering students worked through 4 case scenarios during a 1-month pilot. Self-reported informatics knowledge and attitudes toward the electronic health record, accuracy of computerized documentation, satisfaction, and students’ and educators’ experiences were examined. Demographic and general information regarding informatics learning was also collected. Results: Although 23 students participated in this study, only 13 completed surveys were included in the analysis. Almost two-thirds of the students indicated their overall understanding of nursing informatics as being fair or inadequate. The two-tailed paired samples t test used to evaluate the impact of DocuCare on students’ self-reported informatics knowledge and attitudes toward the electronic health record revealed a statistically significant difference in the mean score of knowledge before and after using DocuCare (before: mean 2.95, SD 0.58; after: mean 3.83, SD 0.39; t12=5.80, two-tailed; P<.001). There was no statistically significant difference in the mean scores of attitudes toward the electronic health record before and after using DocuCare (before: mean 3.75, SD 0.40; after: mean 3.70, SD 0.34; t12=0.39, two-tailed; P=.70). Students’ documentation scores varied from somewhat accurate to completely accurate; however, performance improved for the majority of students as they progressed from case scenarios 1 to 4. Both the faculty and students were highly satisfied with DocuCare and highly recommended its integration. Focus groups with 7 students and 3 educators revealed multiple themes. The participants shared suggestions regarding the DocuCare product customization and strategies for potential integration in undergraduate nursing programs. Conclusions: This study demonstrated the feasibility and suitability of the DocuCare program as a tool to enhance students’ learning about informatics and computerized documentation in electronic health records. Recommendations will be made to academic leadership in undergraduate programs on the basis of this study. Furthermore, a controlled evaluation study will be conducted in the future. %M 34345797 %R 10.2196/26944 %U https://nursing.jmir.org/2021/2/e26944 %U https://doi.org/10.2196/26944 %U http://www.ncbi.nlm.nih.gov/pubmed/34345797 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e28945 %T One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization’s Technical Guidance %A Utunen,Heini %A Van Kerkhove,Maria D %A Tokar,Anna %A O'Connell,Gillian %A Gamhewage,Gaya M %A Fall,Ibrahima Socé %+ Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K COVID-19 %K e-learning %K massive open web-based courses %K OpenWHO %K pandemic %K public health %K web-based learning %K World Health Organization %D 2021 %7 21.4.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) launched the first web-based learning course on COVID-19 on January 26, 2020, four days before the director general of the WHO declared a public health emergency of international concern. The WHO is expanding access to web-based learning for COVID-19 through its open-learning platform for health emergencies, OpenWHO. Throughout the pandemic, OpenWHO has continued to publish learning offerings based on the WHO’s emerging evidence-based knowledge for managing the COVID-19 pandemic. This study presents the various findings derived from the analysis of the performance of the OpenWHO platform during the pandemic, along with the core benefits of massive web-based learning formats. %M 33881404 %R 10.2196/28945 %U https://publichealth.jmir.org/2021/4/e28945 %U https://doi.org/10.2196/28945 %U http://www.ncbi.nlm.nih.gov/pubmed/33881404 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 1 %P e18956 %T Impact Evaluation of the Kenya Frontline Field Epidemiology Training Program: Repeated-Measures Study %A Roka,Zeinab Gura %A Oyugi,Elvis Omondi %A Githuku,Jane Njoki %A Kanyina,Evalyne %A Obonyo,Mark %A Omballa,Victor %A Boru,Waqo Gufu %A Ransom,James %+ Piret Partners Consulting, 611 Pennsylvania Avenue, Unit 358, Washington, DC, 20003, United States, 1 2024252515, james.ransom@piretpartners.com %K field epidemiology %K workforce development %K Kenya %K training %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: In 2014, Kenya’s Field Epidemiology and Laboratory Training Program (FELTP) initiated a 3-month field-based frontline training, Field Epidemiology Training Program (FETP-F), for local public health workers. Objective: This study aimed to measure the effect of FETP-F on participant workplace practices regarding quality and consistency of public health data, critical interaction with public health data, and improvements in on-time reporting (OTR). Methods: Between February and April 2017, FELTP conducted a mixed methods evaluation via online survey to examine outcomes achieved among all 215 graduates from 2014 and 2015. Data quality assessment (DQA) and data consistency assessment (DCA) scores, OTR percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months postcompletion of the training. The qualitative component consisted of semistructured face-to-face interviews and observations. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions. Results: In total, 103 (47%) graduates responded to the survey. Quantitative analyses showed that the training significantly increased the mean DQA and OTR scores but there was a nonsignificant increase in mean DCA scores. Qualitative analyses found that 68% of respondents acquired new skills, 83% applied those skills to their day-to-day work, and 91% improved work methods. Conclusions: FETP-F improved overall data quality and OTR at the agency level but had minimal impact on data consistency between local, county, and national public health agencies. Participants reported that they acquired practical skills that improved data collation and analysis and OTR. %M 33416507 %R 10.2196/18956 %U https://mededu.jmir.org/2021/1/e18956 %U https://doi.org/10.2196/18956 %U http://www.ncbi.nlm.nih.gov/pubmed/33416507 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e21855 %T Health Care Providers’ Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study %A Cutumisu,Maria %A Ghoman,Simran K %A Lu,Chang %A Patel,Siddhi D %A Garcia-Hidalgo,Catalina %A Fray,Caroline %A Brown,Matthew R G %A Greiner,Russell %A Schmölzer,Georg M %+ Department of Educational Psychology, Faculty of Education, University of Alberta, 6-102 Education North, Edmonton, AB, T6G2G5, Canada, 1 7804925211, cutumisu@ualberta.ca %K infant %K newborn %K delivery room %K neonatal resuscitation %K performance %K neonatal resuscitation program %K serious games %K computer-based game simulation %K mindset %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Neonatal resuscitation involves a complex sequence of actions to establish an infant’s cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners’ attitudes toward computer-based learning and assessment environments influence their performance. Objective: This study explores the relation between HCPs’ attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation. Methods: Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants’ survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN. Results: The results revealed that mindset moderated the relation between participants’ perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=–1.19, SE=0.38, t44=–3.12, 95% CI –1.96 to –0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=–1.21, SE=0.38, t44=−3.16, 95% CI –1.99 to –0.44; P=.003). Conclusions: Mindset moderates the strength of the relationship between HCPs’ perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks. %M 33346741 %R 10.2196/21855 %U http://games.jmir.org/2020/4/e21855/ %U https://doi.org/10.2196/21855 %U http://www.ncbi.nlm.nih.gov/pubmed/33346741 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e23963 %T Augmented Reality Technology as a Teaching Strategy for Learning Pediatric Asthma Management: Mixed Methods Study %A Kotcherlakota,Suhasini %A Pelish,Peggy %A Hoffman,Katherine %A Kupzyk,Kevin %A Rejda,Patrick %+ College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, United States, 1 402 559 6375, skotcherlakota@unmc.edu %K augmented reality %K graduate nursing %K pediatric asthma management %K flipped learning %K nursing %K asthma %K chronic disease %K nurse practitioner %K nursing students %K pediatric asthma %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Asthma is a major chronic disease affecting 8.6% of children in the United States. Objective: The purpose of this research was to assess the use of clinical simulation scenarios using augmented reality technology to evaluate learning outcomes for nurse practitioner students studying pediatric asthma management. Methods: A mixed-methods pilot study was conducted with 2 cohorts of graduate pediatric nurse practitioner students (N=21), with each cohort participating for 2 semesters. Results: Significant improvements in pediatric asthma test scores (P<.001) of student learning were found in both cohorts at posttest in both semesters. Student satisfaction with the augmented reality technology was found to be high. The focus group discussions revealed that the simulation was realistic and helpful for a flipped classroom approach. Conclusions: The study results suggest augmented reality simulation to be valuable in teaching pediatric asthma management content in graduate nursing education. %M 34406970 %R 10.2196/23963 %U https://nursing.jmir.org/2001/1/e23963/ %U https://doi.org/10.2196/23963 %U http://www.ncbi.nlm.nih.gov/pubmed/34406970 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e17621 %T Effectiveness of Educational Interventions to Increase Knowledge of Evidence-Based Practice Among Nurses and Physiotherapists in Primary Health Care: Protocol for a Systematic Review %A Verloo,Henk %A Melly,Pauline %A Hilfiker,Roger %A Pereira,Filipa %+ School of Health Sciences, Haute Ecole Spécialisé Suisse Occidentale Valais/Wallis, Sion, Switzerland, 41 0787698990, henk.verloo@hevs.ch %K evidence-based practice %K primary healthcare %K beliefs %K knowledge %K implementation %K nurses %K nurse practitioners %K physiotherapists %K interventions %K education %D 2020 %7 2.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The implementation of evidence-based practice (EBP) in daily health care practice is strongly encouraged; it is widely recognized as a means to improve the quality and safety of health care for patients and reduce avoidable costs. Primary care nurses and physiotherapists face numerous challenges in trying to ensure that they deliver effective daily care. Broadly promoted educational interventions aim to increase the integration and implementation of EBP in their daily practice. Objective: This systematic review will retrieve and evaluate publications examining the effectiveness of educational interventions to increase the integration and implementation of EBP among nurses, nurse practitioners, and physiotherapists active in primary care. Methods: We will conduct a systematic review of published articles in relevant professional, scientific journals (from their start dates) and in the following electronic databases, from inception until October 31, 2020: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb]; from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Central Register of Controlled Trials Wiley (from 1992), PsycINFO Ovid SP (from 1806), Web of Science Core collection (from 1900), PEDro (from 1999), the JBI Database of Systematic Reviews and Implementation Reports (from 1998), and the Trip Database (from 1997). We will use the predefined search terms of “evidence-based practice,” “nurses,” or “physiotherapists” and combinations with other terms, such as “educational interventions.” We will also conduct a hand search of the bibliographies of all the relevant articles and a search for unpublished studies using Google Scholar, the ProQuest Dissertations and Theses dissemination, Mednar, WorldCat, OpenGrey, and Grey Literature Report. We will consider publications in English, French, German, and Portuguese. Results: The electronic database searches were completed in October 2020. Retrieved articles are currently being screened, and the entire study is expected to be completed by March 2021. Conclusions: This systematic review will provide specific knowledge about the effectiveness of educational interventions to increase the implementation and integration of EBP in the daily practice of nurses and physiotherapists providing primary care services. Its findings will inform us about the types and frequencies of the most successful educational interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42017077309; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77309 International Registered Report Identifier (IRRID): DERR1-10.2196/17621 %M 33136056 %R 10.2196/17621 %U https://www.researchprotocols.org/2020/11/e17621 %U https://doi.org/10.2196/17621 %U http://www.ncbi.nlm.nih.gov/pubmed/33136056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21309 %T Partnering With Massage Therapists to Communicate Information on Reducing the Risk of Skin Cancer Among Clients: Longitudinal Study %A Loescher,Lois %A Heslin,Kelly %A Silva,Graciela %A Muramoto,Myra %+ College of Nursing, University of Arizona, 1305 N Martin Ave, P.O. Box 210203, Tucson, AZ, 85721, United States, 1 5206266169, loescher@arizona.edu %K cancer prevention %K skin cancer %K e-training %K electronic intervention %K massage therapists %D 2020 %7 2.