TY - JOUR AU - Gavarkovs, Adam AU - Miller, Erin AU - Coleman, Jaimie AU - Gunasegaran, Tharsiga AU - Kusurkar, A. Rashmi AU - Kulasegaram, Kulamakan AU - Anderson, Melanie AU - Brydges, Ryan PY - 2025/4/11 TI - Motivation Theories and Constructs in Experimental Studies of Online Instruction: Systematic Review and Directed Content Analysis JO - JMIR Med Educ SP - e64179 VL - 11 KW - motivation KW - internet KW - systematic review KW - experimental studies KW - online instruction KW - educator KW - learner KW - researcher KW - health professional KW - education KW - tool-kit KW - autonomy N2 - Background: The motivational design of online instruction is critical in influencing learners? motivation. Given the multifaceted and situated nature of motivation, educators need access to a range of evidence-based motivational design strategies that target different motivational constructs (eg, interest or confidence). Objective: This systematic review and directed content analysis aimed to catalog the motivational constructs targeted in experimental studies of online motivational design strategies in health professions education. Identifying which motivational constructs have been most frequently targeted by design strategies?and which remain under-studied?can offer valuable insights into potential areas for future research. Methods: Medline, Embase, Emcare, PsycINFO, ERIC, and Web of Science were searched from 1990 to August 2022. Studies were included if they compared online instructional design strategies intending to support a motivational construct (eg, interest) or motivation in general among learners in licensed health professions. Two team members independently screened and coded the studies, focusing on the motivational theories that researchers used and the motivational constructs targeted by their design strategies. Motivational constructs were coded into the following categories: intrinsic value beliefs, extrinsic value beliefs, competence and control beliefs, social connectedness, autonomy, and goals. Results: From 10,584 records, 46 studies were included. Half of the studies (n=23) tested strategies aimed at making instruction more interesting, enjoyable, and fun (n=23), while fewer studies tested strategies aimed at influencing extrinsic value beliefs (n=9), competence and control beliefs (n=6), social connectedness (n=4), or autonomy (n=2). A focus on intrinsic value beliefs was particularly evident in studies not informed by a theory of motivation. Conclusions: Most research in health professions education has focused on motivating learners by making online instruction more interesting, enjoyable, and fun. We recommend that future research expand this focus to include other motivational constructs, such as relevance, confidence, and autonomy. Investigating design strategies that influence these constructs would help generate a broader toolkit of strategies for educators to support learners? motivation in online settings. Trial Registration: PROSPERO CRD42022359521; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022359521 UR - https://mededu.jmir.org/2025/1/e64179 UR - http://dx.doi.org/10.2196/64179 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64179 ER - TY - JOUR AU - Laurent, Maxence AU - Jaccard, Arnaud AU - Suppan, Laurent AU - Erriquez, Elio AU - Good, Xavier AU - Golay, Eric AU - Jaccard, Dominique AU - Suppan, Mélanie PY - 2025/3/7 TI - HUMAn, a Real-Time Evolutive Patient Model for Major Incident Simulation: Development and Validation Study JO - JMIR Form Res SP - e66201 VL - 9 KW - physiological model KW - mathematical model KW - computer simulation KW - major incident management KW - emergency medicine KW - mass casualties KW - healthcare professional education KW - professional education KW - continuing education N2 - 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. UR - https://formative.jmir.org/2025/1/e66201 UR - http://dx.doi.org/10.2196/66201 ID - info:doi/10.2196/66201 ER - TY - JOUR AU - Katta, Sravya AU - Davoody, Nadia PY - 2025/3/6 TI - Exploring Health Care Professionals? Perspectives on Education, Awareness, and Preferences for Digital Educational Resources to Support Transgender, Nonbinary, and Intersex Care: Interview Study JO - JMIR Med Educ SP - e67993 VL - 11 KW - health care professionals KW - transgender, nonbinary, and intersex KW - communication challenges KW - systematic barriers KW - information and communication technology N2 - Background: Health care professionals often face challenges in providing affirming and culturally competent care to transgender, nonbinary, and intersex (TNBI) patients due to a lack of understanding and training in TNBI health care. This gap highlights the opportunity for tailored educational resources to enhance health care professionals? interactions with TNBI individuals. Objective: This study aimed to explore health care professionals? perspectives on education and awareness of health issues related to TNBI individuals. Specifically, it aimed to identify their needs, challenges, and preferences in accessing and using digital educational resources to enhance their knowledge and competence in providing inclusive and effective care for this population. Methods: A qualitative research approach was used in this study. In total, 15 health care professionals were recruited via convenience sampling to participate in semistructured interviews. Thematic analysis was applied to identify recurring codes and themes. Results: The study identified several themes and subthemes related to gender diversity awareness, inclusive communication and understanding the needs of TNBI individuals, societal and structural challenges, regulatory gaps in training and support infrastructure, education and training needs for health care professionals on TNBI care, educational resources and training tools for TNBI care, challenges and design considerations for eHealth tools integrations, and evaluating eHealth impact. Participants identified communication barriers, the need for health care providers to use inclusive language, and gaps in both health care system infrastructure and specialized training for gender-affirming care. In addition, participants expressed a need for comprehensive education on transgender and nonbinary health issues, resources for mental health professionals, user-friendly design, and accessibility features in eHealth tools. Conclusions: The study revealed substantial deficiencies in health care professionals? knowledge of gender diversity, cultural competency, and the importance of inclusive communication. Addressing the identified barriers and challenges through targeted interventions, such as providing training and support for health care professionals, investing in user-friendly design and data security, and promoting cultural competence in TNBI health care, is essential. Despite integration challenges, eHealth tools have the potential to improve patient?health care professional relationships and access to care. UR - https://mededu.jmir.org/2025/1/e67993 UR - http://dx.doi.org/10.2196/67993 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053815 ID - info:doi/10.2196/67993 ER - TY - JOUR AU - Shikino, Kiyoshi AU - Yamauchi, Kazuyo AU - Araki, Nobuyuki AU - Shimizu, Ikuo AU - Kasai, Hajime AU - Tsukamoto, Tomoko AU - Tajima, Hiroshi AU - Li, Yu AU - Onodera, Misaki AU - Ito, Shoichi PY - 2025/1/31 TI - Understanding Community Health Care Through Problem-Based Learning With Real-Patient Videos: Single-Arm Pre-Post Mixed Methods Study JO - JMIR Med Educ SP - e68743 VL - 11 KW - community health care KW - community-oriented medical education KW - mixed method KW - problem-based learning KW - real-patient video N2 - Background: Japan faces a health care delivery challenge due to physician maldistribution, with insufficient physicians practicing in rural areas. This issue impacts health care access in remote areas and affects patient outcomes. Educational interventions targeting students? career decision-making can potentially address this problem by promoting interest in rural medicine. We hypothesized that community-based problem-based learning (PBL) using real-patient videos could foster students? understanding of community health care and encourage positive attitudes toward rural health care. Objective: This study investigated the impact of community-based PBL on medical students? understanding and engagement with rural health care, focusing on their knowledge, skills, and career orientation. Methods: Participants were 113 fourth-year medical students from Chiba University, engaged in a transition course between preclinical and clinical clerkships from October 24 to November 2, 2023. The students were randomly divided into 16 groups (7-8 participants per group). Each group participated in two 3-hour PBL sessions per week over 2 consecutive weeks. Quantitative data were collected using pre- and postintervention questionnaires, comprehension tests, and tutor-assessed rubrics. Self-assessment questionnaires evaluated the students? interest in community health care and their ability to envision community health care settings before and after the intervention. Qualitative data from the students? semistructured interviews after the PBL sessions assessed the influence of PBL experience on clinical clerkship in community hospitals. Statistical analysis included median (IQR), effect sizes, and P values for quantitative outcomes. Thematic analysis was used for qualitative data. Results: Of the 113 participants, 71 (62.8%) were male and 42 (37.2%) female. The total comprehension test scores improved significantly (pretest: median 4.0, IQR 2.5-5.0; posttest: median 5, IQR 4-5; P<.001; effect size r=0.528). Rubric-based assessments showed increased knowledge application (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.494) and self-directed learning (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.553). Self-assessment questionnaires revealed significant improvements in the students? interest in community health care (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001) and their ability to envision community health care settings (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001). Thematic analysis revealed key themes, such as ?empathy in patient care,? ?challenges in home health care,? and ?professional identity formation.? Conclusions: Community-based PBL with real-patient videos effectively enhances medical students? understanding of rural health care settings, clinician roles, and the social needs of rural patients. This approach holds potential as an educational strategy to address physician maldistribution. Although this study suggests potential for fostering positive attitudes toward rural health care, further research is needed to assess its long-term impact on students? career trajectories. UR - https://mededu.jmir.org/2025/1/e68743 UR - http://dx.doi.org/10.2196/68743 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68743 ER - TY - JOUR AU - Nowell, Lorelli AU - Johnston, Sonja AU - Dolan, Sara AU - Jacobsen, Michele AU - Lorenzetti, L. Diane AU - Oddone Paolucci, Elizabeth PY - 2025/1/15 TI - Exploring Educators? Perceptions and Experiences of Online Teaching to Foster Caring Profession Students? Development of Virtual Caring Skills: Sequential Explanatory Mixed Methods Study JO - JMIR Nursing SP - e64548 VL - 8 KW - health care education KW - virtual care KW - telehealth KW - online teaching KW - mixed methods study KW - student KW - teaching KW - virtual caring skills KW - cross-sectional survey KW - interview N2 - 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. UR - https://nursing.jmir.org/2025/1/e64548 UR - http://dx.doi.org/10.2196/64548 UR - http://www.ncbi.nlm.nih.gov/pubmed/39608377 ID - info:doi/10.2196/64548 ER - TY - JOUR AU - Fan, Lok Heidi Sze AU - Leung, Yan Emily Tsz AU - Lau, Wing Ka AU - Wong, Ha Janet Yuen AU - Choi, Hang Edmond Pui AU - Lam, Christine AU - Tarrant, Marie AU - Ngan, Sheung Hextan Yuen AU - Ip, Patrick AU - Lin, Chin Chia AU - Lok, Wan Kris Yuet PY - 2025/1/10 TI - A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study JO - JMIR Form Res SP - e64191 VL - 9 KW - Baby-Friendly Community Initiative KW - Baby-Friendly Hospital Initiative KW - breastfeeding KW - community KW - stakeholders KW - mobile app KW - friendly communities KW - baby-friendly KW - well-being KW - mother KW - infant KW - application KW - mHealth KW - qualitative KW - user-friendly KW - self-management N2 - Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ?bfGPS? (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged?bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant?s growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app?s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. UR - https://formative.jmir.org/2025/1/e64191 UR - http://dx.doi.org/10.2196/64191 ID - info:doi/10.2196/64191 ER - TY - JOUR AU - Mielitz, Annabelle AU - Kulau, Ulf AU - Bublitz, Lucas AU - Bittner, Anja AU - Friederichs, Hendrik AU - Albrecht, Urs-Vito PY - 2024/9/30 TI - Teaching Digital Medicine to Undergraduate Medical Students With an Interprofessional and Interdisciplinary Approach: Development and Usability Study JO - JMIR Med Educ SP - e56787 VL - 10 KW - medical education KW - digital medicine KW - digital health N2 - Background: An integration of digital medicine into medical education can help future physicians shape the digital transformation of medicine. Objective: We aim to describe and evaluate a newly developed course for teaching digital medicine (the Bielefeld model) for the first time. Methods: The course was held with undergraduate medical students at Medical School Ostwestfalen-Lippe at Bielefeld University, Germany, in 2023 and evaluated via pretest-posttest surveys. The subjective and objective achievement of superordinate learning objectives and the objective achievement of subordinate learning objectives of the course, course design, and course importance were evaluated using 5-point Likert scales (1=strongly disagree; 5=strongly agree); reasons for absences were assessed using a multiple-choice format, and comments were collected. The superordinate objectives comprised (1) the understanding of factors driving the implementation of digital medical products and processes, (2) the application of this knowledge to a project, and (3) the empowerment to design such solutions in the future. The subordinate objectives comprised competencies related to the first superordinate objective. Results: In total, 10 undergraduate medical students (male: n=4, 40%; female: n=6, 60%; mean age 21.7, SD 2.1 years) evaluated the course. The superordinate objectives were achieved well to very well?the medians for the objective achievement were 4 (IQR 4-5), 4 (IQR 3-5), and 4 (IQR 4-4) scale units for the first, second, and third objectives, respectively, and the medians for the subjective achievement of the first, second, and third objectives were 4 (IQR 3-4), 4.5 (IQR 3-5), and 4 (IQR 3-5) scale units, respectively. Participants mastered the subordinate objectives, on average, better after the course than before (presurvey median 2.5, IQR 2-3 scale units; postsurvey median 4, IQR 3-4 scale units). The course concept was rated as highly suitable for achieving the superordinate objectives (median 5, IQR 4-5 scale units for the first, second, and third objectives). On average, the students strongly liked the course (median 5, IQR 4-5 scale units) and gained a benefit from it (median 4.5, IQR 4-5 scale units). All students fully agreed that the teaching staff was a strength of the course. The category positive feedback on the course or positive personal experience with the course received the most comments. Conclusions: The course framework shows promise in attaining learning objectives within the realm of digital medicine, notwithstanding the constraint of limited interpretability arising from a small sample size and further limitations. The course concept aligns with insights derived from teaching and learning research and the domain of digital medicine, albeit with identifiable areas for enhancement. A literature review indicates a dearth of publications pertaining to analogous courses in Germany. Future investigations should entail a more exhaustive evaluation of the course. In summary, this course constitutes a valuable contribution to incorporating digital medicine into medical education. UR - https://mededu.jmir.org/2024/1/e56787 UR - http://dx.doi.org/10.2196/56787 UR - http://www.ncbi.nlm.nih.gov/pubmed/39189929 ID - info:doi/10.2196/56787 ER - TY - JOUR AU - Burke, B. Harry AU - Hoang, Albert AU - Lopreiato, O. Joseph AU - King, Heidi AU - Hemmer, Paul AU - Montgomery, Michael AU - Gagarin, Viktoria PY - 2024/7/25 TI - Assessing the Ability of a Large Language Model to Score Free-Text Medical Student Clinical Notes: Quantitative Study JO - JMIR Med Educ SP - e56342 VL - 10 KW - medical education KW - generative artificial intelligence KW - natural language processing KW - ChatGPT KW - generative pretrained transformer KW - standardized patients KW - clinical notes KW - free-text notes KW - history and physical examination KW - large language model KW - LLM KW - medical student KW - medical students KW - clinical information KW - artificial intelligence KW - AI KW - patients KW - patient KW - medicine N2 - Background: Teaching medical students the skills required to acquire, interpret, apply, and communicate clinical information is an integral part of medical education. A crucial aspect of this process involves providing students with feedback regarding the quality of their free-text clinical notes. Objective: The goal of this study was to assess the ability of ChatGPT 3.5, a large language model, to score medical students? free-text history and physical notes. Methods: This is a single-institution, retrospective study. Standardized patients learned a prespecified clinical case and, acting as the patient, interacted with medical students. Each student wrote a free-text history and physical note of their interaction. The students? notes were scored independently by the standardized patients and ChatGPT using a prespecified scoring rubric that consisted of 85 case elements. The measure of accuracy was percent correct. Results: The study population consisted of 168 first-year medical students. There was a total of 14,280 scores. The ChatGPT incorrect scoring rate was 1.0%, and the standardized patient incorrect scoring rate was 7.2%. The ChatGPT error rate was 86%, lower than the standardized patient error rate. The ChatGPT mean incorrect scoring rate of 12 (SD 11) was significantly lower than the standardized patient mean incorrect scoring rate of 85 (SD 74; P=.002). Conclusions: ChatGPT demonstrated a significantly lower error rate compared to standardized patients. This is the first study to assess the ability of a generative pretrained transformer (GPT) program to score medical students? standardized patient-based free-text clinical notes. It is expected that, in the near future, large language models will provide real-time feedback to practicing physicians regarding their free-text notes. GPT artificial intelligence programs represent an important advance in medical education and medical practice. UR - https://mededu.jmir.org/2024/1/e56342 UR - http://dx.doi.org/10.2196/56342 ID - info:doi/10.2196/56342 ER - TY - JOUR AU - Nguyen, Tuan Ba AU - Nguyen, Anh Van AU - Blizzard, Leigh Christopher AU - Palmer, Andrew AU - Nguyen, Tu Huu AU - Quyet, Cong Thang AU - Tran, Viet AU - Skinner, Marcus AU - Perndt, Haydn AU - Nelson, R. Mark PY - 2024/7/23 TI - 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 JO - JMIR Med Educ SP - e47127 VL - 10 KW - trauma care KW - emergency medicine KW - primary trauma care course KW - short course KW - medical education KW - trauma KW - emergency KW - urgent KW - professional development KW - workshop KW - injury KW - injured KW - injuries KW - primary care N2 - 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 UR - https://mededu.jmir.org/2024/1/e47127 UR - http://dx.doi.org/10.2196/47127 ID - info:doi/10.2196/47127 ER - TY - JOUR AU - Ferrer Costa, Jose AU - Moran, Nuria AU - Garcia Marti, Carlos AU - Colmenares Hernandez, Javier Leomar AU - Radu Ciorba Ciorba, Florin AU - Ciudad, Jose Maria PY - 2024/4/25 TI - Immediate Impact of an 8-Week Virtual Reality Educational Program on Burnout and Work Engagement Among Health Care Professionals: Pre-Post Pilot Study JO - JMIR XR Spatial Comput SP - e55678 VL - 1 KW - virtual reality KW - burnout KW - mindfulness KW - health care professionals KW - mental health KW - health promotion KW - educational intervention N2 - Background: Health care professionals globally face increasing levels of burnout characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment, and it has been notably exacerbated during the COVID-19 pandemic. This condition not only impacts the well-being of health care workers but also affects patient care and contributes to significant economic burden. Traditional approaches to mitigating burnout have included various psychosocial interventions, with mindfulness being recognized for its effectiveness in enhancing mental health and stress management. The emergence of virtual reality (VR) technology offers a novel immersive platform for delivering mindfulness and emotional management training. Objective: This study aimed to evaluate the immediate impact of an 8-week VR educational program on burnout and work engagement among health care professionals. Methods: This nonrandomized pre-post intervention study enrolled 90 health care professionals, including nurses, physicians, and allied health staff, from 3 different centers. Of these 90 professionals, 83 (92%) completed the program. The intervention consisted of 8 weekly VR sessions of 10-13 minutes each, using Meta Quest 2 headsets. The sessions focused on mindfulness and emotional management. The Maslach Burnout Inventory (MBI) and Utrecht Work Engagement Scale (UWES) were used for assessments. Data analysis involved inferential statistical