TY - JOUR AU - Gashi, Andi AU - Brodmann Maeder, Monika AU - Hennel, K. Eva PY - 2025/4/16 TI - Making Medical Education Courses Visible: Theory-Based Development of a National Database JO - JMIR Med Educ SP - e62838 VL - 11 KW - curriculum mapping KW - faculty development KW - competencies KW - database KW - medical education N2 - Background: Medical education has undergone professionalization during the last decades, and internationally, educators are trained in specific medical education courses also known as ?train the trainer? courses. As these courses have developed organically based on local needs, the lack of a general structure and terminology can confuse and hinder educators? information and development. The first aim of this study was to conduct a national search, analyze the findings, and provide a presentation of medical education courses based on international theoretical frameworks to support Swiss course providers and educators searching for courses. The second aim was to provide a blueprint for such a procedure to be used by the international audience. Objective: In this study, we devised a scholarly approach to sorting and presenting medical education courses to make their content accessible to medical educators. This approach is presented in detailed steps and our openly available exemplary database to make it serve as a blueprint for other settings. Methods: Following our constructivist paradigm, we examined content from medical education courses using a theory-informed inductive data approach. Switzerland served as an example, covering 4 languages and different approaches to medical education. Data were gathered through an online search and a nationwide survey with course providers. The acquired data and a concurrently developed keyword system to standardize course terminology are presented using Obsidian, a software that shows data networks. Results: Our iterative search included several strategies (web search, survey, provider enquiry, and snowballing) and yielded 69 courses in 4 languages, with varying terminology, target audiences, and providers. The database of courses is interactive and openly accessible. An open-access template database structure is also available. Conclusions: This study proposes a novel method for sorting and visualizing medical education courses and the competencies they cover to provide an easy-to-use database, helping medical educators? practical and scholarly development. Notably, our analysis identified a specific emphasis on undergraduate teaching settings, potentially indicating a gap in postgraduate educational offerings. This aspect could be pivotal for future curriculum development and resource allocation. Our method might guide other countries and health care professions, offering a straightforward means of cataloging and making information about medical education courses widely available and promotable. UR - https://mededu.jmir.org/2025/1/e62838 UR - http://dx.doi.org/10.2196/62838 ID - info:doi/10.2196/62838 ER - TY - JOUR AU - Mohd Kassim, Amiruddin Mohd AU - Azli Shah, Yusoff Sidi Muhammad AU - Lim, Yn Jane Tze AU - Mohd Daud, Iryani Tuti PY - 2025/4/15 TI - Online-Based and Technology-Assisted Psychiatric Education for Trainees: Scoping Review JO - JMIR Med Educ SP - e64773 VL - 11 KW - online learning KW - telepsychiatry KW - remote learning KW - virtual KW - training KW - education KW - psychiatry KW - trainees KW - residents N2 - Background: The concept of online learning in medical education has been gaining traction, but whether it can accommodate the complexity of higher-level psychiatric training remains uncertain. Objective: This review aims to identify the various online-based and technology-assisted educational methods used in psychiatric training and to examine the outcomes in terms of trainees? knowledge, skills, and levels of confidence or preference in using such technologies. Methods: A comprehensive search was conducted in PubMed, Cochrane, PsycINFO, Scopus, and ERIC to identify relevant literature from 1991 until 2024. Studies in English and those that had English translations were identified. Studies that incorporated or explored the use of online-based or technology-assisted learning as part of psychiatric training in trainees and had outcomes of interest related to changes in the level of knowledge or skills, changes in the level of preference or confidence in using online-based or technology-assisted learning, and feedback of participants were included. Studies were excluded if they were conducted on populations excluding psychiatric trainees or residents, were mainly descriptive of the concept of the intervention without any relevant study outcome, were not in English or did not have English translations, or were review articles. Results: A total of 82 articles were included in the review. The articles were divided into 3 phases: prior to 2015, 2015 to 2019 (prepandemic), and 2020 onward (postpandemic). Articles mainly originated from Western countries, and there was a significant increase in relevant studies after the pandemic. There were 5 methods identified, namely videoconference, online modules/e-learning, virtual patients, software/applications, and social media. These were applied in various aspects of psychiatric education, such as theory knowledge, skills training, psychotherapy supervision, and information retrieval. Conclusions: Videoconference-based learning was the most widely implemented approach, followed by online modules and virtual patients. Despite the outcome heterogeneity and small sample sizes in the included studies, the application of such approaches may have utility in terms of knowledge and skills attainment and could be beneficial for the training of future psychiatrists, especially those in underserved low- and middle-income countries. UR - https://mededu.jmir.org/2025/1/e64773 UR - http://dx.doi.org/10.2196/64773 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64773 ER - 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 - Bolgova, Olena AU - Shypilova, Inna AU - Mavrych, Volodymyr PY - 2025/4/10 TI - Large Language Models in Biochemistry Education: Comparative Evaluation of Performance JO - JMIR Med Educ SP - e67244 VL - 11 KW - ChatGPT KW - Claude KW - Gemini KW - Copilot KW - biochemistry KW - LLM KW - medical education KW - artificial intelligence KW - NLP KW - natural language processing KW - machine learning KW - large language model KW - AI KW - ML KW - comprehensive analysis KW - medical students KW - GPT-4 KW - questionnaire KW - medical course KW - bioenergetics N2 - Background: Recent advancements in artificial intelligence (AI), particularly in large language models (LLMs), have started a new era of innovation across various fields, with medicine at the forefront of this