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Skin cancer affects millions of Americans and is an important focus of disease prevention efforts. Partnering with non–health care practitioners such as massage therapists (MTs) can reduce the risk of skin cancer. MTs see clients’ skin on a regular basis, which can allow MTs to initiate “helping conversations” (ie, brief behavioral interventions aimed at reducing the risk of skin cancer). Objective: The purpose of this study was to evaluate (1) the feasibility of recruiting, enrolling, and retaining Arizona MTs in an online electronic training (e-training) and (2) the preliminary efficacy of e-training on knowledge, attitudes/beliefs, and practice of risk reduction for skin cancer. We explored MTs’ ability to assess suspicious skin lesions. Methods: We adapted the existing educational content on skin cancer for applicability to MTs and strategies from previous research on helping conversations. We assessed the feasibility of providing such e-training, using Research Electronic Data Capture (REDCap) tools for data capture. We assessed the preliminary efficacy using established self-report surveys at baseline, immediately post training, and at 3 and 6 months post training. Results: A total of 95 participants enrolled in the study, of which 77% (73/95) completed the assessments at 6 months (overall attrition=23%). Project satisfaction and e-training acceptability were high. Knowledge, personal behaviors (skin self-examination, clinical skin examination, sun protection frequency), and practice attitudes (appropriateness and comfort with client-focused communication) of risk reduction for skin cancer improved significantly and were sustained throughout the study. Conclusions: The e-training was feasible and could be delivered online successfully to MTs. Participants were highly satisfied with and accepting of the e-training. As such, e-training has potential as an intervention in larger trials with MTs for reducing the risk of skin cancer. International Registered Report Identifier (IRRID): RR2-10.2196/13480 %M 33136054 %R 10.2196/21309 %U https://formative.jmir.org/2020/11/e21309 %U https://doi.org/10.2196/21309 %U http://www.ncbi.nlm.nih.gov/pubmed/33136054 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e15936 %T The Digital Skills, Experiences and Attitudes of the Northern Ireland Social Care Workforce Toward Technology for Learning and Development: Survey Study %A Synnott,Jonathan %A Harkin,Mairead %A Horgan,Brenda %A McKeown,Andre %A Hamilton,David %A McAllister,Declan %A Trainor,Claire %A Nugent,Chris %+ School of Computing, University of Ulster, Jordanstown Campus, Room 16E07, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 28 9036 8952, j.synnott@ulster.ac.uk %K social work %K learning %K teaching methods %K surveys %K health care workers %K mobile phone %K digital divide %K distance education %K educational technology %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: Continual development of the social care workforce is a key element in improving outcomes for the users of social care services. As the delivery of social care services continues to benefit from innovation in assistive technologies, it is important that the digital capabilities of the social care workforce are aligned. Policy makers have highlighted the importance of using technology to support workforce learning and development, and the need to ensure that the workforce has the necessary digital skills to fully benefit from such provisions. Objective: This study aims to identify the digital capability of the social care workforce in Northern Ireland and to explore the workforce’s appetite for and barriers to using technology for learning and development. This study is designed to answer the following research questions: (1) What is the digital capability of the social care workforce in Northern Ireland? (2) What is the workforce’s appetite to participate in digital learning and development? and (3) If there are barriers to the uptake of technology for learning and development, what are these barriers? Methods: A survey was created and distributed to the Northern Ireland social care workforce. This survey collected data on 127 metrics that described demographics, basic digital skills, technology confidence and access, factors that influence learning and development, experience with digital learning solutions, and perceived value and challenges of using technology for learning. Results: The survey was opened from December 13, 2018, to January 18, 2019. A total of 775 survey respondents completed the survey. The results indicated a workforce with a high level of self-reported basic digital skills and confidence. Face-to-face delivery of learning is still the most common method of accessing learning, which was used by 83.7% (649/775) of the respondents; however, this is closely followed by digital learning, which was used by 79.0% (612/775) of the respondents. There was a negative correlation between age and digital skills (rs=−0.262; P<.001), and a positive correlation between technology confidence and digital skills (rs=0.482; P<.001). There was also a negative correlation between age and the perceived value of technology (rs=−0.088; P=.02). The results indicated a predominantly motivated workforce in which a sizable portion is already engaged in informal digital learning. The results indicated that lower self-reported basic digital skills and confidence were associated with less interest in engaging with e-learning tools and that a portion of the workforce would benefit from additional basic digital skills training. Conclusions: These promising results provide a positive outlook for the potential of digital learning and development within the social care workforce. The findings provide clear areas of focus for the future use of technology for learning and development of the social care workforce and considerations to maximize engagement with such approaches. %M 32965233 %R 10.2196/15936 %U http://mededu.jmir.org/2020/2/e15936/ %U https://doi.org/10.2196/15936 %U http://www.ncbi.nlm.nih.gov/pubmed/32965233 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18290 %T Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis %A Chen,Feng-Qin %A Leng,Yu-Fei %A Ge,Jian-Feng %A Wang,Dan-Wen %A Li,Cheng %A Chen,Bin %A Sun,Zhi-Ling %+ School of Nursing, Nanjing University of Chinese Medicine, 138 Xian Lin Road, Nanjing, China, 86 13813892093, szl@njucm.edu.cn %K virtual reality %K nursing education %K meta-analysis %D 2020 %7 15.9.2020 %9 Review %J J Med Internet Res %G English %X Background: Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes. Objective: The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. Methods: We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Results: A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI –0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI –0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI –0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=–0.55, 95% CI –2.04 to 0.94, P=.47, I2=97%). Conclusions: The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results. %M 32930664 %R 10.2196/18290 %U http://www.jmir.org/2020/9/e18290/ %U https://doi.org/10.2196/18290 %U http://www.ncbi.nlm.nih.gov/pubmed/32930664 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20249 %T Learning With Virtual Reality in Nursing Education: Qualitative Interview Study Among Nursing Students Using the Unified Theory of Acceptance and Use of Technology Model %A Lange,Ann-Kathrin %A Koch,Jana %A Beck,Anastasia %A Neugebauer,Till %A Watzema,Frauke %A Wrona,Kamil J %A Dockweiler,Christoph %+ University of Bielefeld, Universitätsstr 25, Bielefeld, 33615, Germany, 49 521106 ext 5160, ann-kathrin.lange@uni-bielefeld.de %K virtual reality %K edutainment %K serious games %K education %K health care %K gamification %K anatomy %K digital game–based learning %K nursing %K nursing informatics %D 2020 %7 1.9.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Digital games–based learning is a method of using digital games to impart knowledge. Virtual reality (VR) programs are a practical application of this method. Due to demographic changes, the nursing profession will become increasingly important. These VR applications can be of use in training nurses for future professional challenges they may encounter. The continuous development of VR applications enables trainees to encounter simulated real life effectively and to experience increasingly concrete situations. This can be of great importance in nursing education, since 3-dimensionality enables a better visualization of many fields of activity and can prevent potential future errors. In addition to this learning effect, VR applications also bring an element of fun to learning. Objective: The aim of this qualitative research effort is to observe the degree of acceptance of VR applications by nursing students in Germany. Various factors, including social influences, performance expectations, and effort expectations, are taken into consideration. Methods: With a qualitative cohort study, the acceptance of nursing students towards VR applications in anatomy teaching was determined. The 12 participants were first asked to fill out a quantitative questionnaire on their sociodemographic characteristics and the extent to which they valued and liked using technology. The participants were then allowed to test the VR application themselves and were finally asked about their experience in a qualitative interview. For the collection of data and the analysis of results, the unified theory of acceptance and use of technology was used in this study. Results: Overall, the study shows that the interviewed persons rated the VR application quite positively. The greatest influence in this was the personal attitude towards technology; the higher this affinity is, the more useful the VR application appears. Social influences can also increase the participant’s own acceptance if peers have a positive attitude towards such applications. The study shows that the trainees' motivation to learn was increased by using VR. We believe this is because each trainee could learn individually and the VR application was perceived as an enjoyable activity. Nevertheless, the cost factor of implementing VR applications in nursing training is currently still an obstacle, as not every institution has such financial capacities. Conclusions: The extent to which the use of VR applications in the training of nursing staff is justified depends on the degree of personal acceptance. The collected results give good practice-oriented insight into the attitude of trainees towards VR. Many of the interviewed persons saw benefits in the use of VR technologies. As VR applications are constantly developing, it is necessary to conduct further studies on VR applications in nursing education and to include other possible disciplines in which these applications can be helpful. %M 34345791 %R 10.2196/20249 %U https://nursing.jmir.org/2020/1/e20249/ %U https://doi.org/10.2196/20249 %U http://www.ncbi.nlm.nih.gov/pubmed/34345791 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e18822 %T An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study %A Lerner,Dieter %A Mohr,Stefan %A Schild,Jonas %A Göring,Martin %A Luiz,Thomas %+ Fraunhofer Institute for Experimental Software Engineering, Research Program Digital Healthcare, Fraunhofer-Platz 1, Kaiserslautern, 67663, Germany, 49 631 6800 2148, Thomas.Luiz@iese.fraunhofer.de %K virtual reality %K educational virtual realities %K virtual patient simulation %K virtual emergency scenario %K simulation training %K head-mounted display %K immersive media %K training effectiveness %K presence experience %K anaphylaxis %K emergency medicine %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) is increasingly used as simulation technology in emergency medicine education and training, in particular for training nontechnical skills. Experimental studies comparing teaching and learning in VR with traditional training media often demonstrate the equivalence or even superiority regarding particular variables of learning or training effectiveness. Objective: In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR. Methods: The virtual emergency scenario was anaphylaxis grade III with shock, swelling of the upper and lower respiratory tract, as well as skin symptoms in a 5-year-old girl (virtual patient) visiting an indoor family amusement park with her grandfather (virtual agent). A cross-sectional, one-group pretest and posttest design was used to evaluate the training effectiveness and quality of the training execution. The sample included 18 active emergency physicians. Results: The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect. Conclusions: The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through “experience of presence” or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training. %M 32735548 %R 10.2196/18822 %U https://games.jmir.org/2020/3/e18822 %U