techniques for evaluating the impact on the scales, including paired t tests for normally distributed variables and Wilcoxon signed rank tests for nonnormally distributed variables. The significance of changes was indicated by P values <.05, with effect sizes measured using Cohen d for t tests and Cohen r for Wilcoxon tests for quantifying the magnitude of the intervention?s effect. Results: The statistical analysis revealed significant improvements in the MBI and UWES indices after the intervention (P<.05). Specifically, the MBI showed reductions in emotional exhaustion (t82=5.58; P<.001; Cohen d=0.61) and depersonalization (t82=4.67; P<.001; Cohen d=0.51), and an increase in personal accomplishment (t82=?3.62; P<.001; Cohen d=0.4). The UWES revealed enhancements in vigor (t82=?3.77; P<.001; Cohen d=0.41), dedication (Z=?3.63; P<.001; Cohen r=0.41), and absorption (Z=?3.52; P<.001; Cohen r=0.4). Conclusions: The study provides initial data supporting the effectiveness of VR-based educational programs for reducing burnout and enhancing work engagement among health care professionals. While limitations, such as the absence of a control group, are acknowledged, the significant improvements in burnout and engagement indices coupled with high participant adherence and minimal VR discomfort underline the potential of VR interventions in health care settings. These encouraging findings pave the way for more comprehensive studies, including randomized controlled trials, to further validate and expand upon these results. UR - https://xr.jmir.org/2024/1/e55678 UR - http://dx.doi.org/10.2196/55678 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55678 ER - TY - JOUR AU - Castellucci, Clara AU - Malorgio, Amos AU - Budowski, Dinah Alexandra AU - Akbas, Samira AU - Kolbe, Michaela AU - Grande, Bastian AU - Braun, Julia AU - Noethiger, B. Christoph AU - Spahn, R. Donat AU - Tscholl, Werner David AU - Roche, Raoul Tadzio PY - 2023/10/12 TI - Coagulation Management of Critically Bleeding Patients With Viscoelastic Testing Presented as a 3D-Animated Blood Clot (The Visual Clot): Randomized Controlled High-Fidelity Simulation Study JO - J Med Internet Res SP - e43895 VL - 25 KW - avatar technology KW - coagulation management KW - high-fidelity simulation KW - point-of-care testing KW - thrombelastography KW - user-centered design KW - Visual Clot N2 - Background: Guidelines recommend using viscoelastic coagulation tests to guide coagulation management, but interpreting the results remains challenging. Visual Clot, a 3D animated blood clot, facilitates interpretation through a user-centered and situation awareness?oriented design. Objective: This study aims to compare the effects of Visual Clot versus conventional viscoelastic test results (rotational thrombelastometry [ROTEM] temograms) on the coagulation management performance of anesthesia teams in critical bleeding situations. Methods: We conducted a prospective, randomized, high-fidelity simulation study in which anesthesia teams (consisting of a senior anesthesiologist, a resident anesthesiologist, and an anesthesia nurse) managed perioperative bleeding scenarios. Teams had either Visual Clot or ROTEM temograms available to perform targeted coagulation management. We analyzed the 15-minute simulations with post hoc video analysis. The primary outcome was correct targeted coagulation therapy. Secondary outcomes were time to targeted coagulation therapy, confidence, and workload. In addition, we have conducted a qualitative survey on user acceptance of Visual Clot. We used Poisson regression, Cox regression, and mixed logistic regression models, adjusted for various potential confounders, to analyze the data. Results: We analyzed 59 simulations. Teams using Visual Clot were more likely to deliver the overall targeted coagulation therapy correctly (rate ratio 1.56, 95% CI 1.00-2.47; P=.05) and administer the first targeted coagulation product faster (hazard ratio 2.58, 95% CI 1.37-4.85; P=.003). In addition, participants showed higher decision confidence with Visual Clot (odds ratio 3.60, 95% CI 1.49-8.71; P=.005). We found no difference in workload (coefficient ?0.03, 95% CI ?3.08 to 2.88; P=.99). Conclusions: Using Visual Clot led to a more accurate and faster-targeted coagulation therapy than using ROTEM temograms. We suggest that relevant viscoelastic test manufacturers consider augmenting their complex result presentation with intuitive, easy-to-understand visualization to ease users? burden from unnecessary cognitive load and enhance patient care. UR - https://www.jmir.org/2023/1/e43895 UR - http://dx.doi.org/10.2196/43895 UR - http://www.ncbi.nlm.nih.gov/pubmed/37824182 ID - info:doi/10.2196/43895 ER - TY - JOUR AU - Raumer-Monteith, Lauren AU - Kennedy, Madonna AU - Ball, Lauren PY - 2023/7/27 TI - Web-Based Learning for General Practitioners and Practice Nurses Regarding Behavior Change: Qualitative Descriptive Study JO - JMIR Med Educ SP - e45587 VL - 9 KW - continuing professional development KW - continuing medical education KW - web-based KW - e-learning KW - behavior change KW - general practitioner KW - practice nurse KW - nurse KW - medical education KW - professional development KW - general practice KW - web-based learning KW - remote learning KW - adoption KW - perspective KW - health care professional N2 - 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. UR - https://mededu.jmir.org/2023/1/e45587 UR - http://dx.doi.org/10.2196/45587 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498657 ID - info:doi/10.2196/45587 ER - TY - JOUR AU - Preiksaitis, Carl AU - Dayton, R. John AU - Kabeer, Rana AU - Bunney, Gabrielle AU - Boukhman, Milana PY - 2023/2/24 TI - Teaching Principles of Medical Innovation and Entrepreneurship Through Hackathons: Case Study and Qualitative Analysis JO - JMIR Med Educ SP - e43916 VL - 9 KW - hackathon KW - innovation KW - entrepreneurship KW - medical education KW - gamification KW - curriculum KW - biodesign KW - emergency medicine KW - health care innovation KW - medical innovation KW - training KW - design KW - implementation KW - development KW - physician KW - educational N2 - Background: Innovation and entrepreneurship training are increasingly recognized as being important in medical education. However, the lack of faculty comfort with the instruction of these concepts as well as limited scholarly recognition for this work has limited the implementation of curricula focused on these skills. Furthermore, this lack of familiarity limits the inclusion of practicing physicians in health care innovation, where their experience is valuable. Hackathons are intense innovation competitions that use gamification principles to increase comfort with creative thinking, problem-solving, and interpersonal collaboration, but they require further exploration in medical innovation. Objective: To address this, we aimed to design, implement, and evaluate a health care hackathon with 2 main goals: to improve emergency physician familiarity with the principles of health care innovation and entrepreneurship and to develop innovative solutions to 3 discrete problems facing emergency medicine physicians and patients. Methods: We used previously described practices for conducting hackathons to develop and implement our hackathon (HackED!). We partnered with the American College of Emergency Physicians, the Stanford School of Biodesign, and the Institute of Design at Stanford (d.school) to lend institutional support and expertise in health care innovation to our event. We determined a location, time frame, and logistics for the competition and settled on 3 use cases for teams to work on. We planned to explore the learning experience of participants within a pragmatic paradigm and complete an abductive thematic analysis using data from a variety of sources. Results: HackED! took place from October 1-3, 2022. In all, 3 teams developed novel solutions to each of the use cases. Our investigation into the educational experience of participants suggested that the event was valuable and uncovered themes suggesting that the learning experience could be understood within a framework from entrepreneurship education not previously described in relation to hackathons. Conclusions: Health care hackathons appear to be a viable method of increasing physician experience with innovation and entrepreneurship principles and addressing complex problems in health care. Hackathons should be considered as part of educational programs that focus on these concepts. UR - https://mededu.jmir.org/2023/1/e43916 UR - http://dx.doi.org/10.2196/43916 UR - http://www.ncbi.nlm.nih.gov/pubmed/36826988 ID - info:doi/10.2196/43916 ER - TY - JOUR AU - Zeng, Minrui AU - Cai, Yiyuan AU - Cao, Jin AU - He, Qianyu AU - Wang, Xiaohui AU - Lu, Yun AU - Liang, Huijuan AU - Xu, Dong AU - Liao, Jing PY - 2022/12/2 TI - The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China JO - J Med Internet Res SP - e40082 VL - 24 IS - 12 KW - virtual patient KW - unannounced standardized patient KW - primary health care KW - primary care KW - quality assessment KW - quality improvement KW - scenario KW - simulation KW - simulate KW - medical education KW - cross-sectional KW - digital health KW - eHealth N2 - Background: The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. Objective: This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Methods: Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted ? for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Results: Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, ?0.03 (95% CI ?0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted ? for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. Conclusions: There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the ?know-do? gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study. UR - https://www.jmir.org/2022/12/e40082 UR - http://dx.doi.org/10.2196/40082 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459416 ID - info:doi/10.2196/40082 ER - TY - JOUR AU - Lobchuk, Michelle AU - Bathi, Reddy Prachotan AU - Ademeyo, Adedotun AU - Livingston, Aislinn PY - 2022/8/3 TI - Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis JO - JMIR Form Res SP - e35319 VL - 6 IS - 8 KW - web browser KW - user-centered design KW - qualitative research KW - internet KW - empathy N2 - 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. UR - https://formative.jmir.org/2022/8/e35319 UR - http://dx.doi.org/10.2196/35319 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921138 ID - info:doi/10.2196/35319 ER - TY - JOUR AU - Nopiyani, Sri Ni Made AU - Januraga, Putu Pande AU - Wirawan, Ady I. Md AU - Bakta, Made I. PY - 2022/5/23 TI - Comprehensive Travel Health Education for Tour Guides: Protocol for an Exploratory Sequential Mixed Methods Research JO - JMIR Res Protoc SP - e33840 VL - 11 IS - 5 KW - travel health KW - health education KW - tour guides KW - tourists KW - health promotion N2 - Background: Tourists are at risk of experiencing health problems during their travel. However, even