technological revolution. Many studies indicated that at the current level of development, LLMs can pass different board exams. However, the ability to answer specific subject-related questions requires validation. Objective: The objective of this study was to conduct a comprehensive analysis comparing the performance of advanced LLM chatbots?Claude (Anthropic), GPT-4 (OpenAI), Gemini (Google), and Copilot (Microsoft)?against the academic results of medical students in the medical biochemistry course. Methods: We used 200 USMLE (United States Medical Licensing Examination)?style multiple-choice questions (MCQs) selected from the course exam database. They encompassed various complexity levels and were distributed across 23 distinctive topics. The questions with tables and images were not included in the study. The results of 5 successive attempts by Claude 3.5 Sonnet, GPT-4?1106, Gemini 1.5 Flash, and Copilot to answer this questionnaire set were evaluated based on accuracy in August 2024. Statistica 13.5.0.17 (TIBCO Software Inc) was used to analyze the data?s basic statistics. Considering the binary nature of the data, the chi-square test was used to compare results among the different chatbots, with a statistical significance level of P<.05. Results: On average, the selected chatbots correctly answered 81.1% (SD 12.8%) of the questions, surpassing the students? performance by 8.3% (P=.02). In this study, Claude showed the best performance in biochemistry MCQs, correctly answering 92.5% (185/200) of questions, followed by GPT-4 (170/200, 85%), Gemini (157/200, 78.5%), and Copilot (128/200, 64%). The chatbots demonstrated the best results in the following 4 topics: eicosanoids (mean 100%, SD 0%), bioenergetics and electron transport chain (mean 96.4%, SD 7.2%), hexose monophosphate pathway (mean 91.7%, SD 16.7%), and ketone bodies (mean 93.8%, SD 12.5%). The Pearson chi-square test indicated a statistically significant association between the answers of all 4 chatbots (P<.001 to P<.04). Conclusions: Our study suggests that different AI models may have unique strengths in specific medical fields, which could be leveraged for targeted support in biochemistry courses. This performance highlights the potential of AI in medical education and assessment. UR - https://mededu.jmir.org/2025/1/e67244 UR - http://dx.doi.org/10.2196/67244 ID - info:doi/10.2196/67244 ER - TY - JOUR AU - Jourdi, Georges AU - Selmi, Mayssa AU - Gaussem, Pascale AU - Truchot, Jennifer AU - Margaill, Isabelle AU - Siguret, Virginie PY - 2025/4/10 TI - Evaluation of the Inverted Classroom Approach in a Case-Study Course on Antithrombotic Drug Use in a PharmD Curriculum: French Monocentric Randomized Study JO - JMIR Med Educ SP - e67419 VL - 11 KW - antithrombotic drugs KW - case-study course KW - inverted classroom KW - pharmacy students KW - traditional educational approach KW - medical education N2 - Background: Appropriate antithrombotic drug use is crucial knowledge for pharmacy students. Objective: We sought to compare the inverted classroom (IC) approach to a traditional question-and-answer educational approach with the aim of enhancing pharmacy students? engagement with a case-study course on antithrombotic drug use. Methods: Third-year PharmD (Doctor of Pharmacy) students from Paris Cité University were randomly assigned to control (n=171) and IC (n=175) groups. The latter were instructed to read and prepare the preprovided course material 1 week before the in-class session to assume the instructor role on the target day, whereas students of the control group attended a traditional case-study course carried out by the same instructor. All students completed pre- and posttest multiple-choice questions surveys assessing their knowledge levels as well as stress, empathy, and satisfaction questionnaires. Results: A significantly higher participation rate was observed in the control group (93/171, 54%) compared to the IC group (65/175, 37%; P=.002). Women (110/213, 52%) participated more than men (48/133, 36%; P=.002) whatever the group was. Students? knowledge scores from both groups had similar results with no difference neither in the prescore (1.17, SD 0.66 and 1.24, SD 0.72 of 5, respectively) nor in the short-term knowledge retention (2.45, SD 0.61 and 2.35, SD 0.73, respectively). The IC approach did not increase student stress or enhance their empathy for the instructor. It increased the preclass workload (P=.02) and was not well received among students. Conclusions: This study showed that the traditional educational approach remains an efficient method for case-study courses in the early stages (ie, third-year) of the 6-year PharmD curriculum, yet dynamic methods improving the active role of students in the learning process are still needed. UR - https://mededu.jmir.org/2025/1/e67419 UR - http://dx.doi.org/10.2196/67419 ID - info:doi/10.2196/67419 ER - TY - JOUR AU - Munir, Mamoon Malik AU - Ahmed, Nabil PY - 2025/4/7 TI - Using Social Media Platforms to Raise Health Awareness and Increase Health Education in Pakistan: Structural Equation Modeling Analysis and Questionnaire Study JO - JMIR Hum Factors SP - e65745 VL - 12 KW - social media KW - health awareness KW - health education KW - innovation diffusion theory KW - structural equation modeling KW - disease burden KW - healthcare facilities KW - health professionals KW - misinformation KW - cost effective N2 - Background: Current health care education methods in Pakistan use traditional media (eg, television and radio), community health workers, and printed materials, which often fall short of reach and engagement among most of the population. The health care sector in Pakistan has not yet used social media effectively to raise awareness and provide education about diseases. Research on the impact social media can have on health care education in Pakistan may expand current efforts, engage a wider audience, and reduce the disease burden on health care facilities. Objective: This study aims to evaluate the perceptions of health care professionals and paramedic staff regarding social media use to raise awareness and educate people about diseases as a potential means of reducing the disease burden in Pakistan. Methods: The study used two-stage structural equation modeling (SEM). Data analysis used AMOS 26.0 software, adopting scales from previous literature. Four-item scales for each social media usefulness and health awareness construct and 8-item scales for health care education constructs were adopted on the basis of their higher loading in alignment with psychometric literature. A 7-point Likert scale was used to measure each item. Data collection used convenience sampling, with questionnaires distributed to more than 450 health care professionals and paramedic staff