https://doi.org/10.2196/18822 %U http://www.ncbi.nlm.nih.gov/pubmed/32735548 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e16714 %T Delivering Clinical Skin Examination Education to Nurse Practitioners Using an Internet-Based, Microlearning Approach: Development and Feasibility of a Video Intervention %A Stratton,Delaney B %A Shea,Kimberly D %A Knight,Elizabeth P %A Loescher,Lois J %+ College of Nursing, The University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 4802136556, dstratton@email.arizona.edu %K microlearning %K clinical skin examination %K primary care %K nurse practitioners %K melanoma %K skin cancer %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: Skin cancer is the most common cancer; survival of the most serious skin cancers and malignant melanomas depends on early detection. Early detection relies on accessibility to clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) are well-positioned to conduct CSEs; however, they require further education on CSE and have time constraints for continuing education. A digitally delivered intervention grounded in microlearning is a promising approach to deliver new information over a brief period. Objective: Our objective was to develop and explore the feasibility of implementing a 1-week digital video intervention with content on CSE skills, defined as melanoma risk assessment, head-to-toe skin examination, and pigmented lesion assessment, for PCNPs. Specific aims were as follows: (1) Aim 1: to develop three microlearning-based melanoma videos with content on CSE that are suitable for digital delivery to PCNPs in various formats and (2) Aim 2: to assess the feasibility of the video intervention, including enrollment and retention rates, adherence, and acceptability and usability of the video intervention. Methods: For Aim 1, the research team created storyboards for videos that addressed each CSE skill. An expert panel of three dermatologists reviewed the storyboards and videos for relevance, comprehension, and clarity using the content validity index (CVI). The panel evaluated the usability of the video intervention delivery by Research Electronic Data Capture (REDCap) and Vimeo using the System Usability Scale (SUS) and technical video production using Beaudin and Quick’s Quality Evaluation of Video (QEV). Aim 2 evaluated enrollment and retention rates of PCNPs, based on metrics from previous studies of CSE in the literature, and video intervention adherence. SUS and the Attitudes toward Web-based Continuing Learning Survey (AWCL) assessed usability and acceptability. Results: CVI scores indicated relevance and clarity for each video: mean scores ranged from 3.79 to 4, where 4 indicated the video was highly relevant and very clear. The integration of REDCap and Vimeo was usable: the SUS score was 96, where 0 was the worst and 100 was the best. The digital delivery of the videos was rated as exceptional on all five technical items: the mean score was 5, where scores ranged from 1 (poor) to 5 (exceptional). Of the 32 PCNPs who were sent emails, 12 enrolled (38%) and, out of these 12, 10 (83%) completed the intervention and the surveys. Video intervention adherence was ≤50%. Participants rated the usability as better (mean 85.8, SD 10.6; better=70-90) and favorably ranked the acceptability of the AWCL’s constructs of perceived usefulness (mean 5.26, SD 0.08), perceived ease of use (mean 5.40, SD 0.41), behavior (mean 5.53, SD 0.12), and affection (mean 5.77, SD 0.04), where scores ranged from 1 (strongly disagree) to 7 (strongly agree). Conclusions: The video intervention was feasible to deliver to PCNPs using a digital, microlearning approach. The findings provide support for using the videos as an intervention in a future pilot randomized trial targeting behavioral CSE outcomes among PCNPs and other primary care providers. %R 10.2196/16714 %U http://derma.jmir.org/2020/1/e16714/ %U https://doi.org/10.2196/16714 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e18313 %T Immersive Virtual Reality for the Reduction of State Anxiety in Clinical Interview Exams: Prospective Cohort Study %A Concannon,Brendan Joseph %A Esmail,Shaniff %A Roduta Roberts,Mary %+ Department of Occupational Therapy, University of Alberta, 8205 - 114 St 2-64 Corbett Hall, Edmonton, AB, T6G 2G4, Canada, 1 780 492 2499, mroberts@ualberta.ca %K virtual reality %K VR %K head-mounted display %K HMD %K immersive technology %K occupational therapy %K OSCE %K simulation %K psychology %K anxiety %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Immersive virtual reality (VR) with head-mounted display was used to determine if clinical interview simulation could reduce the anxiety levels of first-year occupational therapy (OT) students as they prepared for upcoming Objective Structured Clinical Examinations (OSCEs). Anxiety among health science students is a potential problem that may diminish their performance during OSCEs. This investigation aimed to fill the gap in the literature regarding the effectiveness of VR to reduce anxiety in OT students. Objective: This investigation aimed to uncover the effectiveness of immersive VR in reducing state anxiety in OT students who were preparing for OSCEs. Methods: A prospective, experimental, nonrandomized controlled trial compared levels of state anxiety, test anxiety, and academic self-efficacy in two groups of first-year OT students; these levels were measured at four different time points by self-reported psychometric scales, analyzed with a mixed factorial analysis of variance (ANOVA). Members of Phase 1 (NoVR) were not exposed to the VR simulation and acted as a control group for members of Phase 2 (YesVR), who were exposed to the VR simulation. VR simulation featured a virtual clinic and a standardized patient who students could interview in natural language. Measures of student study strategies and previous experience with VR were also recorded. Results: A total of 49 participants—29 in the NoVR group and 20 in the YesVR group—showed that state anxiety had a rise-then-fall trend, peaking at the time point just before the OSCE. At that point, the YesVR students showed significantly less state anxiety than did the NoVR students (t46.19=2.34, P=.02, Cohen d=0.65, ηp2=0.105). The mean difference was 6.78 units (95% CI 0.96-12.61). In similar trends for both groups, student test anxiety remained relatively static across the time points, while academic self-efficacy continually increased. A moderate positive correlation was found for total time spent studying and peak state anxiety (NoVR r=.46, n=28, P=.01; YesVR r=.52, n=19, P=.02). Conclusions: This investigation shows evidence of immersive VR’s capability to reduce state anxiety in OT students preparing for clinical practical exams. Immersive VR simulation, used for the reduction of anxiety in health science students, can potentially lead to a future of positive mental health change from the virtual to the real world. %M 32673223 %R 10.2196/18313 %U http://games.jmir.org/2020/3/e18313/ %U https://doi.org/10.2196/18313 %U http://www.ncbi.nlm.nih.gov/pubmed/32673223 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e18358 %T Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial %A Koka,Avinash %A Suppan,Laurent %A Cottet,Philippe %A Carrera,Emmanuel %A Stuby,Loric %A Suppan,Mélanie %+ Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 795532579, laurent.suppan@hcuge.ch %K active learning %K electronic learning %K video %K stroke %K online learning %K e-learning %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition. Objective: This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics. Methods: A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a “Declaration of no objection.” Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague. Results: The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12). Conclusions: Use of an e-learning module shows promising results in teaching the NIHSS to paramedics. %M 32299792 %R 10.2196/18358 %U http://www.jmir.org/2020/6/e18358/ %U https://doi.org/10.2196/18358 %U http://www.ncbi.nlm.nih.gov/pubmed/32299792 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e15408 %T Nurse-Led Education and Engagement for Diabetes Care in Sub-Saharan Africa: Protocol for a Mixed Methods Study %A Singh,Arti %A Nichols,Michelle %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, United States, 1 8437921802, nicholmg@musc.edu %K diabetes %K mobile health %K Ghana %K sub-Saharan Africa %K global health %K nurses %K task-shifting %K mixed methods %K focused ethnography %D 2020 %7 3.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the impact of diabetes grows steeply in sub-Saharan Africa, improvement of the control and treatment of diabetes is a goal that health care systems in sub-Saharan Africa must achieve in the near future. Sub-Saharan Africa faces a number of challenges in addressing the increasing effects of diabetes. One important factor is the shortage of adequately trained health care workers. Diabetes management in sub-Saharan Africa would benefit from innovative approaches that are founded upon solid theoretical constructs, built upon existing human resources and infrastructure, and culturally tailored to the priorities and needs of the local population. Existing resources, such as mobile phones and task-shifting strategies, may be used to assist individuals with glycemic self-management and to facilitate management of additional day-to-day clinical responsibilities. Objective: The objective of the Nurse-Led Education and Engagement Study for Diabetes Care (NEEDS) mixed-methods protocol is to develop a practical, collaborative, effective, and sustainable program for diabetes prevention and management specifically for patients with type 2 diabetes mellitus in sub-Saharan Africa. The protocol aims to improve access to care through task-shifting strategies and the use of mobile health technology. Methods: This study was designed using a convergent parallel mixed-methods approach that consisted of surveys, key informant interviews, focus group discussions, and focused ethnography. Novel approaches, such as task-shifting strategies and the use of mobile technology, were implemented for type 2 diabetes mellitus health care in sub-Saharan Africa—currently an under-researched area. Results: Data collection began in February 2018, after ethics approval, at the Kwame Nkrumah University of Science and Technology. As of May 2020, participant surveys have been completed (N=100), key informant interviews (n=7) have been completed, and focus groups (5 focus groups; patients, n=18; caregivers, n=6; community leaders, n=2; and faith leaders, n=3) as well as focused ethnographic field observations have been completed. All audio recordings have been transcribed and transcripts of sessions recorded in Twi have been translated to English. Data analysis is currently underway and anticipated completion is in the spring of 2020. Following data analysis, investigators plan to publish study findings. Conclusions: Insights from this study will inform the preliminary development of a feasible and effective nurse-led education and engagement mobile health intervention that has the potential to reduce diabetes-related morbidity, mortality, and burden in sub-Saharan Africa. International Registered Report Identifier (IRRID): DERR1-10.2196/15408 %M 32442137 %R 10.2196/15408 %U https://www.researchprotocols.org/2020/6/e15408 %U https://doi.org/10.2196/15408 %U http://www.ncbi.nlm.nih.gov/pubmed/32442137 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16772 %T Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial %A Chan,Windy SY %A Leung,Angela YM %+ School of Health Sciences, Caritas Institute of Higher Education, 2 Chui Ling Lane, Tseung Kwan O, New Territories, China (Hong Kong), 852 36536664, sychan@cihe.edu.hk %K dementia %K Facebook %K social network sites %K continuous professional education %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes. Objective: This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia. Methods: Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs. Results: Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6). Conclusions: The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants’ knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings. %M 32484441 %R 10.2196/16772 %U https://www.jmir.org/2020/6/e16772 %U https://doi.org/10.2196/16772 %U http://www.ncbi.nlm.nih.gov/pubmed/32484441 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e16946 %T Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study %A Kynge,Lucy %+ Interburns, Swansea University, Haldane Building, Swansea, SA2 8PP, United Kingdom, 44 07742437420, lucy.kynge@interburns.org %K online education %K digital content %K health care %K burns %K low-resource settings %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: The reach of internet and mobile phone coverage has grown rapidly in low- and middle-income countries (LMICs). The potential for sharing knowledge with health care workers in low-resource settings to improve working practice is real, but barriers exist that limit access to online information. Burns affect more than 11 million people each year, but health care workers in low-resource settings receive little or no