though tour guides have the potential to become travel health promoters, their participation has not been optimal. Objective: This study aims to develop a comprehensive travel health education model to help tour guides improve health information delivery to tourists. Methods: This is an exploratory sequential mixed methods research. The first phase consisted of a qualitative study with an informed grounded theory design. In-depth interviews were carried out with tour guides from all language divisions and policymakers of the Indonesian Tour Guide Association Bali Branch or Himpunan Pramuwisata Indonesia Daerah Bali (HPI Bali). The interview guidelines were developed based on the theory of planned behavior and identity theory. Qualitative data were analyzed thematically. In the interim phase, a travel health education model and questionnaire were developed based on the qualitative findings. The initial model and its instruments were finetuned after consultation with travel medicine and health promotion experts. Furthermore, the validity and reliability of the questionnaire were tested on 30 tour guides. The second phase consisted of a quantitative study with a randomized pretest-posttest control group design. A total of 76 tour guides in the intervention group received comprehensive travel health education, while 76 in the control group received no specific intervention. Outcome variables (ie, attitudes, subjective norms, perceived behavioral control, actual behavioral control, role identity, and behavioral intention) were measured at baseline (T0), after the online training (T1), before information sharing via WhatsApp (T2), a month after the start of the WhatsApp intervention (T3), and at the end of the WhatsApp intervention (T4). The mean difference of each outcome variable before and after the intervention will be compared between the intervention and control groups. Thereafter, the quantitative and qualitative findings will be integrated into a joint display. Results: The qualitative phase was conducted through in-depth interviews with 21 informants who included tour guides and policymakers from HPI Bali from May to June 2021. The education model, educational materials, and questionnaire were developed based on the qualitative findings and consultation with experts. The education model consists of online training and information sharing through WhatsApp and was trialed with tour guides from November 2021 to February 2022. As of April 2022, this study is in the quantitative data analysis stage. Conclusions: A travel health education model was developed based on qualitative findings and consultation with experts. The model was tested with tour guides, and a series of self-administered questionnaires were completed. This study is in the quantitative data analysis stage and will continue by integrating qualitative and quantitative findings into a joint display. Trial Registration: ClinicalTrials.gov NCT04961983; https://clinicaltrials.gov/ct2/show/NCT04961983 UR - https://www.researchprotocols.org/2022/5/e33840 UR - http://dx.doi.org/10.2196/33840 UR - http://www.ncbi.nlm.nih.gov/pubmed/35604754 ID - info:doi/10.2196/33840 ER - TY - JOUR AU - Landis-Lewis, Zach AU - Flynn, Allen AU - Janda, Allison AU - Shah, Nirav PY - 2022/5/10 TI - A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34990 VL - 11 IS - 5 KW - learning health system KW - audit and feedback KW - anesthesiology KW - knowledge-based system KW - human-centered design N2 - Background: Health care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric?s level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A&F. From an informatics perspective, precision A&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels. Objective: This study aims to implement and evaluate a demonstration system for precision A&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium. Methods: We propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes. Results: The proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024. Conclusions: The proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective. International Registered Report Identifier (IRRID): PRR1-10.2196/34990 UR - https://www.researchprotocols.org/2022/5/e34990 UR - http://dx.doi.org/10.2196/34990 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536637 ID - info:doi/10.2196/34990 ER - TY - JOUR AU - Ajab, Shereen AU - Pearson, Emma AU - Dumont, Steven AU - Mitchell, Alicia AU - Kastelik, Jack AU - Balaji, Packianathaswamy AU - Hepburn, David PY - 2022/5/9 TI - An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study JO - JMIR Med Educ SP - e33565 VL - 8 IS - 2 KW - simulation KW - high fidelity KW - low fidelity KW - COVID-19 KW - bedside teaching KW - undergraduate medical education KW - fidelity KW - medical education KW - medical student KW - review KW - innovation KW - risk KW - design KW - implementation N2 - Background: Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students? confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods. Objective: To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19?safe environment using SimMan 3G. Methods: Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session. Results: In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature. Conclusions: Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally. UR - https://mededu.jmir.org/2022/2/e33565 UR - http://dx.doi.org/10.2196/33565 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404828 ID - info:doi/10.2196/33565 ER - TY - JOUR AU - Dunn, Sheila AU - Munro, Sarah AU - Devane, Courtney AU - Guilbert, Edith AU - Jeong, Dahn AU - Stroulia, Eleni AU - Soon, A. Judith AU - Norman, V. Wendy PY - 2022/5/5 TI - A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study JO - J Med Internet Res SP - e34302 VL - 24 IS - 5 KW - mifepristone KW - abortion KW - community of practice KW - virtual community of practice KW - diffusion of innovation KW - learning community N2 - 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 UR - https://www.jmir.org/2022/5/e34302 UR - http://dx.doi.org/10.2196/34302 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511226 ID - info:doi/10.2196/34302 ER - TY - JOUR AU - White, A. Andrew AU - King, M. Ann AU - D?Addario, E. Angelo AU - Brigham, Berg Karen AU - Dintzis, Suzanne AU - Fay, E. Emily AU - Gallagher, H. Thomas AU - Mazor, M. Kathleen PY - 2022/4/29 TI - Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory JO - JMIR Med Educ SP - e30988 VL - 8 IS - 2 KW - medical error disclosure KW - simulation studies KW - communication assessment KW - graduate medical education KW - crowdsourcing KW - patient-centered care KW - generalizability theory KW - medical education KW - medical error KW - communication N2 - Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents? error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates? and crowdsourced laypeople?s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. UR - https://mededu.jmir.org/2022/2/e30988 UR - http://dx.doi.org/10.2196/30988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486423 ID - info:doi/10.2196/30988 ER - TY - JOUR AU - Lauffenburger, C. Julie AU - DiFrancesco, F. Matthew AU - Barlev, A. Renee AU - Robertson, Ted AU - Kim, Erin AU - Coll, D. Maxwell AU - Haff, Nancy AU - Fontanet, P. Constance AU - Hanken, Kaitlin AU - Oran, Rebecca AU - Avorn, Jerry AU - Choudhry, K. Niteesh PY - 2022/4/27 TI - Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31464 VL - 11 IS - 4 KW - pragmatic trial KW - behavioral science KW - prescribing KW - benzodiazepines KW - antipsychotics KW - impact evaluation N2 - Background: Gaps between rational thought and actual decisions are increasingly recognized as a reason why people make suboptimal choices in states of heightened emotion, such as stress. These observations may help explain why high-risk medications continue to be prescribed to acutely ill hospitalized older adults despite widely accepted recommendations against these practices. Role playing and other efforts, such as simulation training, have demonstrated benefits to help people avoid decisional gaps but have not been tested to reduce overprescribing of high-risk medications. Objective: This study aims to evaluate the impact of a simulation-based training program designed to address decisional gaps on prescribing of high-risk medications compared with control. Methods: In this 2-arm pragmatic trial, we are randomizing at least 36 first-year medical resident physicians (ie, interns) who provide care on inpatient general medicine services at a large academic medical center to either intervention (simulation-based training) or control (online educational training). The intervention comprises a 40-minute immersive individual simulation training consisting of a reality-based patient care scenario in a simulated environment at the beginning of their inpatient service rotation. The simulation focuses on 3 types of high-risk medications, including benzodiazepines, antipsychotics, and sedative hypnotics (Z-drugs), in older adults, and is specifically designed to help the physicians identify their reactions and prescribing decisions in stressful situations that are common in the inpatient setting. The simulation scenario is followed by a semistructured debriefing with an expert facilitator. The trial?s primary outcome is the number of medication doses for any of the high-risk medications prescribed by the interns to patients aged 65 years or older who were not taking one of the medications upon admission. Secondary outcomes include prescribing by all providers on the care team, being discharged on 1 of the medications, and prescribing of related medications (eg, melatonin, trazodone), or the medications of interest for the control intervention. These outcomes will be measured using electronic health record data. Results: Recruitment of interns began on March 29, 2021. Recruitment for the trial ended in Q42021, with follow-up completed by Q12022. Conclusions: This trial will evaluate the impact of a simulation-based training program designed using behavioral science principles on prescribing of high-risk medications by junior physicians. If the intervention is shown to be effective, this approach could potentially be reproducible by others and for a broader set of behaviors. Trial Registration: ClinicalTrials.gov NCT04668248; https://clinicaltrials.gov/ct2/show/NCT04668248 International Registered Report Identifier (IRRID): PRR1-10.2196/31464 UR - https://www.researchprotocols.org/2022/4/e31464 UR - http://dx.doi.org/10.2196/31464 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475982 ID - info:doi/10.2196/31464 ER - TY - JOUR AU - Sanavro, M. Sanne AU - van der Worp, Henk AU - Jansen, Danielle AU - Koning, Paul AU - Blanker, H. Marco AU - PY - 2022/4/1 TI - Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study JO - JMIR Hum Factors SP - e33630 VL - 9 IS - 2 KW - primary care KW - digital consultation KW - interdisciplinary KW - specialist care N2 - Background: Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective: This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods: We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results: In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions: Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking. UR - https://humanfactors.jmir.org/2022/2/e33630 UR - http://dx.doi.org/10.2196/33630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363155 ID - info:doi/10.2196/33630 ER - TY - JOUR AU - Tahri Sqalli, Mohammed AU - Al-Thani, Dena AU - Elshazly, B. Mohamed AU - Al-Hijji, Mohammed AU - Alahmadi, Alaa AU - Sqalli Houssaini, Yahya PY - 2022/2/9 TI - Understanding Cardiology Practitioners? Interpretations of Electrocardiograms: An Eye-Tracking Study JO - JMIR Hum Factors SP - e34058 VL - 9 IS - 1 KW - eye tracking KW - electrocardiogram KW - ECG interpretation KW - cardiology practitioners KW - human-computer interaction KW - cardiology KW - ECG N2 - Background: Visual expertise refers to advanced visual skills demonstrated when performing domain-specific visual tasks. Prior research has emphasized the fact that medical experts rely on such perceptual pattern-recognition skills when interpreting medical images, particularly in the field of electrocardiogram (ECG) interpretation. Analyzing and modeling cardiology practitioners? visual behavior across different levels of expertise in the health care sector is crucial. Namely, understanding such acquirable visual skills may help train less experienced clinicians to interpret ECGs accurately. Objective: This study aims to quantify and analyze through the use of eye-tracking technology differences in the visual behavior and methodological practices for different expertise levels of cardiology practitioners such as medical students, cardiology nurses, technicians, fellows, and consultants when interpreting several types of ECGs. Methods: A total of 63 participants with different levels of clinical expertise took part in an eye-tracking study that consisted of interpreting 10 ECGs with different cardiac abnormalities. A counterbalanced within-subjects design was used with one independent variable consisting of the expertise level of the cardiology practitioners and two dependent variables of eye-tracking metrics (fixations count and fixation revisitations). The eye movements data revealed by specific visual behaviors were analyzed according to the accuracy of interpretation and the frequency with which interpreters visited different parts/leads on a standard 12-lead ECG. In addition, the median and SD in the IQR for the fixations count and the mean and SD for the ECG lead revisitations were calculated. Results: Accuracy of interpretation ranged between 98% among consultants, 87% among fellows, 70% among technicians, 63% among nurses, and finally 52% among medical students. The results of the eye fixations count, and eye fixation revisitations indicate that the less experienced cardiology practitioners need to interpret several ECG leads more carefully before making any decision. However, more experienced cardiology practitioners rely on their skills to recognize the visual signal patterns of different cardiac abnormalities, providing an accurate ECG interpretation. Conclusions: The results show that visual expertise for ECG interpretation is linked to the practitioner?s role within the health care system and the number of years of practical experience interpreting ECGs. Cardiology practitioners focus on different ECG leads and different waveform abnormalities according to their role in the health care sector and their expertise levels. UR - https://humanfactors.jmir.org/2022/1/e34058 UR - http://dx.doi.org/10.2196/34058 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138258 ID - info:doi/10.2196/34058 ER - TY - JOUR AU - Burgon, Trever AU - Casebeer, Linda AU - Aasen, Holly AU - Valdenor, Czarlota AU - Tamondong-Lachica, Diana AU - de Belen, Enrico AU - Paculdo, David AU - Peabody, John PY - 2021/12/23 TI - Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial JO - J Med Internet Res SP - e31042 VL - 23 IS - 12 KW - quality improvement KW - physician engagement KW - MIPS KW - case simulation KW - feedback KW - value-based care KW - care standardization KW - simulation KW - gamification KW - medical education KW - continuing education KW - outcome KW - serious game KW - decision-support N2 - Background: Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. Objective: In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). Methods: We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians ?cared? for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. Results: We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<.001) and osteoarthritis (+7.6%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. Conclusions: Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. Trial Registration: ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901 UR - https://www.jmir.org/2021/12/e31042 UR - http://dx.doi.org/10.2196/31042 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941547 ID - info:doi/10.2196/31042 ER - TY - JOUR AU - Darnell, Doyanne AU - Areán, A. Patricia AU - Dorsey, Shannon AU - Atkins, C. David AU - Tanana, J. Michael AU - Hirsch, Tad AU - Mooney, D. Sean AU - Boudreaux, D. Edwin AU - Comtois, Anne Katherine PY - 2021/12/15 TI - Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research JO - JMIR Res Protoc SP - e33695 VL - 10 IS - 12 KW - suicide prevention KW - hospital KW - training KW - e-learning KW - artificial intelligence KW - implementation science KW - user-centered design KW - task-shifting KW - quality assessment KW - fidelity N2 - 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 UR - https://www.researchprotocols.org/2021/12/e33695 UR - http://dx.doi.org/10.2196/33695 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914618 ID - info:doi/10.2196/33695 ER - TY - JOUR AU - Massanelli, Jackson AU - Sexton, W. Kevin AU - Lesher, T. Chris AU - Jensen, K. Hanna AU - Kimbrough, K. Mary AU - Privratsky, Anna AU - Taylor, R. John AU - Bhavaraju, Avi PY - 2021/12/13 TI - Integration of Web Analytics Into Graduate Medical Education: Usability Study JO - JMIR Form Res SP - e29748 VL - 5 IS - 12 KW - graduate medical education KW - website analysis KW - residency recruitment KW - medical education KW - website KW - analytics KW - usage KW - usability KW - user engagement KW - user-centered design KW - website design N2 - Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department?s website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website?s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. UR - https://formative.jmir.org/2021/12/e29748 UR - http://dx.doi.org/10.2196/29748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898459 ID - info:doi/10.2196/29748 ER - TY - JOUR AU - Peng, R. Cynthia AU - Schertzer, A. Kimberly AU - Caretta-Weyer, A. Holly AU - Sebok-Syer, S. Stefanie AU - Lu, William AU - Tansomboon, Charissa AU - Gisondi, A. Michael PY - 2021/11/17 TI - Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study JO - JMIR Med Educ SP - e32356 VL - 7 IS - 4 KW - simulation KW - graduate medical education KW - assessment KW - gamification KW - entrustable professional activities KW - emergency medicine KW - undergraduate medical education N2 - Background: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 ?look for? statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results: All participants had at least one missing critical action, and 40% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54%). Other errors included selecting incorrect documentation passages (6/15, 40%) and indiscriminately applying oxygen (9/15, 60%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans. UR - https://mededu.jmir.org/2021/4/e32356 UR - http://dx.doi.org/10.2196/32356 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787582 ID - info:doi/10.2196/32356 ER - TY - JOUR AU - Stunden, Chelsea AU - Zakani, Sima AU - Martin, Avery AU - Moodley, Shreya AU - Jacob, John PY - 2021/11/17 TI - Replicating Anatomical Teaching Specimens Using 3D Modeling Embedded Within a Multimodal e-Learning Course: Pre-Post Study Exploring the Impact on Medical Education During COVID-19 JO - JMIR Med Educ SP - e30533 VL - 7 IS - 4 KW - congenital heart disease KW - cardiac anatomy, pathologic anatomy KW - education KW - learning aids KW - 3D models N2 - Background: The COVID-19 pandemic has had significant effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal method of learning anatomy. We created and tested a customized congenital heart disease e-learning course for medical students that contained interactive 3D models of anonymized pediatric congenital heart defects. Objective: The aim of this study is to assess whether a multimodal e-learning course contributed to learning outcomes in a cohort of first-year undergraduate medical students studying congenital heart diseases. The secondary aim is to assess student attitudes and experiences associated with multimodal e-learning. Methods: The pre-post study design involved 290 first-year undergraduate medical students. Recruitment was conducted by course instructors. Data were collected before and after using the course. The primary outcome was knowledge acquisition (test scores). The secondary outcomes included attitudes and experiences, time to complete the modules, and browser metadata. Results: A total of 141 students were included in the final analysis. Students? knowledge significantly improved by an average of 44.6% (63/141) when using the course (SD 1.7%; Z=?10.287; P<.001). Most students (108/122, 88.3%) were highly motivated to learn with the course, and most (114/122, 93.5%) reported positive experiences with the course. There was a strong correlation between attitudes and experiences, which was statistically significant (rs=0.687; P<.001; n=122). No relationships were found between the change in test scores and attitudes (P=.70) or experiences (P=.47). Students most frequently completed the e-learning course with Chrome (109/141, 77.3%) and on Apple macOS (86/141, 61%) or Windows 10 (52/141, 36.9%). Most students (117/141, 83%) had devices with high-definition screens. Most students (83/141, 58.9%) completed the course in <3 hours. Conclusions: Multimodal e-learning could be a viable solution in improving learning outcomes and experiences for undergraduate medical students who do not have access to cadavers. Future research should focus on validating long-term learning outcomes. UR - https://mededu.jmir.org/2021/4/e30533 UR - http://dx.doi.org/10.2196/30533 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787589 ID - info:doi/10.2196/30533 ER - TY - JOUR AU - Zuo, Tianming AU - Sun, Baozhi AU - Guan, Xu AU - Zheng, Bin AU - Qu, Bo PY - 2021/11/9 TI - Evidence of Construct Validity of Computer-Based Tests for Clinical Reasoning: Instrument Validation Study JO - JMIR Serious Games SP - e17670 VL - 9 IS - 4 KW - medical education KW - assessment KW - computer-based test KW - clinical reasoning KW - validity