from 2 private hospitals in Lahore, Pakistan. There were 389 useful responses received. However, 340 completed questionnaires were included in the data analysis. Results: The study found that all the squared multiple correlation (SMC) values were greater than 0.30. Furthermore, convergent validity was measured using (1) standardized factor loading (found greater than 0.5), (2) average variance explained (found greater than 0.5), and (3) composite reliability (found greater than 0.7). The confirmatory factor analysis (CFA) of the measurement model indicated the fitness of the constructs (Chi-square minimum [CMIN]=357.62; CMIN/degrees of freedom [DF]=1.80; Goodness of Fit [GFI]=0.90; Adjusted Goodness of Fit Index [AGFI]=0.89; Buntler-Bonett Normed Fit Index [NFI]=0:915; Comparative Fit Index [CFI]=0:93; Root Mean Square Residual [RMR]=0:075; Root Mean Square Error of Approximation [RMSEA]=0:055). Moreover, the structural model fitness was also confirmed (CMIN=488.6; CMIN/DF=1.85; GFI=0.861; AGFI=0.893; NFI=0.987; CFI=0.945; RMR=0:079; RMSEA=0.053). Hence, the results indicated that social media usefulness has a positive and significant effect on health awareness (hypothesis 1: ?=.669, P<.001), and health awareness has a positive and significant effect on health care education in Pakistan (hypothesis 2: ?=.557, P<.001). Conclusions: This study concludes that health care professionals and paramedic staff in private hospitals support the use of social media to raise awareness and provide health care education. It is considered an effective tool for reducing the disease burden in Pakistan. The study results also revealed that young health care professionals are more inclined toward social media usage and express the need for legislation to support it and establish a monitoring process to avoid misinformation. UR - https://humanfactors.jmir.org/2025/1/e65745 UR - http://dx.doi.org/10.2196/65745 ID - info:doi/10.2196/65745 ER - TY - JOUR AU - El Arab, Adel Rabie AU - Al Moosa, Abdulaziz Omayma AU - Abuadas, H. Fuad AU - Somerville, Joel PY - 2025/4/4 TI - The Role of AI in Nursing Education and Practice: Umbrella Review JO - J Med Internet Res SP - e69881 VL - 27 KW - artificial intelligence KW - nursing practice KW - nursing education KW - ethical implications KW - social implications KW - AI integration KW - AI literacy KW - ethical frameworks N2 - Background: Artificial intelligence (AI) is rapidly transforming health care, offering substantial advancements in patient care, clinical workflows, and nursing education. Objective: This umbrella review aims to evaluate the integration of AI into nursing practice and education, with a focus on ethical and social implications, and to propose evidence-based recommendations to support the responsible and effective adoption of AI technologies in nursing. Methods: We included systematic reviews, scoping reviews, rapid reviews, narrative reviews, literature reviews, and meta-analyses focusing on AI integration in nursing, published up to October 2024. A new search was conducted in January 2025 to identify any potentially eligible reviews published thereafter. However, no new reviews were found. Eligibility was guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework; databases (PubMed or MEDLINE, CINAHL, Web of Science, Embase, and IEEE Xplore) were searched using comprehensive keywords. Two reviewers independently screened records and extracted data. Risk of bias was assessed with Risk of Bias in Systematic Reviews (ROBIS) and A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2), which we adapted for systematic and nonsystematic review types. A thematic synthesis approach, conducted independently by 2 reviewers, identified recurring patterns across the included reviews. Results: The search strategy yielded 18 eligible studies after screening 274 records. These studies encompassed diverse methodologies and focused on nursing professionals, students, educators, and researchers. First, ethical and social implications were consistently highlighted, with studies emphasizing concerns about data privacy, algorithmic bias, transparency, accountability, and the necessity for equitable access to AI technologies. Second, the transformation of nursing education emerged as a critical area, with an urgent need to update curricula by integrating AI-driven educational tools and fostering both technical competencies and ethical decision-making skills among nursing students and professionals. Third, strategies for integration were identified as essential for effective implementation, calling for scalable models, robust ethical frameworks, and interdisciplinary collaboration, while also addressing key barriers such as resistance to AI adoption, lack of standardized AI education, and disparities in technology access. Conclusions: AI holds substantial promises for revolutionizing nursing practice and education. However, realizing this potential necessitates a strategic approach that addresses ethical concerns, integrates AI literacy into nursing curricula, and ensures equitable access to AI technologies. Limitations of this review include the heterogeneity of included studies and potential publication bias. Our findings underscore the need for comprehensive ethical frameworks and regulatory guidelines tailored to nursing applications, updated nursing curricula to include AI literacy and ethical training, and investments in infrastructure to promote equitable AI access. Future research should focus on developing standardized implementation strategies and evaluating the long-term impacts of AI integration on nursing practice and patient outcomes. UR - https://www.jmir.org/2025/1/e69881 UR - http://dx.doi.org/10.2196/69881 UR - http://www.ncbi.nlm.nih.gov/pubmed/40072926 ID - info:doi/10.2196/69881 ER - TY - JOUR AU - Martinez, Jacob AU - Cordero, I. Jacquelin AU - Whitney, Meagan AU - LaRoche, L. Katie AU - Frietze, Gabriel AU - Moya, M. Eva AU - Gosselink, Kristin PY - 2025/4/3 TI - Web-Based Human Papillomavirus Education and Professional Skills Intervention for Health Care Providers: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60790 VL - 14 KW - human papillomavirus KW - randomized controlled trial KW - HPV knowledge KW - HPV vaccine KW - health care provider KW - provider recommendations KW - communication strategies KW - Hispanic N2 - Background:  The human papillomavirus (HPV) vaccine is an effective way to prevent HPV and its associated cancers. Provider recommendation has been shown to be one of the most successful strategies for increasing the uptake of the HPV vaccine; however, more training and resources are needed to help boost health care providers? confidence and communication skills in recommending the HPV vaccine to their patients, particularly in underserved