training in treating burn patients. Interburns' training programs are tailor-made to improve the quality of burn care in Asia, Africa, and the Middle East; the challenge is to understand the best way of delivering these resources digitally toward improved treatment and care of burn patients. Objective: The aim of the study, funded by the National Institute for Health Research (NIHR), was to understand issues and barriers that affect health care worker access to online learning in low-resource settings in order to broaden access to Interburns' training materials and improve burn-patient care. Methods: A total of 546 participants of Interburns' Essential Burn Care (EBC) course held in Bangladesh, Nepal, Ethiopia, and the West Bank, the occupied Palestinian Territories, between January 2016 and June 2018 were sent an online survey. EBC participants represent the wide range of health care professionals involved with the burn-injured patient. A literature review was carried out as well as research into online platforms. Results: A total of 207 of 546 (37.9%) participants of the EBC course did not provide an email address. Of the 339 email addresses provided, 81 (23.9%) “bounced” back. Surgeons and doctors were more likely to provide an email address than nurses, intern doctors, or auxiliary health care workers. A total of 258 participants received the survey and 70 responded, giving a response rate of 27.1%. Poor internet connection, lack of time, and limited access to computers were the main reasons for not engaging with online learning, along with lack of relevant materials. Computers were seen as more useful for holding information, while mobile phones were better for communicating and sharing knowledge. Health care workers in LMICs use mobile phones professionally on a daily basis. A total of 80% (56/70) felt that educational content on burns should be available through mobile apps. Conclusions: Health care workers in low-resource settings face a variety of barriers to accessing educational content online. The reliance on email for sign-up to learning management systems is a significant barrier. Materials need to be relevant, localized, and easy to consume offline if necessary, to avoid costs of mobile phone data. Smartphones are increasingly used professionally every day for communication and searching for information, pointing toward the need for tailored educational content to be more available through mobile- and web-based apps. %M 32452810 %R 10.2196/16946 %U http://mededu.jmir.org/2020/1/e16946/ %U https://doi.org/10.2196/16946 %U http://www.ncbi.nlm.nih.gov/pubmed/32452810 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e19076 %T Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data %A Utunen,Heini %A Ndiaye,Ngouille %A Piroux,Corentin %A George,Richelle %A Attias,Melissa %A Gamhewage,Gaya %+ Learning and Capacity Development Unit, World Health Organization Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K online learning %K OpenWHO %K novel coronavirus %K COVID-19 %K coronavirus %K pandemic %K WHO %K e-learning %K MOOC %K public health %D 2020 %7 27.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: At the onset of the coronavirus outbreak, the World Health Organization’s (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO’s health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID‑19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users’ professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses’ statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform’s own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99%) of all course enrollments, and the English language course was comprised of 38.21% (n=88,988) of enrollments. The WHO’s Region of the Americas accounted for most of the course enrollments, with more than 72.47% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10% enrollment for each. A total of 32.43% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as “Other.” With the COVID-19 introductory course, the largest number of users selected “Other” (16,527/52,214, 31.65%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO’s technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform’s aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. %M 32293580 %R 10.2196/19076 %U https://www.jmir.org/2020/4/e19076 %U https://doi.org/10.2196/19076 %U http://www.ncbi.nlm.nih.gov/pubmed/32293580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18604 %T A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors’ Teaching Competencies: Pretest and Posttest Study %A Wu,Xi Vivien %A Chi,Yuchen %A Panneer Selvam,Umadevi %A Devi,M Kamala %A Wang,Wenru %A Chan,Yah Shih %A Wee,Fong Chi %A Zhao,Shengdong %A Sehgal,Vibhor %A Ang,Neo Kim Emily %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K blended learning %K case-based learning %K clinical pedagogy %K clinical teaching competency %K web-based program %K nurse preceptor %D 2020 %7 24.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies. Objective: This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods: A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. Results: Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. Conclusions: The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education. %M 32329743 %R 10.2196/18604 %U http://www.jmir.org/2020/4/e18604/ %U https://doi.org/10.2196/18604 %U http://www.ncbi.nlm.nih.gov/pubmed/32329743 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e15877 %T Current and Future Trends in Life Sciences Training: Questionnaire Study %A Magagna,William %A Wang,Nicole %A Peck,Kyle %+ Department of Learning Performance System, Pennsylvania State University, Keller Building, University Park, PA, United States, 1 2154072119, nwang@psu.edu %K professional training %K training with technologies %K life sciences professionals %K mixed methods %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: Every year, the life science field spends billions of dollars on educational activities worldwide. The continuing professional development of employees, especially in this field, encompasses great challenges. Emerging technologies appear to offer opportunity, but relatively little research has been done on the effectiveness of pedagogies and tools that have been used in the life sciences, and even less research has been devoted to understanding the potential power of emerging options that might determine the field’s future. Objective: In collaboration with the Life Sciences Trainers & Educators Network (LTEN), this study investigated the current state of the pedagogies and tools currently adopted by corporate training professionals in the life sciences as well as the professionals’ perceptions of the impacts of emerging technologies on training. Methods: This study adopted a mixed methods approach that included a survey and a follow-up interview. The survey consists of 18 broad questions with 15 subquestions in each of the five specific sectors of the life sciences field. Interviews were conducted by phone and lasted approximately 40 minutes, covering 18 questions designed to follow-up on findings from the survey items. Results: Both survey and interview results indicated that the professionals were not satisfied with the status quo and that training and education in this field need to change. Most of the techniques and tools currently used have been used for some time. The professionals surveyed were not satisfied with the current techniques and tools and did not find them cost-effective. In addition, the respondents pictured the future of training in this field to be more engaging and effective. Conclusions: This is the first study in a series designed to better understand education and training in the life sciences on a macro level, in order to build a foundation for progress and evolution of the future landscape. Next steps involve developing strategies for how to extend this vision throughout individual organizations. %M 32329739 %R 10.2196/15877 %U http://mededu.jmir.org/2020/1/e15877/ %U https://doi.org/10.2196/15877 %U http://www.ncbi.nlm.nih.gov/pubmed/32329739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16808 %T A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review %A Moehead,Anne %A DeSouza,Kathryn %A Walsh,Karen %A Pit,Sabrina W %+ Northern New South Wales Local Health District, New South Wales Ministry of Health, Uralba St, Lismore, 2480, Australia, 61 429449591, gmo11800@dodo.com.au %K education %K workforce %K online learning %K Web-based learning %K distance education %K dementia %K nursing %K facilitated learning %K competency %K training %K network %K capability %K skills %K person-centered %D 2020 %7 22.1.2020 %9 Review %J J Med Internet Res %G English %X Background: Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia. Objective: This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program—an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice—and (2) determine how these features correlate with the DCC&TN. Methods: Six electronic databases—Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar—were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick’s model for the evaluation of training were used to ensure quality and rigor of the analysis. Results: A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick’s four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick’s model. Features were then correlated against the DCC&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC&TN. Conclusions: A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick’s salient elements of the model—reaction, learning, behavior, and results—in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick’s levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training. %M 32012077 %R 10.2196/16808 %U http://www.jmir.org/2020/1/e16808/ %U https://doi.org/10.2196/16808 %U http://www.ncbi.nlm.nih.gov/pubmed/32012077 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e15828 %T The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study %A Hughes,Charmayne %A Musselman,Elaine A %A Walsh,Lilia %A Mariscal,Tatiana %A Warner,Sam %A Hintze,Amy %A Rashidi,Neela %A Gordon-Murer,Chloe %A Tanha,Tiana %A Licudo,Fahrial %A Ng,Rachel %A Tran,Jenna %+ Health Equity Institute, San Francisco State University, 1600 Holloway Ave, Department of Kinesiology, San Francisco, CA, 94132, United States, 1 4157708121, cmhughes@sfsu.edu %K intimate partner violence %K domestic violence %K nursing education %K learning %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. %M 34345778 %R 10.2196/15828 %U https://nursing.jmir.org/2020/1/e15828 %U https://doi.org/10.2196/15828 %U http://www.ncbi.nlm.nih.gov/pubmed/34345778 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e11963 %T A Web-Based Alcohol Screening and Brief Intervention Training Module Within Physician Assistant Programs in the Midwest to Increase Knowledge, Attitudes, and Confidence: Evaluation Study %A Tenkku Lepper,Leigh E %A Cleveland,Tracy %A DelRosario,Genevieve %A Ervie,Katherine %A Link,Catherine %A Oakley,Lara %A Elfagir,Abdelmoneim %A Sprague,Debra J %+ School of Social Work and Public Health Program, University of Missouri-Columbia, 707 Clark Hall, Columbia, MO, 65211, United States, 1 5738845459, tenkkul@missouri.edu %K alcohol education %K alcohol screening and brief intervention %K Web-based training %K standardized patient %K physician assistant %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Preventing and reducing risky alcohol use and its side effects remains a public health priority. Discussing alcohol use with patients can be difficult; dedicated training for health care providers is needed to facilitate these conversations. A Web-based alcohol screening and brief intervention (SBI), comprising didactic and skills application training, was designed for physician assistant students. Objective: This paper details experiences and outcomes in developing an alcohol SBI training curriculum and coordinating virtual encounters with standardized patients. We also explain challenges faced with developing an alcohol SBI training and a Web-based learning management site to fit the needs of 5 different physician assistant programs. Methods: Training development comprised 3 phases—precourse, development, and implementation. The precourse phase included developing the initial training curriculum, building a website, and testing with a pilot group. The development phase refined the training curriculum based on user feedback and moved into a three-component module: didactic training module, guided interactive encounter with a simulated patient, and live encounter with a standardized patient. A learning management system website was also created. In the implementation phase, 5 physician assistant schools incorporated the Web-based training into curricula. Each school modified the implementation method to suit their organizational environment. Evaluation methods included pre- and postchange over time on trainee attitudes, knowledge, and skills (confidence) on talking to patients about alcohol use, trainee self-reported proficiency on the standardized patient encounter, standardized patient evaluation of the trainee proficiency during the alcohol use conversation, user evaluation of the type