N2 - Background: Clinical reasoning (CR) is a fundamental skill for all medical students. In our medical education system, however, there are shortcomings in the conventional methods of teaching CR. New technology is needed to enhance our CR teaching, especially as we are facing an influx of new health trainees. China Medical University (CMU), in response to this need, has developed a computer-based CR training system (CMU-CBCRT). Objective: We aimed to find evidence of construct validity of the CMU-CBCRT. Methods: We recruited 385 students from fifth year undergraduates to postgraduate year (PGY) 3 to complete the test on CMU-CBCRT. The known-groups technique was used to evaluate the construct validity of the CBCRT by comparing the test scores among 4 training levels (fifth year MD, PGY-1, PGY-2, and PGY-3). Results: We found that test scores increased with years of training. Significant differences were found in the test scores on information collection, diagnosis, and treatment and total scores among different training years of participants. However, significant results were not found for treatment errors. Conclusions: We provided evidence of construct validity of the CMU-CBCRT, which could determine the CR skills of medical students at varying early stage in their careers. UR - https://games.jmir.org/2021/4/e17670 UR - http://dx.doi.org/10.2196/17670 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751658 ID - info:doi/10.2196/17670 ER - TY - JOUR AU - Schoenmakers, Birgitte AU - Wens, Johan PY - 2021/8/16 TI - Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study JO - JMIR Form Res SP - e23834 VL - 5 IS - 8 KW - primary care KW - education KW - graduate KW - medical education KW - testing KW - assessment KW - app KW - COVID-19 KW - efficiency KW - accuracy N2 - Background: The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates? behaviors. Objective: We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure?s impact on exam scores. Methods: The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students? exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results: Of the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions: This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates? awareness of being monitored via a safe browser plug-in for exams. UR - https://formative.jmir.org/2021/8/e23834 UR - http://dx.doi.org/10.2196/23834 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398786 ID - info:doi/10.2196/23834 ER - TY - JOUR AU - Park, Sungjin AU - Kim, Sangkyun PY - 2021/4/20 TI - Leaderboard Design Principles to Enhance Learning and Motivation in a Gamified Educational Environment: Development Study JO - JMIR Serious Games SP - e14746 VL - 9 IS - 2 KW - leaderboard design KW - gamification KW - learning motivation KW - affordance N2 - Background: Gamification in education enhances learners? motivation, problem-solving abilities, decision-making abilities, and social skills such as communication. Numerous ongoing studies are examining the application of gamification design methodology and game mechanics to a learning environment. Leaderboards are a type of game mechanic that assist learners in goal setting and unleash the motivation for learning. Objective: The aim of this study was to develop leaderboard design principles to assist learners in efficient goal setting, improve learning motivation, and promote learning in gamified learning environments. Methods: This study implemented 2 different strategies. First, we analyzed previous research on leaderboards that focus on educational efficacy and influence on social interactions. Second, we collected and analyzed data related to cases of leaderboards being used in educational and sport environments. Results: This study determined 4 leaderboard design objectives from previous studies. Based on these objectives, we developed 3 leaderboard design principles. First, macro leaderboards and micro leaderboards should be designed and used together. Second, all the elements used to measure learners? achievements in an educational environment should be incorporated into the micro leaderboard. Third, leaderboards should be designed and considered for application in contexts other than learning environments. This study further analyzes best practices considering the 3 leaderboard design principles. Conclusions: This study contributes toward resolving problems associated with leaderboard design for the application of gamification in educational environments. Based upon our results, we strongly suggest that when teachers consider applying gamification in classrooms, the leaderboard design principles suggested in this research should be incorporated. UR - https://games.jmir.org/2021/2/e14746 UR - http://dx.doi.org/10.2196/14746 UR - http://www.ncbi.nlm.nih.gov/pubmed/33877049 ID - info:doi/10.2196/14746 ER - TY - JOUR AU - Glover, Kevin AU - Bodzin, Alec PY - 2020/2/6 TI - Learner Analysis to Inform the Design and Development of a Serious Game for Nongaming Female Emerging Health Care Preprofessionals: Qualitative Sample Study JO - JMIR Serious Games SP - e16003 VL - 8 IS - 1 KW - games KW - health care KW - education KW - females KW - motivation KW - instructional design N2 - Background: Overall, 75% of health care practitioners are women, but half of all females do not play digital games of any kind. There is no consensus in the literature regarding optimal design elements to maximize the efficacy of serious games. To capitalize on the promise of serious games in health care education, it is important for instructional designers to understand the underlying learners? values, attitudes, and beliefs that might motivate nongaming female health care preprofessional students to independently choose to persistently play serious games to mastery. Objective: Specifically, the aim of this study was to seek answers to 2 questions. First, what values, attitudes, and beliefs contribute to the nongaming behaviors of 12th-grade female emerging health care preprofessionals? Second, how do the values, attitudes, and beliefs of 12th-grade female emerging health care preprofessionals align with important design features of serious games? Methods: In this study, a learner analysis was conducted using semistructured interviews with 8 12th-grade college-bound female health science students to better understand learners? values, attitudes, and beliefs to inform the design and development of a serious game. These interviewees represented a diverse subset of the female emerging health care preprofessionals who self-identified themselves as not playing games at all, not very often, or infrequently. Results: The findings suggest that the study participants exhibited a complex fusion of desire for both accomplishment and affiliation. The participants were all independent, competitive, and prosocial leaders. They thought strategically and consciously self-limited their leisure time to achieve personally meaningful long-term goals. They embraced overcoming expected failures and aimed to achieve relevant high-stakes wins in all academic, athletic, extracurricular, and leisure activities they valued while consciously avoiding what they considered to be non?goal-oriented activities. Conclusions: The results of this study reinforce the need for a robust learner analysis to identify the multifaceted behavioral characteristics of targeted learners before the design and development of serious games. The common characteristics of the 12th-grade female health science students in this study suggest that they will choose to invest their limited leisure time playing a personally meaningful, preprofessionally authentic serious game if the collective design elements are aligned with the students? self-conceptualization of their present or future selves. UR - https://games.jmir.org/2020/1/e16003 UR - http://dx.doi.org/10.2196/16003 UR - http://www.ncbi.nlm.nih.gov/pubmed/32027312 ID - info:doi/10.2196/16003 ER - TY - JOUR AU - Schuelper, Nikolai AU - Ludwig, Sascha AU - Anders, Sven AU - Raupach, Tobias PY - 2019/07/22 TI - The Impact of Medical Students? Individual Teaching Format Choice on the Learning Outcome Related to Clinical Reasoning JO - JMIR Med Educ SP - e13386 VL - 5 IS - 2 KW - undergraduate medical education KW - case histories N2 - Background: Repeated formative assessments using key feature questions have been shown to enhance clinical reasoning. Key feature questions augmented by videos presenting clinical vignettes may be more effective than text-based questions, especially in a setting where medical students are free to choose the format they would like to work with. This study investigated learning outcomes related to clinical reasoning in students using video- or text-based key feature questions according to their individual preferences. Objective: The aim of this study was to test the hypothesis that repeated exposure to video-based key feature questions enhances clinical reasoning to a greater extent than repeated exposure to text-based key feature questions if students are allowed to choose between those different formats on their own. Methods: In this monocentric, prospective, nonrandomized trial, fourth-year medical students attended 12 computer-based case seminars during which they worked on case histories containing key feature questions. Cases were available in a text- and a video-based format. Students chose their preferred presentation format at the beginning of each case seminar. Student performance in key feature questions was assessed in formative entry, exit, and retention exams and was analyzed with regard to preceding exposure to video- or text-based case histories. Results: Of 102 eligible students, 75 provided written consent and complete data at all study exams (response rate=73.5%). A majority of students (n=52) predominantly chose the text-based format. Compared with these, students preferring the video-based format achieved a nonsignificantly higher score in the exit exam (mean 76.2% [SD 12.6] vs 70.0% [SD 19.0]; P=.15) and a significantly higher score in the retention exam (mean 75.3% [SD 16.6] vs 63.4% [SD 20.3]; P=.02). The effect was independent of the video- or text-based presentation format, which was set as default in the respective exams. Conclusions: Despite students? overall preference for text-based case histories, the learning outcome with regard to clinical reasoning was higher in students with higher exposure to video-based items. Time-on-task is one conceivable explanation for these effects as working with video-based items was more time-consuming. The baseline performance levels of students do not account for the results as the preceding summative exam results were comparable across the 2 groups. Given that a substantial number of students chose a presentation format that was less effective, students might need to be briefed about the beneficial effects of using video-based case histories to be able to make informed choices about their study methods. UR - http://mededu.jmir.org/2019/2/e13386/ UR - http://dx.doi.org/10.2196/13386 