Hispanic communities where vaccination rates among all ages are lower. Objective:  This study aims to compare HPV educational and professional skills intervention effectiveness on improving provider recommendations and patient communication strategies with health care providers serving the El Paso United States?Mexico border region. Methods:  We will conduct a randomized, blinded, multiple posttest-only controlled behavioral trial using a parallel group design that will examine the effectiveness of a fully automated, web-based, culturally tailored HPV education and professional skills intervention containing unique reading material and video role-play, as compared to a standard Centers for Disease Control and Prevention fact sheet and video about general communication skills. Participants were recruited using a purposive sampling technique, both internet-based and in-person outreach events. Study data are being collected and managed using REDCap (Research Electronic Data Capture; Vanderbilt University) hosted at the University of Texas at El Paso. Chi-square analyses, ANOVA, and other statistical tests will be used with 2-tail ? to reject null hypotheses at .05 to analyze the self-assessed outcome data. The Mauchly test of sphericity for each ANOVA and the Huynh-Feldt epsilon test or Greenhouse-Geisser correction to the degrees of freedom of the F-ratio will be reported for each significant effect. We may use multiple imputation procedures to handle the missing data (if applicable). This study is being conducted in the west Texas or southeast New Mexico region of the United States. Chi-square analyses will be used to assess associations between variables reported on the baseline provider knowledge, attitudes, and practice scales. We seek to examine self-assessed changes in provider attitudes and behaviors regarding HPV vaccine recommendation 1 month after receiving our unique multimedia and culturally tailored intervention. Results:  Research and data collection for this clinical trial began in December 2023. Participant recruitment was closed by May 2024 (N=128), with final data collection expected to be completed by December 2024. Conclusions:  This study team decided to report on the intervention protocol to help ensure transparency in the research process and facilitate the improvement of the research design. Tailored web-based educational programs for health care professionals, designed to address regional and patient population characteristics, may be a promising approach to enhancing the real-world implementation of clinical practice guidelines. Trial Registration: ClinicalTrials.gov NCT05120869; http://clinicaltrials.gov/ct2/show/NCT05120869 International Registered Report Identifier (IRRID): PRR1-10.2196/60790 UR - https://www.researchprotocols.org/2025/1/e60790 UR - http://dx.doi.org/10.2196/60790 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60790 ER - TY - JOUR AU - Huang, Kuo-Ting AU - Ma, Zexin AU - Yao, Lan PY - 2025/3/31 TI - Media-Induced and Psychological Factors That Foster Empathy Through Virtual Reality in Nursing Education: 2×2 Between-Subjects Experimental Study JO - JMIR Med Educ SP - e59083 VL - 11 KW - nursing education KW - narrative transportation KW - presence KW - virtual reality KW - game-based learning KW - affective empathy N2 - Background: Virtual reality (VR) has emerged as a promising tool in medical education, particularly for fostering critical skills such as empathy. However, how VR, combined with perspective-taking, influences affective empathy in nursing education remains underexplored. Objective: This study investigates the influence of VR and perspective-taking on affective empathy in nursing education, focusing on 4 psychological factors: perceived self-location, narrative transportation, emotional engagement, and affective empathy. Methods: A 2×2 between-subjects design was used, involving 69 nursing undergraduates from two Midwest universities. The participants engaged with a narrative-focused video game, That Dragon, Cancer, in either VR or non-VR conditions and from the perspective of either parents or clinicians. Results: VR significantly enhanced perceived self-location (P=.01), while adopting a clinician?s perspective amplified emotional engagement (P=.03). However, VR did not significantly influence narrative transportation (P=.35). An interaction effect was found between the platform and player?s perspective on narrative transportation (P=.04). Several indirect effects of media elements on affective empathy were observed via other psychological factors, though the direct effect of VR on affective empathy was not significant (P=.84). Conclusions: These findings underscore the potential of VR in medical education, suggesting that perspective-taking should be carefully considered when designing immersive learning experiences. The study advocates for broader integration of VR technologies into medical curricula to enhance instruction quality and patient-centered care. UR - https://mededu.jmir.org/2025/1/e59083 UR - http://dx.doi.org/10.2196/59083 ID - info:doi/10.2196/59083 ER - TY - JOUR AU - Hylander, Johan AU - Gyllencreutz, Lina AU - Haney, Michael AU - Westman, Anton PY - 2025/3/28 TI - Ambulance Commanders? Reluctance to Enter Road Tunnels in Simulated Incidents and the Effects of a Tunnel-Specific e-Learning Course on Decision-Making: Web-Based Randomized Controlled Trial JO - JMIR Form Res SP - e58542 VL - 9 KW - e-learning KW - major incident KW - incident management KW - disaster medicine KW - road tunnels N2 - Background: The optimal response to a major incident in a road tunnel involves efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness. Objective: We aimed to assess decision-making among ambulance commanders in simulated road tunnel incidents after they had participated in a tunnel-specific e-learning course designed to support timely and correct decisions in this context. Methods: We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden who were randomly allocated to a test or control group. The control group (n=10, 50%) received a lecture on general incident management, while the intervention group (n=10, 50%) completed an e-learning course consisting of 5 modules focused on tunnel structure, safety, and collaboration in response. The participants took part in 2 simulation-based assessments for ambulance commander decision-making in major road tunnel incidents 1 month and 6 months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the question regarding how to appropriately enter the road tunnel. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5, 25%), and collected data were analyzed using qualitative content analysis. Results: All 20 participants completed the first simulation, and 16 (80%) completed the second. The main finding was that none (0/20, 0%) of the participants correctly answered the question on entering the tunnel system in the 1-month assessment. There were no significant differences between the groups (P=.59; 2-sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups: ?0.58 points, 95% CI ?1.88 to 0.73; P=.36). The e-learning course was also not associated with a shorter time to completion compared to the nonintervention group in either assessment. Interviews identified 3 categories linked to the main outcome: information (lack of), risk (limited knowledge and equipment), and mitigation (access to maps and aide-mémoire). Conclusions: Participation in a tunnel-specific e-learning course did not result in a measurable change in ambulance commanders? decision-making behavior during simulated road tunnel incidents. The observed hesitation to enter the road tunnel system may have several plausible causes, such as the lack of actionable intelligence and tunnel-specific plans. This novel approach to assessing commander decision-making may be transferable to other educational settings. UR - https://formative.jmir.org/2025/1/e58542 UR - http://dx.doi.org/10.2196/58542 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58542 ER - TY - JOUR AU - Muthukumar, Radhakrishnan AU - Thepwongsa, Isaraporn AU - Sripa, Poompong AU - Jindawong, Bangonsri AU - Jenwitheesuk, Kamonwan AU - Virasiri, Surapol PY - 2025/3/27 TI - Preclinical Medical Students' Perspectives and Experiences With Structured Web-Based English for Medical Purposes Courses: Cross-Sectional Study JO - JMIR Med Educ SP - e65779 VL - 11 KW - English for medical purposes KW - online course KW - online learning KW - online education KW - medical students KW - medical school KW - online KW - online learners KW - perspectives KW - English KW - English language KW - medical research KW - educational method KW - lesson KW - course KW - instructional designs KW - English for medical professional KW - EMP KW - barriers KW - web-based N2 - Background: English for medical purposes (EMP) is essential for medical students as it serves as a foundational language for medical communication and education. However, students often undervalue its importance within the medical curriculum. Given their demanding schedules and workload, educational methods for EMP must align with their needs. Structured web-based learning offers flexibility and convenience, yet limited research has explored its exclusive application for EMP in undergraduate medical education. Objective: This study aimed to evaluate medical students? perspectives on structured web-based EMP courses and assess their impact on medical English proficiency using objective and subjective measures. Methods: Structured web-based EMP courses were developed based on evidence-based guidelines, addressing barriers to web-based learning during development and implementation. A cross-sectional study was conducted with 535 medical students who completed these courses. Data were collected via questionnaires, the learning management system, and the Khon Kaen University Medical English Test (KKUMET), which assessed proficiency in listening, reading, writing, and speaking. Data were analyzed using descriptive statistics. Results: Of the 535 students, 452 (84.5%) completed the survey. Participants reported confidence in reading (mean 4.11, SD 0.87), vocabulary (mean 4.04, SD 0.84), and listening skills (mean 4, SD 0.89), but lower confidence in writing skills (mean 3.46, SD 1.07). The KKUMET results showed statistically significant improvements in all 4 language skills after course completion (P<.001). The top-rated benefits of the courses were convenience (mean 4.77, SD 0.59), sufficient instruction (mean 4.5, SD 0.85), and clear content (mean 4.41, SD 0.80). Conclusions: Structured web-based EMP courses are relevant and well received by medical students. These courses significantly improve students? medical English proficiency, as evidenced by both subjective feedback and objective measures. Medical educators should consider integrating structured web-based EMP programs to better support students? language proficiency in medical contexts. UR - https://mededu.jmir.org/2025/1/e65779 UR - http://dx.doi.org/10.2196/65779 ID - info:doi/10.2196/65779 ER - TY - JOUR AU - Ba, Hongjun AU - Zhang, Lili AU - He, Xiufang AU - Li, Shujuan PY - 2025/3/26 TI - Knowledge Mapping and Global Trends in Simulation in Medical Education: Bibliometric and Visual Analysis JO - JMIR Med Educ SP - e71844 VL - 11 KW - medical education KW - simulation-based teaching KW - bibliometrics KW - visualization analysis KW - knowledge mapping N2 - Background: With the increasing recognition of the importance of simulation-based teaching in medical education, research in this field has developed rapidly. To comprehensively understand the research dynamics and trends in this area, we conducted an analysis of knowledge mapping and global trends. Objective: This study aims to reveal the research hotspots and development trends in the field of simulation-based teaching in medical education from 2004 to 2024 through bibliometric and visualization analyses. Methods: Using CiteSpace and VOSviewer, we conducted bibliometric and visualization analyses of 6743 articles related to simulation-based teaching in medical education, published in core journals from 2004 to 2024. The analysis included publication trends, contributions by countries and institutions, author contributions, keyword co-occurrence and clustering, and keyword bursts. Results: From 2004 to 2008, the number of articles published annually did not exceed 100. However, starting from 2009, the number increased year by year, reaching a peak of 850 articles in 2024, indicating rapid development in this research field. The United States, Canada, the United Kingdom, Australia, and China published the most articles. Harvard University emerged as a research hub with 1799 collaborative links, although the overall collaboration density was low. Among the 6743 core journal articles, a total of 858 authors were involved, with Lars Konge and Adam Dubrowski being the most prolific. However, collaboration density was low, and the collaboration network was relatively dispersed. A total of 812 common keywords were identified, forming 4189 links. The keywords ?medical education,? ?education,? and ?simulation? had the highest frequency of occurrence. Cluster analysis indicated that ?cardiopulmonary resuscitation? and ?surgical education? were major research hotspots. From 2004 to 2024, a total of 20 burst keywords were identified, among which ?patient simulation,? ?randomized controlled trial,? ?clinical competence,? and ?deliberate practice? had high burst strength. In recent years, ?application of simulation in