of technology mode for the standardized patient conversation, and overall trainee satisfaction with the Web-based training on alcohol SBI. Results: Final evaluation outcomes indicated a significant (P<.01) change over time in trainee knowledge and skills (confidence) in the conduct of the alcohol SBI with a standardized patient, regardless of the program implementation method. Trainees were generally satisfied with the Web-based training experience and rated the use of the videoconference medium as most useful when conducting the alcohol SBI conversation with the standardized patient. Training that included a primer on the importance of screening, individual participation in the Web-based didactic alcohol SBI modules, and virtual encounters with standardized patients through a university-based simulation center was the most widely accepted. Successful implementation included program investment and curriculum planning. Implementation barriers involved technical challenges with standardized patient encounters and simulation center logistics, and varying physician assistant school characteristics. Conclusions: Development and implementation of Web-based educational modules to educate health care professionals on alcohol SBI is effective, easy to reproduce, and readily accessible. Identifying challenges affecting development, implementation, and utilization of learned techniques in practice, enhances facilitation of learning and training efficacy. As the value of technology-based learning becomes more apparent, reports detailing what has worked versus what has not may help guide the process. %M 31647473 %R 10.2196/11963 %U http://mental.jmir.org/2019/10/e11963/ %U https://doi.org/10.2196/11963 %U http://www.ncbi.nlm.nih.gov/pubmed/31647473 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14451 %T Impact of Training of Primary Health Care Centers’ Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study %A Amily,Ali Sadiq %A Lami,Faris %A Khader,Yousef %+ Immunization Section, Wasit Directorate of Health, Iraqi Ministry of Health, Tamooz, Kut, Iraq, 964 7813928919, amily_ali@yahoo.com %K immunization %K primary health care %K intervention %K practices %K Iraq %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children’s Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objective: The goal of this study was to assess the impact of training of primary health care centers’ (PHCs) vaccinators on the quality of ISPs. Methods: This was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, “Managing an Immunization Session”, and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores. Results: A total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02). Conclusions: The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services. %M 31593540 %R 10.2196/14451 %U https://publichealth.jmir.org/2019/4/e14451 %U https://doi.org/10.2196/14451 %U http://www.ncbi.nlm.nih.gov/pubmed/31593540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e15118 %T Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews %A Rouleau,Geneviève %A Gagnon,Marie-Pierre %A Côté,José %A Payne-Gagnon,Julie %A Hudson,Emilie %A Dubois,Carl-Ardy %A Bouix-Picasso,Julien %+ Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry 1050 Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 407576, marie-pierre.gagnon@fsi.ulaval.ca %K continuing education %K e-learning %K nurses %K nursing care %K systematic review of systematic reviews %D 2019 %7 2.10.2019 %9 Review %J J Med Internet Res %G English %X Background: E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context. Objective: We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context. Methods: We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results). Results: We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration. Conclusions: The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714 %M 31579016 %R 10.2196/15118 %U https://www.jmir.org/2019/10/e15118 %U https://doi.org/10.2196/15118 %U http://www.ncbi.nlm.nih.gov/pubmed/31579016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14676 %T Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration %A Kononowicz,Andrzej A %A Woodham,Luke A %A Edelbring,Samuel %A Stathakarou,Natalia %A Davies,David %A Saxena,Nakul %A Tudor Car,Lorainne %A Carlstedt-Duke,Jan %A Car,Josip %A Zary,Nabil %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Science Building, Singapore,, Singapore, 65 6340 2480, josip.car@ntu.edu.sg %K computer simulation %K professional education %K computer-assisted instruction %K systematic review %K meta-analysis %D 2019 %7 02.07.2019 %9 Review %J J Med Internet Res %G English %X Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients. %M 31267981 %R 10.2196/14676 %U https://www.jmir.org/2019/7/e14676/ %U https://doi.org/10.2196/14676 %U http://www.ncbi.nlm.nih.gov/pubmed/31267981 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12795 %T Evidence-Based Physical Therapy Practice in the State of Kuwait: A Survey of Attitudes, Beliefs, Knowledge, Skills, and Barriers %A Alrowayeh,Hesham N %A Buabbas,Ali J %A Alshatti,Talal A %A AlSaleh,Fatemah M %A Abulhasan,Jawad F %+ Physical Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Health Science Center, Jabriya, 46300, Kuwait, 965 97960000, hrowayeh@hsc.edu.kw %K physical therapy practice %K evidence-based practice %K attitudes %K knowledge %D 2019 %7 07.06.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: Evidence-based practice (EBP) is necessary to improve the practice of physical therapy. However, a lack of knowledge and skills among physical therapists and the presence of barriers may hinder the implementation of EBP in the State of Kuwait. Objective: The objectives of this study were to extensively (1) investigate attitudes toward EBP, (2) assess the current level of knowledge and skills necessary for EBP, and (3) identify the barriers to EBP among physical therapists in the State of Kuwait. Methods: The following methods were used: (1) a previously validated self-reported questionnaire and (2) a face-to-face semistructured interview. The questionnaire, which was distributed to 200 physical therapists, examined the attitudes and beliefs of physical therapists about EBP; the interest in and motivation to engage in EBP; educational background, knowledge, and skills related to accessing and interpreting information; the level of attention to and use of the literature; access to and availability of information to promote EBP; and the perceived barriers to using EBP. The interview explored the factors that promote or discourage EBP. Descriptive statistics and logistic regression analyses were used. Results: Of the 200 nonrandomly distributed questionnaires, 92% (184/200) were completed and returned. In general, the physical therapists had positive attitudes, beliefs, and interests in EBP. Their educational background, knowledge, and skills related to assessing and interpreting information were well-founded. The top 3 barriers included insufficient time (59.2%, 109/184), lack of information resources (49.4%, 91/184), and inapplicability of the research findings to the patient population (40.7%, 75/184). Conclusions: EBP lacks support from superiors at work. Thus, identifying methods and strategies to support physical therapists in adopting EBP in the State of Kuwait is necessary. %M 31237840 %R 10.2196/12795 %U http://mededu.jmir.org/2019/1/e12795/ %U https://doi.org/10.2196/12795 %U http://www.ncbi.nlm.nih.gov/pubmed/31237840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e13480 %T Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study %A Loescher,Lois J %A Heslin,Kelly M %A Szalacha,Laura A %A Silva,Graciela E %A Muramoto,Myra L %+ College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ,, United States, 1 (520) 626 6196, loescher@email.arizona.edu %K skin cancer %K primary prevention %K secondary prevention %K health education %K e-learning %K massage %K web-based learning %K massage therapists %D 2019 %7 15.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients’ skin and are amenable to performing skin cancer risk reduction activities during massage appointments. Objective: The objective of this study is to describe the Massage Therapists Skin Health Awareness, Referral, and Education protocol, presenting an overview of our systematic approach to developing rigorous e-training for MTs to enable them to be partners in skin cancer risk reduction. We also describe procedures for usability and feasibility testing of the training. Methods: We developed an integrated electronic learning system that includes electronic training (e-training) technology, simulated client interactions, online data collection instruments, and in-person assessment of MTs’ application of their training. Results: A total of 20 participants nationally scored the e-training as high for usability and satisfaction. We have screened an additional 77 MTs in Arizona for interest and eligibility, and currently have 37 enrolled participants, of whom 32 have completed the Web-based training. Conclusions: The structured and rigorous development approach for this skin cancer risk reduction and brief behavioral intervention e-training for MTs begins to fill a gap in skin cancer risk reduction research. Iterative usability testing of our asynchronous Web-based training resulted in positive participant response. Our e-training approach offers greater learner accessibility, increased convenience, and greater scalability than the few existing programs and has the potential to reach many MTs nationally. International Registered Report Identifier (IRRID): DERR1-10.2196/13480 %M 31094348 %R 10.2196/13480 %U http://www.researchprotocols.org/2019/5/e13480/ %U https://doi.org/10.2196/13480 %U http://www.ncbi.nlm.nih.gov/pubmed/31094348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13446 %T Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series %A Thew,Graham R %A Powell,Candice LYM %A Kwok,Amy PL %A Lissillour Chan,Mandy H %A Wild,Jennifer %A Warnock-Parkes,Emma %A Leung,Patrick WL %A Clark,David M %+ Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford, OX1 1TW, United Kingdom, 44 01865 618600, graham.thew@psy.ox.ac.uk %K anxiety %K social phobia %K internet %K cognitive therapy %K clinical competence %K cross-cultural comparison %K Hong Kong %K benchmarking %K psychology, clinical %K mental health %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients’ clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. %M 31094320 %R 10.2196/13446 %U http://formative.jmir.org/2019/2/e13446/ %U https://doi.org/10.2196/13446 %U http://www.ncbi.nlm.nih.gov/pubmed/31094320 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e13350 %T Exploring Care Providers’ Perceptions and Current Use of Telehealth Technology at Work, in Daily Life, and in Education: Qualitative and Quantitative Study %A Hah,Hyeyoung %A Goldin,Deana %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3053484342, hyeyoung.hah@gmail.com %K telehealth technology %K nurse practitioners %K daily technology use %K telehealth care performance %K nursing education %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: A telehealth technology education curriculum designed to integrate information technology and telecommunication well has great potential to prepare care providers for health care delivery across space, time, and social and cultural barriers. It is important to assess the readiness level of care providers to use and maximize the benefits of telehealth technology in the health care delivery process. Therefore, this study explored care providers’ existing experience using technology in various use contexts and compared their familiarity with telehealth technology’s relevant features. Objective: This study’s objective was to explore care providers’ familiarity with using technology in different settings and their perceptions of telehealth-driven care performance to lay a foundation for the design of an effective telehealth education program. Methods: The study used quantitative and qualitative analyses. The online survey included four items that measured care providers’ perceptions of care performance when using telehealth technology. Advanced practice registered nurse students rated each item on a 7-point Likert scale, ranging from 1 (“strongly disagree”) to 7 (“strongly agree”). They also responded to three open-ended questions about what kinds of health information technology they use at work, after work, and in their current educational program. Results: A total of 109 advanced practice registered nurse students responded to the online survey and open-ended questionnaire. Most indicated that using telehealth technology enhances care performance (mean 5.67, median 6.0, SD 1.36), helps make their care tasks more effective (mean 5.73, median 6.0, SD 1.30), improves the quality of performing care tasks (mean 5.71, median 6.0, SD 1.30), and decreases error in communicating and sharing information with others (mean 5.35, median 6.0, SD 1.53). In addition, our qualitative analyses revealed that the students used the electronic health records technology primarily at work, combined with clinical decision support tools for medication and treatment management. Outside work, they primarily used