UR - http://www.ncbi.nlm.nih.gov/pubmed/31333193 ID - info:doi/10.2196/13386 ER - TY - JOUR AU - de Leeuw, Robert AU - Scheele, Fedde AU - Walsh, Kieran AU - Westerman, Michiel PY - 2019/07/22 TI - A 9-Step Theory- and Evidence-Based Postgraduate Medical Digital Education Development Model: Empirical Development and Validation JO - JMIR Med Educ SP - e13004 VL - 5 IS - 2 KW - postgraduate medical e-learning KW - instructional design KW - e-learning KW - distance education KW - design model KW - education, medical KW - education, distance KW - models, educational N2 - Background: Digital education tools (e-learning, technology-enhanced learning) can be defined as any educational intervention that is electronically mediated. Decveloping and applying such tools and interventions for postgraduate medical professionals who work and learn after graduation can be called postgraduate medical digital education (PGMDE), which is increasingly being used and evaluated. However, evaluation has focused mainly on reaching the learning goals and little on the design. Design models for digital education (instructional design models) help educators create a digital education curriculum, but none have been aimed at PGMDE. Studies show the need for efficient, motivating, useful, and satisfactory digital education. Objective: Our objective was (1) to create an empirical instructional design model for PGMDE founded in evidence and theory, with postgraduate medical professionals who work and learn after graduation as the target audience, and (2) to compare our model with existing models used to evaluate and create PGMDE. Methods: Previously we performed an integrative literature review, focus group discussions, and a Delphi procedure to determine which building blocks for such a model would be relevant according to experts and users. This resulted in 37 relevant items. We then used those 37 items and arranged them into chronological steps. After we created the initial 9-step plan, we compared these steps with other models reported in the literature. Results: The final 9 steps were (1) describe who, why, what, (2) select educational strategies, (3) translate to the real world, (4) choose the technology, (5) complete the team, (6) plan the budget, (7) plan the timing and timeline, (8) implement the project, and (9) evaluate continuously. On comparing this 9-step model with other models, we found that no other was as complete, nor were any of the other models aimed at PGMDE. Conclusions: Our 9-step model is the first, to our knowledge, to be based on evidence and theory building blocks aimed at PGMDE. We have described a complete set of evidence-based steps, expanding a 3-domain model (motivate, learn, and apply) to an instructional design model that can help every educator in creating efficient, motivating, useful, and satisfactory PGMDE. Although certain steps are more robust and have a deeper theoretical background in current research (such as education), others (such as budget) have been barely touched upon and should be investigated more thoroughly in order that proper guidelines may also be provided for them. UR - http://mededu.jmir.org/2019/2/e13004/ UR - http://dx.doi.org/10.2196/13004 UR - http://www.ncbi.nlm.nih.gov/pubmed/31333194 ID - info:doi/10.2196/13004 ER - TY - JOUR AU - Park, Sungjin AU - Kim, Sangkyun PY - 2019/05/29 TI - A Badge Design Framework for a Gamified Learning Environment: Cases Analysis and Literature Review for Badge Design JO - JMIR Serious Games SP - e14342 VL - 7 IS - 2 KW - badge design framework KW - educational badge KW - digital badge KW - badge types KW - gamified learning environment N2 - Background: In the past, the educational badge was an extrinsic means of rewarding the motivation to learn. Based on continued research, however, the badge began to be recognized as a scale to measure the learner?s knowledge and skill and an important means of helping learners to gradually build intrinsic motivation by using certain extrinsic motivators. As the badge?s value has grown, the importance of its design has garnered attention. Objective: The objective of this research was to establish a badge design framework that can be used in a gamified learning environment. Methods: Data were collected from previous studies on badge design, 943 badge cases were extracted from 11 online and offline gamification in education contents, and their patterns and features were analyzed. Results: Based on the analysis of results from previous studies and 943 collected badge cases, our study suggests three conditions for badge design. Through the literature review and collected badge cases, our study designed a badge design framework. First, it is necessary to distinguish whether the type of learning activity required for earning badges is physical or conceptual. Second, it is necessary to distinguish whether the scale of an activity required for earning badges requires individual learning or interaction-induced learning. Third, it is important to review whether the time and effort invested in earning badges is simple, repetitive, and short-term or continuous and long-term. Based on these three conditions, collected badge cases were analyzed. To verify self-developed badge types, we conducted a chi-square test on the collected cases and confirmed that there was a significant difference for each of the eight badge types (Pearson chi-square 1117.7, P<.001). Conclusions: Through its literature review on previous studies, this study demonstrated the badge?s educational effectiveness. The badge design framework suggested in our study is expected to resolve some of the difficulties experienced during the badge design process in a gamified learning environment, encourage efficient badge design, and maximize learning effect. UR - http://games.jmir.org/2019/2/e14342/ UR - http://dx.doi.org/10.2196/14342 UR - http://www.ncbi.nlm.nih.gov/pubmed/31144664 ID - info:doi/10.2196/14342 ER - TY - JOUR AU - Mazor, M. Kathleen AU - King, M. Ann AU - Hoppe, B. Ruth AU - Kochersberger, O. Annie AU - Yan, Jie AU - Reim, D. Jesse PY - 2019/02/14 TI - Video-Based Communication Assessment: Development of an Innovative System for Assessing Clinician-Patient Communication JO - JMIR Med Educ SP - e10400 VL - 5 IS - 1 KW - communication KW - crowdsourcing KW - health care KW - mobile phone KW - patient-centered care KW - video-based communication assessment UR - http://mededu.jmir.org/2019/1/e10400/ UR - http://dx.doi.org/10.2196/10400 UR - http://www.ncbi.nlm.nih.gov/pubmed/30710460 ID - info:doi/10.2196/10400 ER - TY - JOUR AU - Adam, Maya AU - McMahon, A. Shannon AU - Prober, Charles AU - Bärnighausen, Till PY - 2019/01/30 TI - Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach JO - J Med Internet Res SP - e12128 VL - 21 IS - 1 KW - human-centered design KW - health promotion KW - health behavior KW - health knowledge, attitudes, practice KW - community health workers KW - telemedicine KW - eHealth KW - mHealth UR - http://www.jmir.org/2019/1/e12128/ UR - http://dx.doi.org/10.2196/12128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698531 ID - info:doi/10.2196/12128 ER - TY - JOUR AU - Eggeling, Marie AU - Bientzle, Martina AU - Shiozawa, Thomas AU - Cress, Ulrike AU - Kimmerle, Joachim PY - 2018/11/22 TI - The Impact of Visualization Format and Navigational Options on Laypeople?s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey JO - J Participat Med SP - e12338 VL - 10 IS - 4 KW - attitude KW - decision aids KW - emotions KW - informed decision making KW - knowledge acquisition KW - medical decision making KW - surgery KW - video N2 - Background: Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. Objective: We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients? knowledge gain, emotions, attitude, and hypothetical decision-making ability. Methods: In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. Results: In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. Conclusion: Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. Trial Registration: Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN) UR - http://jopm.jmir.org/2018/4/e12338/ UR - http://dx.doi.org/10.2196/12338 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/12338 ER - TY - JOUR AU - Omer, Selma AU - Choi, Sunhea AU - Brien, Sarah AU - Parry, Marcus PY - 2017/09/27 TI - Log In to Experiential Learning Theory: Supporting Web-Based Faculty Development JO - JMIR Med Educ SP - e16 VL - 3 IS - 2 KW - computer-assisted instruction KW - models, educational KW - staff development KW - education, medical KW - computer simulation N2 - Background: For an increasingly busy and geographically dispersed faculty, the Faculty of Medicine at the University of Southampton, United Kingdom, developed a range of Web-based faculty development modules, based on Kolb?s experiential learning cycle, to complement the faculty?s face-to-face workshops. Objective: The objective of this study was to assess users? views and perceptions of the effectiveness of Web-based faculty development modules based on Kolb?s experiential learning cycle. We explored (1) users? satisfaction with the modules, (2) whether Kolb?s design framework supported users? learning, and (3) whether the design principle impacts their work as educators. Methods: We gathered data from users over a 3-year period using evaluation surveys built into each of the seven modules. Quantitative data were analyzed using descriptive statistics, and responses to open-ended questions were analyzed using content analysis. Results: Out of the 409 module users, 283 completed the survey (69.1% response rate). Over 80% of the users reported being satisfied or very satisfied with seven individual aspects of the modules. The findings suggest a strong synergy between the design features that users rated most highly and the key stages of Kolb?s learning cycle. The use of simulations and videos to give the users an initial experience as well as the opportunity to ?Have a go? and receive feedback in a safe environment were both considered particularly useful. In addition to providing an opportunity for reflection, many participants considered that the modules would enhance their roles as educators through: increasing their knowledge on various education topics and the required standards for medical training, and improving their skills in teaching and assessing students through practice and feedback and ultimately increasing their confidence. Conclusions: Kolb?s theory-based design principle used for Web-based faculty development can support faculty to improve their skills and has impact on their role as educators. Grounding Web-based training in learning theory offers an effective and flexible approach for faculty development. UR - http://mededu.jmir.org/2017/2/e16/ UR - http://dx.doi.org/10.2196/mededu.7939 UR - http://www.ncbi.nlm.nih.gov/pubmed/28954718 ID - info:doi/10.2196/mededu.7939 ER - TY - JOUR AU - Daruwalla, J. Zubin AU - Loh, L. Jing AU - Dong, Chaoyan PY - 2016/08/09 TI - Spaced Education and the Importance of