medical education,? ?3D printing,? ?augmented reality,? and ?simulation training? have become research frontiers. Conclusions: Research on the application of simulation-based teaching in medical education has become a hotspot, with expanding research areas and hotspots. Future research should strengthen interinstitutional collaboration and focus on the application of emerging technologies in simulation-based teaching. UR - https://mededu.jmir.org/2025/1/e71844 UR - http://dx.doi.org/10.2196/71844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71844 ER - TY - JOUR AU - Wiet, Ryan AU - Casanova, P. Madeline AU - Moore, D. Jonathan AU - Deming, M. Sarah AU - Baker Jr, T. Russell PY - 2025/3/21 TI - Creation of the ECHO Idaho Podcast: Tutorial and Pilot Assessment JO - JMIR Med Educ SP - e55313 VL - 11 KW - Project ECHO KW - ECHO Idaho KW - medical education KW - medical training KW - medication teaching KW - medical knowledge KW - rural health care KW - rural medicine KW - underserved population KW - underserved people KW - substance use KW - substance use disorder KW - SUD KW - drug abuse KW - drug use KW - alcoholism KW - addiction KW - pain KW - behavioral health KW - podcast KW - webinar N2 - Background: Project ECHO (Extension for Community Health Outcomes) is an innovative program that uses videoconferencing technology to connect health care providers with experts. The model has been successful in reaching health care providers in rural and underserved areas and positively impacting clinical practice. ECHO Idaho, a replication partner, has developed programming that has increased knowledge and confidence of health care professionals throughout the state of Idaho, United States. Although the ECHO model has a demonstrated ability to recruit, educate, and train health care providers, barriers to attending Project ECHO continuing education (CE) programs remain. The asynchronous nature of podcasts could be used as an innovative medium to help address barriers to CE access that health care professionals face. The ECHO Idaho ?Something for the Pain? podcast was developed to increase CE accessibility to rural and frontier providers, while upscaling their knowledge of and competence to treat and assess substance use disorders, pain, and behavioral health conditions. Objective: This paper describes the creation and preliminary assessment of the ECHO Idaho ?Something for the Pain? podcast. Methods: Podcast episodes consisted of interviews with individuals as well as didactic lectures. Audio from these recordings were edited for content and length and then professionally reviewed by subject matter experts (eg, featured episode speakers). Target audiences consisted of health care providers and community members interested in behavioral health and substance use disorders. Metrics on podcast listeners were assessed using SoundCloud?s RSS feed, continuing education survey completion, and iECHO. Results: The ECHO Idaho ?Something for the Pain? podcast?s inaugural season comprised 14 episodes with 626 minutes of CE material. The podcast series received a total of 2441 listens from individuals in 14 different cities across Idaho, and 63 health care providers listened and claimed CE credits. The largest professional group was social workers (n=22; 35%). Conclusions: We provide preliminary evidence that podcasts can be used to provide health care providers with opportunities to access CE material. Health care providers listened to and claimed CE credits from the ECHO Idaho ?Something for the Pain? podcast. Project ECHO programs should consider creating podcasts as an additional platform for disseminating ECHO material. UR - https://mededu.jmir.org/2025/1/e55313 UR - http://dx.doi.org/10.2196/55313 ID - info:doi/10.2196/55313 ER - TY - JOUR AU - Sun, Chao AU - Dai, Huohuo AU - M.J.J. van der Kleij, Rianne AU - Li, Rong AU - Wu, Hengchang AU - Hallensleben, Cynthia AU - Willems, H. Sofie AU - Chavannes, H. Niels PY - 2025/3/18 TI - Digital Health Education for Chronic Lung Disease: Scoping Review JO - J Med Internet Res SP - e53142 VL - 27 KW - digital health education KW - digital health interventions KW - chronic lung disease KW - eHealth KW - scoping review N2 - Background: Chronic lung disease (CLD) is one of the most prevalent noncommunicable diseases globally, significantly burdening patients and increasing health care expenditures. Digital health education (DHE) is increasingly important in chronic disease prevention and management. However, DHE characteristics and impacts in CLD are rarely reported. Objective: This study aimed to provide an overview of the existing literature on DHE for CLD, with a focus on exploring the DHE mediums, content, mechanisms, and reported outcomes in patients with CLD. Methods: We searched PubMed, Web of Science, Embase, PsycINFO, and The Cochrane Library with the assistance of a librarian specialist. Articles were screened by the reviewer team with ASReview (Utrecht University) and EndNote X9 (Clarivate Analytics) based on predefined inclusion and exclusion criteria and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Quality assessment was conducted with the Critical Appraisal Skills Program tool. A descriptive analysis was used to summarize the study characteristics, DHE characteristics, and outcomes. Results: A total of 22 studies were included in this review with medium or high quality. They were published between 2000 and 2022, showing an increasing publication trend with the year, mostly in developed countries (16/22, 73%). Websites and mobile apps (10/22, 45%) were the most widely used DHE medium. Education on self-management skills of CLD was the primary topic (21/22, 95%), 4/22 (18%) of which mentioned DHE mechanisms. The majority of studies reported positive changes in CLD awareness (14/16, 88%), clinical outcomes (3/6, 50%), DHE feasibility, acceptability, and satisfaction (6/8, 75%), lifestyle outcomes (3/3, 100%), and psychosocial outcomes (7/8, 88%). Only 2 studies reported cost-effectiveness (2/22, 9%). Conclusions: Despite the heterogeneity of the study situation, some aspects can be concluded. DHE can improve disease awareness and clinical outcomes in patients with chronic lung disease, with good feasibility, acceptability, and satisfaction through different mediums and learning content. There is still relatively little research among people in low- and middle-income countries. Future research should consider the impact on cost-effectiveness, duration, frequency, and theoretical mechanisms of the DHE to maximize the potential impact. It should also be conducted in the context of health services research to better reflect the real world. UR - https://www.jmir.org/2025/1/e53142 UR - http://dx.doi.org/10.2196/53142 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53142 