video-text communication tools and were exposed to some telehealth technology in their education setting. Further, they believe that use of nonhealth technology helps them use health information technology to access health information, confirm their diagnoses, and ensure patient safety. Conclusions: This research highlights the importance of identifying care providers’ existing experience of using technology to better design a telehealth technology education program. By focusing explicitly on the characteristics of care providers’ existing technology use in work, nonwork, and educational settings, we found a potential consistency between practice and education programs in care providers’ requirements for technology use, as well as areas of focus to complement their frequent use of nonhealth technologies that resemble telehealth technology. Health policymakers and practitioners need to provide compatible telehealth education programs tailored to the level of care providers’ technological familiarity in both their work and nonwork environments. %M 31008708 %R 10.2196/13350 %U http://mededu.jmir.org/2019/1/e13350/ %U https://doi.org/10.2196/13350 %U http://www.ncbi.nlm.nih.gov/pubmed/31008708 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12058 %T Motivating HIV Providers in Vietnam to Learn: A Mixed-Methods Analysis of a Mobile Health Continuing Medical Education Intervention %A Larson Williams,Anna %A Hawkins,Andrew %A Sabin,Lora %A Halim,Nafisa %A Le Ngoc,Bao %A Nguyen,Viet Ha %A Nguyen,Tam %A Bonawitz,Rachael %A Gill,Christopher %+ Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, United States, 1 617 638 5234, alarsonw@bu.edu %K continuing medical education %K HIV/AIDS %K mHealth %K Vietnam %K health education %K SMS intervention %K telemedicine %K text messaging %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])–based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants. Objective: The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants’ views of the intervention. We also developed an explanatory framework for future trial replication. Methods: At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education. Results: A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians’ decision to engage in higher learning, or “lateral learning,” including the participant’s availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context. Conclusions: Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention’s impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education. Trial Registration: ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743 %M 30998220 %R 10.2196/12058 %U http://mededu.jmir.org/2019/1/e12058/ %U https://doi.org/10.2196/12058 %U http://www.ncbi.nlm.nih.gov/pubmed/30998220 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e10982 %T Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study %A Alturkistani,Abrar %A Majeed,Azeem %A Car,Josip %A Brindley,David %A Wells,Glenn %A Meinert,Edward %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford,, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K education, distance %K education %K teaching %K online learning %K online education %K MOOC %K massive open online course %D 2019 %7 02.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark’s method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners’ experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology. %M 30938683 %R 10.2196/10982 %U http://mededu.jmir.org/2019/1/e10982/ %U https://doi.org/10.2196/10982 %U http://www.ncbi.nlm.nih.gov/pubmed/30938683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11529 %T Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial %A Padilha,José Miguel %A Machado,Paulo Puga %A Ribeiro,Ana %A Ramos,José %A Costa,Patrício %+ Nursing School of Porto; CINTESIS – Tech4edusim, Street Dr António Bernardino de Almeida, Porto, 4200-072, Portugal, 351 225 073 500, miguelpadilha@esenf.pt %K clinical virtual simulation %K nursing education %K virtual patient %K user-computer interface %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods: A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results: The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students. %M 30882355 %R 10.2196/11529 %U http://www.jmir.org/2019/3/e11529/ %U https://doi.org/10.2196/11529 %U http://www.ncbi.nlm.nih.gov/pubmed/30882355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11123 %T Evaluation of an E-Learning Training Program to Support Implementation of a Group-Based, Theory-Driven, Self-Management Intervention For Osteoarthritis and Low-Back Pain: Pre-Post Study %A Hurley,Deirdre A %A Keogh,Alison %A Mc Ardle,Danielle %A Hall,Amanda M %A Richmond,Helen %A Guerin,Suzanne %A Magdalinski,Tara %A Matthews,James %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, D4, Ireland, 353 17166524, deirdre.hurleyosing@ucd.ie %K technology-enhanced learning %K evaluation %K e-learning %K digital learning %K program evaluation %K effectiveness %K physiotherapy %K implementation %K osteoarthritis %K low-back pain %D 2019 %7 07.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: By adaptation of the face-to-face physiotherapist-training program previously used in the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) feasibility trial, an asynchronous, interactive, Web-based, e-learning training program (E-SOLAS) underpinned by behavior and learning theories was developed. Objective: This study investigated the effect of the E-SOLAS training program on relevant outcomes of effective training and implementation. Methods: Thirteen physiotherapists from across Ireland were trained via E-SOLAS by using mixed methods, and seven physiotherapists progressed to implementation of the 6-week group-based SOLAS intervention. The effectiveness of E-SOLAS was evaluated using the Kirkpatrick model at the levels of reaction (physiotherapist engagement and satisfaction with E-SOLAS training methods and content), learning (pre- to posttraining changes in physiotherapists’ confidence and knowledge in delivering SOLAS content and self-determination theory-based communication strategies, administered via a SurveyMonkey questionnaire), and behavior (fidelity to delivery of SOLAS content using physiotherapist-completed weekly checklists). During implementation, five physiotherapists audio recorded delivery of one class, and the communication between physiotherapists and clients was assessed using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behaviour Scale (CCBS), and an intervention-specific measure (ISM; 7-point Likert scale). A range of implementation outcomes were evaluated during training and delivery (ie, acceptability, appropriateness, feasibility, fidelity, and sustainability of E-SOLAS) using a posttraining feedback questionnaire and individual semistructured telephone interviews. Results: With regard to their reaction, physiotherapists (n=13) were very satisfied with E-SOLAS posttraining (median 5.0; interquartile range 1.0; min-max 4.0-5.0) and completed training within 3-4 weeks. With regard to learning, there were significant increases in physiotherapists’ confidence and knowledge in delivery of all SOLAS intervention components (P<.05). Physiotherapists’ confidence in 7 of 10 self-determination theory-based communication strategies increased (P<.05), whereas physiotherapists’ knowledge of self-determination theory-based strategies remained high posttraining (P>.05). In terms of behavior, physiotherapists delivered SOLAS in a needs supportive manner (HCCQ: median 5.2, interquartile range 1.3, min-max 3.7-5.8; CCBS: median 6.6, interquartile range 1.0, min-max 5.6-7.0; ISM: median 4.5, interquartile range 1.2, min-max 2.8-4.8). Fidelity scores were high for SOLAS content delivery (total %mean fidelity score 93.5%; SD 4.9%). The posttraining questionnaire and postdelivery qualitative interviews showed that physiotherapists found E-SOLAS acceptable, appropriate, feasible, and sustainable within primary care services to support the implementation of the SOLAS intervention. Conclusions: This study provides preliminary evidence of the effectiveness, acceptability, and feasibility of an e-learning program to train physiotherapists to deliver a group-based self-management complex intervention in primary care settings, which is equivalent to face-to-face training outcomes and would support inclusion of physiotherapists in a definitive trial of SOLAS. %M 30843863 %R 10.2196/11123 %U https://www.jmir.org/2019/3/e11123/ %U https://doi.org/10.2196/11123 %U http://www.ncbi.nlm.nih.gov/pubmed/30843863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12997 %T Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration %A Huang,Zhilian %A Semwal,Monika %A Lee,Shuen Yee %A Tee,Mervin %A Ong,William %A Tan,Woan Shin %A Bajpai,Ram %A Tudor Car,Lorainne %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18, Clinical Sciences Building, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K evidence-based practice %K health personnel %K learning %K systematic review %K diabetes mellitus %D 2019 %7 21.02.2019 %9 Review %J J Med Internet Res %G English %X Background: There is a shortage of health care professionals competent in diabetes management worldwide. Digital education is increasingly used in educating health professionals on diabetes. Digital diabetes self-management education for patients has been shown to improve patients’ knowledge and outcomes. However, the effectiveness of digital education on diabetes management for health care professionals is still unknown. Objective: The objective of this study was to assess the effectiveness and economic impact of digital education in improving health care professionals’ knowledge, skills, attitudes, satisfaction, and competencies. We also assessed its impact on patient outcomes and health care professionals’ behavior. Methods: We included randomized controlled trials evaluating the impact of digitalized diabetes management education for health care professionals pre- and postregistration. Publications from 1990 to 2017 were searched in MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, ERIC, and Web of Science. Screening, data extraction and risk of bias assessment were conducted independently by 2 authors. Results: A total of 12 studies met the inclusion criteria. Studies were heterogeneous in terms of digital education modality, comparators, outcome measures, and intervention duration. Most studies comparing digital or blended education to traditional education reported significantly higher knowledge and skills scores in the intervention group. There was little or no between-group difference in patient outcomes or economic impact. Most studies were judged at a high or unclear risk of bias. Conclusions: Digital education seems to be more effective than traditional education in improving diabetes management–related knowledge and skills. The paucity and low quality of the available evidence call for urgent and well-designed studies focusing on important outcomes such as health care professionals’ behavior, patient outcomes, and cost-effectiveness as well as its impact in diverse settings, including developing countries. %M 30789348 %R 10.2196/12997 %U http://www.jmir.org/2019/2/e12997/ %U https://doi.org/10.2196/12997 %U http://www.ncbi.nlm.nih.gov/pubmed/30789348 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 2 %P e10222 %T How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study %A Barteit,Sandra %A Jahn,Albrecht %A Bowa,Annel %A Lüders,Sigrid %A Malunga,Gregory %A Marimo,Clemence %A Wolter,Sigrid %A Neuhann,Florian %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215634030, barteit@uni-heidelberg.de %K evaluation %K medical e-learning %K intervention %K sustainability %K effectiveness %K adoption %K health care workers %K rural health %K sub-Saharan Africa %D 2018 %7 27.11.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials. Objective: Our aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training. Methods: The pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data’s adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills. Results: In total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80%) and high agreement (>75%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized. Conclusions: The pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes. %M 30482744 %R 10.2196/10222 %U http://mededu.jmir.org/2018/2/e10222/ %U https://doi.org/10.2196/10222 %U http://www.ncbi.nlm.nih.gov/pubmed/30482744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10396 %T Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study %A Choi,Sunhea %A Yuen,Ho Ming %A Annan,Reginald %A Pickup,Trevor %A Pulman,Andy %A Monroy-Valle,Michele %A Aduku,Nana Esi Linda %A Kyei-Boateng,Samuel %A Velásquez Monzón,Carmen Isabel %A Portillo Sermeño,Carmen Elisa %A Penn,Andrew %A Ashworth,Ann %A Jackson,Alan A %+ Human Development and Health, Faculty of Medicine, University of Southampton, Mailpoint 820, Level B, South Academic Block, Southampton General Hospital, Southampton, SO16 6YD, United Kingdom, 44 23 8120 4330, s.choi@southampton.ac.uk %K eLearning %K severe acute malnutrition %K WHO guidelines for malnutrition %K capacity building %K staff development %K quality improvement %K nutrition training and education %D 2018 %7 03.