Raising Awareness of the Personal Data Protection Act: A Medical Student Population-Based Study JO - JMIR Med Educ SP - e12 VL - 2 IS - 2 KW - medical education KW - MyDoc KW - Personal Data Protection Act KW - secure messaging KW - spaced education KW - telehealth KW - telemedicine N2 - Background: The Personal Data Protection Act (PDPA) of Singapore was first passed in 2012, with subsequent enforcement regulations effective in 2014. Although medical education via digital platforms is not often used in medical schools in Singapore as of yet, many current means of communication at all levels in the medical community from medical schools to clinics to hospitals are unsecure and noncompliant with the PDPA. Objective: This pilot study will assess the effectiveness of MyDoc, a secure, mobile telehealth application and messaging platform, as an educational tool, secure communications tool, and a tool to raise awareness of the PDPA. Methods: By replacing current methods of communication with MyDoc and using weekly clinical case discussions in the form of unidentifiable clinical photos and questions and answers, we raised awareness the PDPA among medical students and gained feedback and determined user satisfaction with this innovative system via questionnaires handed to 240 medical students who experienced using MyDoc over a 6-week period. Results: All 240 questionnaires were answered with very positive and promising results, including all 100 students who were not familiar with the PDPA prior to the study attributing their awareness of it to MyDoc. Conclusions: Potential uses of MyDoc in a medical school setting include PDPA-compliant student-to-student and student-to-doctor communication and clinical group case discussions with the sharing of patient-sensitive data, including clinical images and/or videos of hospital patients that students may benefit from viewing from an educational perspective. With our pilot study having excellent results in terms of acceptance and satisfaction from medical students and raising awareness of the PDPA, the integration of a secure, mobile digital health application and messaging platform is something all medical schools should consider, because our students of today are our doctors of tomorrow. UR - http://mededu.jmir.org/2016/2/e12/ UR - http://dx.doi.org/10.2196/mededu.5586 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731866 ID - info:doi/10.2196/mededu.5586 ER - TY - JOUR AU - Antoniades, Athos AU - Nicolaidou, Iolie AU - Spachos, Dimitris AU - Mylläri, Jarkko AU - Giordano, Daniela AU - Dafli, Eleni AU - Mitsopoulou, Evangelia AU - Schizas, N. Christos AU - Pattichis, Constantinos AU - Nikolaidou, Maria AU - Bamidis, Panagiotis PY - 2015/10/09 TI - Medical Content Searching, Retrieving, and Sharing Over the Internet: Lessons Learned From the mEducator Through a Scenario-Based Evaluation JO - J Med Internet Res SP - e229 VL - 17 IS - 10 KW - searching and sharing of medical educational content KW - repurposing KW - metadata KW - evaluation N2 - Background: The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users? performance, was designed and utilized for the evaluation of these solutions. Objective: The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - ?MEdical Education LINnked Arena? MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. Methods: A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. Results: The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end-user perspective, users faced difficulties in achieving a shared understanding of the meaning of some metadata fields and in correctly managing the intellectual property rights of repurposed content. Conclusions: The results of this evaluation impact researchers, medical professionals, and designers interested in using similar systems for educational content sharing in medical and other domains. Recommendations on how to improve the search, retrieval, identification, and obtaining of medical resources are provided, by addressing issues of content description metadata, content description procedures, and intellectual property rights for re-purposed content. UR - http://www.jmir.org/2015/10/e229/ UR - http://dx.doi.org/10.2196/jmir.3650 UR - http://www.ncbi.nlm.nih.gov/pubmed/26453250 ID - info:doi/10.2196/jmir.3650 ER - TY - JOUR AU - Janssen, Anna AU - Shaw, Tim AU - Goodyear, Peter PY - 2015/09/28 TI - Using Video Games to Enhance Motivation States in Online Education: Protocol for a Team-Based Digital Game JO - JMIR Res Protoc SP - e114 VL - 4 IS - 3 KW - digital games KW - medical education KW - online learning N2 - Background: Video and computer games for education have been of interest to researchers for several decades. Over the last half decade, researchers in the health sector have also begun exploring the value of this medium. However, there are still many gaps in the literature regarding the effective use of video and computer games in medical education, particularly in relation to how learners interact with the platform, and how the games can be used to enhance collaboration. Objective: The objective of the study is to evaluate a team-based digital game as an educational tool for engaging learners and supporting knowledge consolidation in postgraduate medical education. Methods: A mixed methodology will be used in order to establish efficacy and level of motivation provided by a team-based digital game. Second-year medical students will be recruited as participants to complete 3 matches of the game at spaced intervals, in 2 evenly distributed teams. Prior to playing the game, participants will complete an Internet survey to establish baseline data. After playing the game, participants will voluntarily complete a semistructured interview to establish motivation and player engagement. Additionally, metrics collected from the game platform will be analyzed to determine efficacy. Results: The research is in the preliminary stages, but thus far a total of 54 participants have been recruited into the study. Additionally, a content development group has been convened to develop appropriate content for the platform. Conclusions: Video and computer games have been demonstrated to have value for educational purposes. Significantly less research has addressed how the medium can be effectively utilized in the health sector. Preliminary data from this study would suggest there is an interest in games for learning in the medical student body. As such, it is beneficial to undertake further research into how these games teach and engage learners in order to evaluate their role in tertiary and postgraduate medical education in the future. UR - http://www.researchprotocols.org/2002/3/e114/ UR - http://dx.doi.org/10.2196/resprot.4016 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416522 ID - info:doi/10.2196/resprot.4016 ER - TY - JOUR AU - Zhu, Egui AU - Lilienthal, Anneliese AU - Shluzas, Aquino Lauren AU - Masiello, Italo AU - Zary, Nabil PY - 2015/09/18 TI - Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework JO - JMIR Medical Education SP - e10 VL - 1 IS - 2 KW - augmented reality KW - health care education KW - antibiotics KW - general practitioners KW - learning environment KW - learning theory KW - mobile technology N2 - Background: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. Objective: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs? rational use of antibiotics. Methods: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. Results: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories?situated, experiential, and transformative learning?provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners? personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners? personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. Conclusions: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework. UR - http://mededu.jmir.org/2015/2/e10/ UR - http://dx.doi.org/10.2196/mededu.4443 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731839 ID - info:doi/10.2196/mededu.4443 ER - TY - JOUR AU - Shenson, Andrew Jared AU - Adams, Christopher Ryan AU - Ahmed, Toufeeq S. AU - Spickard, Anderson PY - 2015/09/17 TI - Formation of a New Entity to Support Effective Use of Technology in Medical Education: The Student Technology Committee JO - JMIR Medical Education SP - e9 VL - 1 IS - 2 KW - committee membership KW - educational technology KW - medical education KW - medical students KW - organizational innovation KW - organizational models N2 - Background: As technology in medical education expands from teaching tool to crucial component of curricular programming, new demands arise to innovate and optimize educational technology. While the expectations of today?s digital native students are significant, their experience and unique insights breed new opportunities to involve them as stakeholders in tackling educational technology challenges. Objective: The objective of this paper is to present our experience with a novel medical student-led and faculty-supported technology committee that was developed at Vanderbilt University School of Medicine to harness students? valuable input in a comprehensive fashion. Key lessons learned through the initial successes and challenges of implementing our model are also discussed. Methods: A committee was established with cooperation of school administration, a faculty advisor with experience launching educational technologies, and a group of students passionate about this domain. Committee membership is sustained through annual selective recruitment of interested students. Results: The committee serves 4 key functions: acting as liaisons between students and administration; advising development of institutional educational technologies; developing, piloting, and assessing new student-led educational technologies; and promoting biomedical and educational informatics within the school community. Participating students develop personally and professionally, contribute to program implementation, and extend the field?s understanding by pursuing research initiatives. The institution benefits from rapid improvements to educational technologies that meet students? needs and enhance learning opportunities. Students and the institution also gain from fostering a campus culture of awareness and innovation in informatics and medical education. The committee?s success hinges on member composition, school leadership buy-in, active involvement in institutional activities, and support for committee initiatives. Conclusions: Students should have an integral role in advancing medical education technology to improve training for 21st-century physicians. The student technology committee model provides a framework for this integration, can be readily implemented at other institutions, and creates immediate value for students, faculty, information technology staff, and the school community. UR - http://mededu.jmir.org/2015/2/e9/ UR - http://dx.doi.org/10.2196/mededu.4676 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731843 ID - info:doi/10.2196/mededu.4676 ER -