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. Objective: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. Methods: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. Results: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)—a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. Conclusions: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course. %R 10.2196/10396 %U http://www.jmir.org/2018/10/e10396/ %U https://doi.org/10.2196/10396 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e193 %T The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial %A de Ruijter,Dennis %A Candel,Math %A Smit,Eline Suzanne %A de Vries,Hein %A Hoving,Ciska %+ Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, , Maastricht,, Netherlands, 31 43 388 24 06, d.deruijter@maastrichtuniversity.nl %K online learning %K guideline adherence %K advanced practice nursing %K randomized controlled trial %K smoking cessation %D 2018 %7 22.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving practice nurses’ (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet. Objective: The aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs’ smoking cessation guideline adherence. Methods: A Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs’ demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program’s effectiveness in improving PNs’ guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results: After 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program’s effect on PNs’ overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence. Conclusions: Results from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a wider range of HCPs. Trial Registration: Netherlands Trial Register NTR4436; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4436 (Archived by WebCite at http://www.webcitation.org/6zJQuSRq0) %M 29789278 %R 10.2196/jmir.9276 %U http://www.jmir.org/2018/5/e193/ %U https://doi.org/10.2196/jmir.9276 %U http://www.ncbi.nlm.nih.gov/pubmed/29789278 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e5 %T Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study %A Bond,Stuart Evan %A Crowther,Shelley P %A Adhikari,Suman %A Chubaty,Adriana J %A Yu,Ping %A Borchard,Jay P %A Boutlis,Craig Steven %A Yeo,Wilfred Winston %A Miyakis,Spiros %+ Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Aberford Rd, Wakefield, WF14DG, United Kingdom, 44 01924317043, stuart.bond@nhs.net %K nursing education %K pharmacy education %K medical education %K continuing education %K survey methods %K antibacterial agents %D 2018 %7 26.02.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Objective: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. Methods: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. Results: Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. Conclusions: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool’s effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future. %M 29483071 %R 10.2196/mededu.7719 %U http://mededu.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/mededu.7719 %U http://www.ncbi.nlm.nih.gov/pubmed/29483071 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e2 %T A Web-Based Course on Public Health Principles in Disaster and Medical Humanitarian Response: Survey Among Students and Faculty %A Tam,Greta %A Chan,Emily Ying Yang %A Liu,Sida %+ Collaborating Centre for Oxford University and Chinese University of Hong Kong for Disaster and Medical Humanitarian Response, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 308, 3rd Floor, Prince of Wales Hospital, 30-32 Ngan Shing St, Sha Tin, Hong Kong,, China (Hong Kong), 852 22528411, emily.chan@cuhk.edu.hk %K disaster planning %K online education %K Donabedian model %K public health %D 2018 %7 26.01.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Web-based public health courses are becoming increasingly popular. “Public Health Principles in Disaster and Medical Humanitarian Response” is a unique Web-based course in Hong Kong. This course aimed to fill a public health training gap by reaching out to postgraduates who are unable to access face-to-face learning. Objective: The aim of this paper was to use a structured framework to objectively evaluate the effectiveness of a Web-based course according to Greenhalgh et al’s quality framework and the Donabedian model to make recommendations for program improvement. Methods: An interim evaluation of the first cohort of students in 2014 was conducted according to the Donabedian model and a quality framework by Greenhalgh et al using objective and self-reported data. Results: Students who registered for the first cohort (n=1152) from June 16, 2014 to December 15, 2014 (6 months) were surveyed. Two tutors and the course director were interviewed. The Web-based course was effective in using technology to deliver suitable course materials and assessment and to enhance student communication, support, and learning. Of the total number of students registered, 59.00% (680/1152) were nonlocal, originating from 6 continents, and 72.50% (835/1152) possessed a bachelor’s or postgraduate degree. The completion rate was 20.00% (230/1152). The chi-square test comparing students who completed the course with dropouts showed no significant difference in gender (P=.40), age (P=.98), occupation (P=.43), or qualification (P=.17). The cost (HK $272 per student) was lower than that of conducting a face-to-face course (HK $4000 per student). Conclusions: The Web-based course was effective in using technology to deliver a suitable course and reaching an intended audience. It had a higher completion rate than other Web-based courses. However, sustainable sources of funding may be needed to maintain the free Web-based course. %M 29374007 %R 10.2196/mededu.8495 %U http://mededu.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/mededu.8495 %U http://www.ncbi.nlm.nih.gov/pubmed/29374007 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e19 %T Integrated Decentralized Training for Health Professions Education at the University of KwaZulu-Natal, South Africa: Protocol for the I-DecT Project %A Govender,Pragashnie %A Chetty,Verusia %A Naidoo,Deshini %A Pefile,Ntsikelelo %+ College of Health Sciences, University of KwaZulu-Natal, Private Bag x54001, Durban,, South Africa, 27 312608258, naidoopg@ukzn.ac.za %K decentralized clinical training, health science, South Africa, health care %D 2018 %7 25.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Integrated Decentralized Training (i-DecT) project was created to address the current need for health care in South Africa among resource poor climates in rural and periurban settings. The University of KwaZulu-Natal (UKZN) in South Africa has embarked on a program within the School of Health Sciences (SHS) to decentralize the clinical learning platform in order to address this disparity. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of decentralized clinical training (DCT) within the province of KwaZulu-Natal. There currently remains uncertainty as to how the implementation of this program will unfold, especially for the diverse SHS, which includes specialities like audiology, dentistry, occupational therapy, optometry, pharmacy, physiotherapy, speech-language pathology, and sport science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the participating students have a positive learning experience and achieve expected academic outcomes, and that the needs of the communities are addressed adequately. Objective: The study aims to explore the factors that will influence the roll-out of the DCT by developing an inclusive and context-specific model that will adhere to the standards set by the SHS for the DCT program at UKZN. Methods: Key role players, including but not limited to, the South African Ministry of Health policy makers, clinicians, policy makers at UKZN, clinical educators, academicians, and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralized training, a context-specific model for DCTl will be proposed based on initial pilot data that will be tested within iterative cycles in an Action Learning Action Research (ALAR) process. Results: The study was designed to fit within the existing structures, and emerging framework and memorandum of understanding between the partners of this initiative, namely, the Ministry of Health and UKZN in order to develop health care professionals that are competent and prepared for the changing dynamics of healthcare in a developing world. Conclusions: It is envisioned that this study, the first to include a combination of health professionals in a DCT platform at UKZN, will not only contribute to effective service delivery, but may also serve to promote an interprofessional cooperation within the SHS and tertiary institutions in similar settings. %M 29371175 %R 10.2196/resprot.7551 %U http://www.researchprotocols.org/2018/1/e19/ %U https://doi.org/10.2196/resprot.7551 %U http://www.ncbi.nlm.nih.gov/pubmed/29371175 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e411 %T A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing %A Srikesavan,Cynthia Swarnalatha %A Williamson,Esther %A Eldridge,Lucy %A Heine,Peter %A Adams,Jo %A Cranston,Tim %A Lamb,Sarah E %+ Centre for Rehabilitation Research in Oxford, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, United Kingdom, 44 01865 737907, cynthia.srikesavan@ndorms.ox.ac.uk %K hand function %K hand exercises %K rheumatoid arthritis %K online training %K implementation %D 2017 %7 13.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. %M 29237581 %R 10.2196/jmir.8424 %U http://www.jmir.org/2017/12/e411/ %U https://doi.org/10.2196/jmir.8424 %U http://www.ncbi.nlm.nih.gov/pubmed/29237581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e214 %T Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists %A Fairburn,Christopher G %A Allen,Elizabeth %A Bailey-Straebler,Suzanne %A O'Connor,Marianne E %A Cooper,Zafra %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford,, United Kingdom, 44 186 561 3199, credo@medsci.ox.ac.uk %K psychotherapy %K training %K dissemination %K Internet %K eating disorders %K cognitive behavior therapy %D 2017 %7 16.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl –6.62 to –5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. %M 28623184 %R 10.2196/jmir.7864 %U http://www.jmir.org/2017/6/e214/ %U https://doi.org/10.2196/jmir.7864 %U http://www.ncbi.nlm.nih.gov/pubmed/28623184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e203 %T The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers’ Emotional Responses After a Clinical Error %A Mira,José Joaquín %A Carrillo,Irene %A Guilabert,Mercedes %A Lorenzo,Susana %A Pérez-Pérez,Pastora %A Silvestre,Carmen %A Ferrús,Lena %A , %+ Alicante-Sant Joan Health District, Universidad Miguel Hernández, Avenue Universidad s/n, Elche (Alicante), 03202, Spain, 34 606433599, jose.mira@umh.es %K patient safety %K professionals %K hospital %K primary care %K second victims %K clinical error %K e-learning %D 2017 %7 08.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Adverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening. Objective: The aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon. Methods: The design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design). Results: The website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88% (23/26) and 92% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse event (P<.001). Conclusions: The MISE program differs from existing intervention initiatives by its preventive nature in relation to the second victim phenomenon. Its online nature makes it an easily accessible tool for the professional community. This program has shown to increase user’s knowledge on this issue and it helps them correct their approach. Furthermore, it is one of the first initiatives to attempt to bring the second victim phenomenon closer to primary care. %M 28596148 %R 10.2196/jmir.7840 %U http://www.jmir.org/2017/6/e203/ %U https://doi.org/10.2196/jmir.7840 %U http://www.ncbi.nlm.nih.gov/pubmed/28596148 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 1 %P e8 %T Simulation Training: Evaluating the Instructor’s Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training %A Katz,Aric %A Tepper,Ronnie %A Shtub,Avraham %+ Technion - Israel Institute of Technology, Industrial Engineering & Management, Technion, Technion City, Haifa, 3200003, Israel, 972 972 4 8294402, shtub@ie.technion.ac.il %K distance learning %K feedback %K simulation training %K evaluation research %D 2017 %7 21.04.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow’s graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse. Objectives: This quantitative study assessed the effectiveness of a computerized interactive simulator coupled with an instructor who monitored students’ progress and provided Web-based immediate feedback. Methods: A low-cost, globally accessible, telemedicine simulator, developed at the Technion—Israel Institute of Technology, Haifa, Israel—was used. A previous study in the field of interventional cardiology, evaluating the efficacy of the simulator to enhanced learning via knowledge exams, presented promising results of average scores varying from 94% after training and 54% before training (n=20) with P<.001. Two independent experiments involving obstetrics and gynecology (Ob-Gyn) physicians and senior ultrasound sonographers, with 32 subjects, were conducted using a new interactive concept of the WOZ (Wizard of OZ) simulator platform. The contribution of an instructor to learning outcomes was evaluated by comparing students’ knowledge before and after each interactive instructor-led session as well as after fully automated e-learning in the field of Ob-Gyn. Results from objective knowledge tests were analyzed using hypothesis testing and model fitting. Results: A significant advantage (P=.01) was found in favor of the WOZ training approach. Content type and training audience were not significant. Conclusions: This study evaluated the contribution of an integrated teaching environment using a computerized interactive simulator, with an instructor providing immediate Web-based immediate feedback to trainees. Involvement of an instructor in the simulation-based training process provided better learning outcomes that varied training content and trainee populations did not affect the overall learning gains. %M 28432039 %R 10.2196/mededu.6312 %U http://mededu.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/mededu.6312 %U http://www.ncbi.nlm.nih.gov/pubmed/28432039 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 1 %P e6 %T The Coags Uncomplicated App: Fulfilling Educational Gaps Around Diagnosis and Laboratory Testing of Coagulation Disorders %A Kessler,Craig %A Peerschke,Ellinor I %A Chitlur,Meera B %A Kulkarni,Roshni %A Holot,Natalia %A Cooper,David L %+ Georgetown University Medical Center, Lombardi Cancer Center, Podium A, 3700 Reservoir Road, NW, Washington, DC, 20007, United States, 1 (202) 444 8676, KESSLERC@gunet.georgetown.edu %K blood coagulation disorders %K smartphone %K diagnosis %K hematology %K differential diagnosis %D 2017 %7 18.04.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Patients with coagulation disorders may present to a variety of physician specialties; however, accurate and efficient diagnosis can be challenging for physicians not specialized in hematology, due to identified gaps in knowledge around appropriate laboratory assays and interpretation of test results. Coags Uncomplicated was developed to fill this unmet educational need by increasing practical knowledge of coagulation disorders among nonexpert physicians and other health care professionals (HCPs) in a point-of-care (POC) setting. Objective: The aim of this study was to assess patterns of use of the mobile app Coags Uncomplicated, a tool designed to support education regarding accurate and efficient diagnosis of bleeding disorders. Methods: App metrics were obtained by tracking registered user data. Additionally, a survey was distributed to registered users, to assess circumstances and frequency of use. Results: The most common specialties of 7596 registered US users were hematology-oncology (n=1534, 20.19%), hematology (n=1014, 13.35%), and emergency medicine (n=1222, 16.09%); most identified as physicians (n=4082, 53.74%). Specialties accounting for the greatest numbers of screen views were hematology-oncology (99,390 views), hematology (47,808 views), emergency medicine (23,121 views), and internal medicine (22,586 views). The most common diagnostic endpoints reached were disseminated intravascular coagulation (DIC; 2713 times), liver disease effect (2108 times), and vitamin K deficiency (1584 times). Of 3424 users asked to take the survey, 262 responded (7.65%); most were physicians in direct clinical care (71%) and specialized in hematology-oncology (39%) or emergency medicine (21%). Most frequent use was reported by hematologists (69%, ≥6 times) and hematologists-oncologists (38%, ≥6 times). Most physicians (89.2%) reported using the app for patient-case-related education around appropriate use of laboratory tests in diagnostic evaluation. Physicians rated Lab Value Analyzer (mean 4.43) and Lab Test Algorithm (mean 4.46) tools highly on a 5-point “how helpful” scale and were likely to recommend the app to colleagues. Conclusions: App use among physicians and other HCPs is consistent with value as a POC educational tool, which may facilitate differential diagnoses and appropriate early consultation with hematologists. %M 28420603 %R 10.2196/mededu.6858 %U http://mededu.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/mededu.6858 %U http://www.ncbi.nlm.nih.gov/pubmed/28420603 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e1 %T Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology %A Paim,Crislaine Pires Padilha %A Goldmeier,Silvia %+ Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, 395 Princesa Isabel Avenue, Porto Alegre, 90620-001, Brazil, 55 51 32303600, sgoldmeier@gmail.com %K nursing education research %K educational technology %K perioperative nursing %D 2017 %7 10.01.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. Objective: To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. Methods: The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom’s taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. Results: The development of the game called “Playing with Tweezers” was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. Conclusions: The “digital” nursing student needs engagement, stimulation, reality, and entertainment, not just readings. “Playing with Tweezers” is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not replace curricular practice, but helps. %M 28073736 %R 10.2196/games.6048 %U http://games.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/games.6048 %U http://www.ncbi.nlm.nih.gov/pubmed/28073736 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e2 %T Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study %A Muramoto,Myra L %A Howerter,Amy %A Eaves,Emery R %A Hall,John R %A Buller,David B %A Gordon,Judith S %+ University of Arizona, Department of Family & Community Medicine, 1450 N Cherry Ave, Tucson, AZ, 85719, United States, 1 520 626 1090, myram@email.arizona.edu %K tobacco cessation %K brief intervention %K online training %K communication %K acupuncture %K chiropractic %K massage therapy %D 2016 %7 06.01.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of Web-based training for health professionals, Web-based evaluation of clinical skills competency remains underdeveloped. Objective: In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners. Methods: In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the Internet; (2) develop a novel, Web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient; (3) pilot test the Web-based training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability, and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and (4) conduct qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement). Results: Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete. Conclusions: To realize CAM practitioners’ potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use. %M 26740468 %R 10.2196/resprot.5061 %U http://www.researchprotocols.org/2016/1/e2/ %U https://doi.org/10.2196/resprot.5061 %U http://www.ncbi.nlm.nih.gov/pubmed/26740468 %0 Journal Article %@ 2369-3762 %I JMIR Publications Inc. %V 1 %N 2 %P e15 %T Mobile Virtual Learning Object for the Assessment of Acute Pain as a Learning Tool to Assess Acute Pain in Nursing: An Analysis of the Mental Workload %A Alvarez,Ana Graziela %A Sasso,Grace %A Iyengar,Sriram %+ Science Health Center, Department of Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Bairro Trindade, Florianópolis, 88040-900, Brazil, 55 48 3721 4910, grazielaalvarez@gmail.com %K nursing %K nursing informatics %K distance learning %K computer-assisted instruction %K educational technology %K nursing education %K acute pain %K persuasive technology %K mental workload %D 2015 %7 06.11.2015 %9 Original Paper %J JMIR Medical Education %G English %X Background: The inclusion of new technologies in education has motivated the development of studies on mental workload. These technologies are now being used in the teaching and learning process. The analysis enables identification of factors intervening in this workload as well as planning of overload prevention for educational activities using these technologies. Objective: To analyze the mental workload of an educational intervention with the Mobile Virtual Learning Object for the Assessment of Acute Pain in adults and newborns, according to the NASA Task Load Index criteria. Methods: A methodological study with data collected from 5 nurses and 75 students, from November of 2013 to February of 2014. Results: The highest students’ and specialists’ means were in the dimensions of “Mental demand” (57.20 ± 22.27; 51 ± 29.45) and “Performance” (58.47 ± 24.19; 73 ± 28.85). The specialists’ mental workload index was higher (50.20 ± 7.28) when compared with students’ (47.87 ± 16.85) on a scale from 0 to 100 (P=.557). Conclusions: The instrument allowed for the assessment of mental workload after an online educational intervention with a mobile learning virtual object. An excessive overload was not identified among participants. Assessing mental workload from the use of educational technologies at the end of a task is a key to their applicability, with the aim of providing a more effective, stimulating, and long-lasting experience of the learning process. %M 27731849 %R 10.2196/mededu.4958 %U http://mededu.jmir.org/2015/2/e15/ %U https://doi.org/10.2196/mededu.4958 %U http://www.ncbi.nlm.nih.gov/pubmed/27731849 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e221 %T Designing and Testing an Inventory for Measuring Social Media Competency of Certified Health Education Specialists %A Alber,Julia M %A Bernhardt,Jay M %A Stellefson,Michael %A Weiler,Robert M %A Anderson-Lewis,Charkarra %A Miller,M David %A MacInnes,Jann %+ Center for Health Behavior Research, Perelman School of Medicine, University of Pennsylvania, 110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9894, alberj@upenn.edu %K social media %K health education %K professional competence %D 2015 %7 23.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media can promote healthy behaviors by facilitating engagement and collaboration among health professionals and the public. Thus, social media is quickly becoming a vital tool for health promotion. While guidelines and trainings exist for public health professionals, there are currently no standardized measures to assess individual social media competency among Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES). Objective: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES. Methods: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines. Results: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r<.30), high interitem correlations (Ρ>.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|. Conclusions: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES. %M 26399428 %R 10.2196/jmir.4943 %U http://www.jmir.org/2015/9/e221/ %U https://doi.org/10.2196/jmir.4943 %U http://www.ncbi.nlm.nih.gov/pubmed/26399428 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e97 %T Review and Evaluation of Online Tobacco Dependence Treatment Training Programs for Health Care Practitioners %A Selby,Peter %A Goncharenko,Karina %A Barker,Megan %A Fahim,Myra %A Timothy,Valerie %A Dragonetti,Rosa %A Kemper,Katherine %A Herie,Marilyn %A Hays,J Taylor %+ Centre for Addiction and Mental Health, Addictions Division, 175 College Street, 3rd Floor, Toronto, ON, M5T1P7, Canada, 1 416 535 8501 ext 36859, peter.selby@camh.ca %K distance education %K tobacco use %K health care %K smoking cessation %K tobacco dependence %K program evaluation %K continuing medical education %D 2015 %7 17.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Training health care professionals is associated with increased capacity to deliver evidence-based smoking cessation interventions and increased quit rates among their patients. Online training programs hold promise to provide training but questions remain regarding the quality and usability of available programs. Objective: The aim was to assess the quality of English-language online courses in tobacco dependence treatment using a validated instrument. Methods: An environmental scan was conducted using the Google search engine to identify available online tobacco dependence treatment courses. The identified courses were then evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. It also has clear and concise criteria descriptions to ensure uniformity of evaluations by trained experts. Results: A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor’s role, and assessment and evaluation. Evaluation results and suggestions for improvement were shared with course administrators. Conclusions: Based on the courses evaluated in this review, course developers are encouraged to employ best practices in instructional design, such as cohesiveness of material, linearity of design, practice exercises, problem solving, and ongoing evaluation to improve existing courses and in the design of new online learning opportunities. %M 25887187 %R 10.2196/jmir.3284 %U http://www.jmir.org/2015/4/e97/ %U https://doi.org/10.2196/jmir.3284 %U http://www.ncbi.nlm.nih.gov/pubmed/25887187