ER - TY - JOUR AU - Jacobs, Chris PY - 2025/3/18 TI - Examining Multimodal AI Resources in Medical Education: The Role of Immersion, Motivation, and Fidelity in AI Narrative Learning JO - JMIR Med Educ SP - e72190 VL - 11 KW - artificial intelligence KW - cinematic clinical narrative KW - cinemeducation KW - medical education KW - narrative learning KW - AI KW - medical students KW - preclinical education KW - long-term retention KW - pharmacology KW - AI tools KW - GPT-4 KW - image KW - applicability KW - CCN UR - https://mededu.jmir.org/2025/1/e72190 UR - http://dx.doi.org/10.2196/72190 ID - info:doi/10.2196/72190 ER - TY - JOUR AU - Bland, Tyler PY - 2025/3/18 TI - Author?s Reply: Examining Multimodal AI Resources in Medical Education: The Role of Immersion, Motivation, and Fidelity in AI Narrative Learning JO - JMIR Med Educ SP - e72336 VL - 11 KW - artificial intelligence KW - cinematic clinical narrative KW - cinemeducation KW - medical education KW - narrative learning KW - pharmacology KW - AI KW - medical students KW - preclinical education KW - long-term retention KW - AI tools KW - GPT-4 KW - image KW - applicability KW - CCN UR - https://mededu.jmir.org/2025/1/e72336 UR - http://dx.doi.org/10.2196/72336 ID - info:doi/10.2196/72336 ER - TY - JOUR AU - Alreshaid, Lulwah AU - Alkattan, Rana PY - 2025/3/18 TI - Feedback From Dental Students Using Two Alternate Coaching Methods: Qualitative Focus Group Study JO - JMIR Med Educ SP - e68309 VL - 11 KW - student feedback KW - coaching KW - dental education KW - student evaluation KW - teaching methods KW - educational intervention N2 - Background: Student feedback is crucial for evaluating the effectiveness of institutions. However, implementing feedback can be challenging due to practical difficulties. While student feedback on courses can improve teaching, there is a debate about its effectiveness if not well-written to provide helpful information to the receiver. Objective: This study aimed to evaluate the impact of coaching on proper feedback given by dental students in Saudi Arabia. Methods: A total of 47 first-year dental students from a public dental school in Riyadh, Saudi Arabia, completed 3 surveys throughout the academic year. The surveys assessed their feedback on a Dental Anatomy and Operative Dentistry course, including their feedback on the lectures, practical sessions, examinations, and overall experience. The surveys focused on assessing student feedback on the knowledge, understanding, and practical skills achieved during the course, as aligned with the defined course learning outcomes. The surveys were distributed without coaching, after handout coaching and after workshop coaching on how to provide feedback, designated as survey #1, survey #2, and survey #3, respectively. The same group of students received all 3 surveys consecutively (repeated measures design). The responses were then rated as neutral, positive, negative, or constructive by 2 raters. The feedback was analyzed using McNemar test to compare the effectiveness of the different coaching approaches. Results: While no significant changes were found between the first 2 surveys, a significant increase in constructive feedback was observed in survey #3 after workshop coaching compared with both other surveys (P<.001). The results also showed a higher proportion of desired changes in feedback, defined as any change from positive, negative, or neutral to constructive, after survey #3 (P<.001). Overall, 20.2% reported desired changes at survey #2% and 41.5% at survey #3 compared with survey #1. Conclusions: This study suggests that workshops on feedback coaching can effectively improve the quality of feedback provided by dental students. Incorporating feedback coaching into dental school curricula could help students communicate their concerns more effectively, ultimately enhancing the learning experience. UR - https://mededu.jmir.org/2025/1/e68309 UR - http://dx.doi.org/10.2196/68309 ID - info:doi/10.2196/68309 ER - TY - JOUR AU - Fleet, Andrew AU - Kaustov, Lilia AU - Belfiore, BR Elio AU - Kapralos, Bill AU - Matava, Clyde AU - Wiegelmann, Julian AU - Giacobbe, Peter AU - Alam, Fahad PY - 2025/3/11 TI - Current Clinical and Educational Uses of Immersive Reality in Anesthesia: Narrative Review JO - J Med Internet Res SP - e62785 VL - 27 KW - virtual reality KW - augmented reality KW - mixed reality KW - anesthesia KW - immersive reality KW - medical education KW - artificial intelligence N2 - Background: The concept of immersive reality (IR), an umbrella term that encompasses virtual reality, augmented reality, and mixed reality, has been established within the health care realm as a potentially valuable tool with numerous applications in both medical education and patient care. Objective: This review aimed to introduce anesthesiologists to the emerging and rapidly evolving literature on IR, its use in anesthesia education, and its transferability into the clinical context. Methods: A review of the relevant literature was conducted using the PubMed database from inception to July 5, 2023. Additional references were identified from the reference lists of selected papers. Results: A total of 51 papers related to the use of IR in anesthesia medical education (including both technical and nontechnical skills) and 63 papers related to applications in clinical practice (eg, preprocedure planning, patient education, and pain management) were included. We present evidence supporting the use of IR in the training and clinical practice of modern anesthesiologists. Conclusions: IR is useful for a variety of applications in anesthesia medical education and has potential advantages over existing simulation approaches. Similarly, IR has demonstrated potential improvements in patient care across several clinical contexts relevant to practicing anesthesiologists. However, many applications remain in the early stages of development, and robust trials are urgently needed to confirm clinical or educational effectiveness and to assess mechanisms, educational validity, and cost-effectiveness. UR - https://www.jmir.org/2025/1/e62785 UR - http://dx.doi.org/10.2196/62785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62785 ER - TY - JOUR AU - Zainal, Humairah AU - Xiao Hui, Xin AU - Thumboo, Julian AU - Kok Yong, Fong PY - 2025/3/7 TI - Organizational Leaders? Views on Digital Health Competencies in Medical Education: Qualitative Semistructured Interview Study JO - JMIR Med Educ SP - e64768 VL - 11 KW - technology KW - medical education KW - curriculum KW - clinical competence KW - digital competence KW - Singapore KW - digital health KW - qualitative study KW - medical school KW - risk KW - comprehensive framework KW - doctor KW - thematic analysis KW - information technology KW - evidence-based KW - undergraduate KW - healthcare systems KW - mobile phone N2 - Background: Digital technologies (DTs) have profoundly impacted health care delivery globally and are increasingly used in clinical practice. Despite this, there is a scarcity of guidelines for implementing training in digital health competencies (DHC) in medical schools, especially for clinical practice. A lack of sustained integration of DHC risks creating knowledge gaps due to a limited understanding of how DT should be used in health care. Furthermore, few studies have explored reasons for this lag, both within and beyond the medical school curriculum. Current frameworks to address these barriers are often specific to individual countries or schools and focus primarily on curriculum design and delivery. A comprehensive framework is therefore required to ensure consistent implementation of DHC across various contexts and times. Objective: This study aims to use Singapore as a case study and examine the perspectives of doctors in organizational leadership positions to identify and analyze the barriers to DHC implementation in the undergraduate curriculum of Singapore?s medical schools. It also seeks to apply the Normalization Process Theory (NPT) to address these barriers and bridge the gap between health care systems and digital health education (DHE) training. Methods: Individual semistructured interviews were conducted with doctors in executive and organizational leadership roles. Participants were recruited through purposive sampling, and the data were interpreted using qualitative thematic analysis. Results: A total of 33 doctors participated, 26 of whom are currently in organizational leadership roles and 7 of whom have previously held such positions. A total of 6 barriers were identified: bureaucratic inertia, lack of opportunities to pursue nontraditional career pathways, limited protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, insufficient integration between medical school education and clinical experience, and poor IT integration within the health care industry. Conclusions: These barriers are also present in other high-income countries experiencing health care digitalization, highlighting the need for a theoretical framework that broadens the generalizability of existing recommendations. Applying the NPT underscores the importance of addressing these barriers to effectively integrate DHC into the curriculum. The active involvement of multiple stakeholders and the incorporation of continuous feedback mechanisms are essential. Our proposed framework provides concrete, evidence-based, and step-by-step recommendations for implementation practice, supporting the introduction of DHC in undergraduate medical education. UR - https://mededu.jmir.org/2025/1/e64768 UR - http://dx.doi.org/10.2196/64768 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053774 ID - info:doi/10.2196/64768 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 - Doru, Berin AU - Maier, Christoph AU - Busse, Sophie Johanna AU - Lücke, Thomas AU - Schönhoff, Judith AU - Enax- Krumova, Elena AU - Hessler, Steffen AU - Berger, Maria AU - Tokic, Marianne PY - 2025/3/3 TI - Detecting Artificial Intelligence?Generated Versus Human-Written Medical Student Essays: Semirandomized Controlled Study JO - JMIR Med Educ SP - e62779 VL - 11 KW - artificial intelligence KW - ChatGPT KW - large language models KW - textual analysis KW - writing style KW - AI KW - chatbot KW - LLMs KW - detection KW - authorship KW - medical student KW - linguistic quality KW - decision-making KW - logical coherence N2 - Background: Large language models, exemplified by ChatGPT, have reached a level of sophistication that makes distinguishing between human- and artificial intelligence (AI)?generated texts increasingly challenging. This has raised concerns in academia, particularly in medicine, where the accuracy and authenticity of written work are paramount. Objective: This semirandomized controlled study aims to examine the ability of 2 blinded expert groups with different levels of content familiarity?medical professionals and humanities scholars with expertise in textual analysis?to distinguish between longer scientific texts in German written by medical students and those generated by ChatGPT. Additionally, the study sought to analyze the reasoning behind their identification choices, particularly the role of content familiarity and linguistic features. Methods: Between May and August 2023, a total of 35 experts (medical: n=22; humanities: n=13) were each presented with 2 pairs of texts on different medical topics. Each pair had similar content and structure: 1 text was written by a medical student, and the other was generated by ChatGPT (version 3.5, March 2023). Experts were asked to identify the AI-generated text and justify their choice. These justifications were analyzed through a multistage, interdisciplinary qualitative analysis to identify relevant textual features. Before unblinding, experts rated each text on 6 characteristics: linguistic fluency and spelling/grammatical accuracy, scientific quality, logical coherence, expression of knowledge limitations, formulation of future research questions, and citation quality. Univariate tests and multivariate logistic regression analyses were used to examine associations between participants? characteristics, their stated reasons for author identification, and the likelihood of correctly determining a text?s authorship. Results: Overall, in 48 out of 69 (70%) decision rounds, participants accurately identified the AI-generated texts, with minimal difference between groups (medical: 31/43, 72%; humanities: 17/26, 65%; odds ratio [OR] 1.37, 95% CI 0.5-3.9). While content errors had little impact on identification accuracy, stylistic features?particularly redundancy (OR 6.90, 95% CI 1.01-47.1), repetition (OR 8.05, 95% CI 1.25-51.7), and thread/coherence (OR 6.62, 95% CI 1.25-35.2)?played a crucial role in participants? decisions to identify a text as AI-generated. Conclusions: The findings suggest that both medical and humanities experts were able to identify ChatGPT-generated texts in medical contexts, with their decisions largely based on linguistic attributes. The accuracy of identification appears to be independent of experts? familiarity with the text content. As the decision-making process primarily relies on linguistic attributes?such as stylistic features and text coherence?further quasi-experimental studies using texts from other academic disciplines should be conducted to determine whether instructions based on these features can enhance lecturers? ability to distinguish between student-authored and AI-generated work. UR - https://mededu.jmir.org/2025/1/e62779 UR - http://dx.doi.org/10.2196/62779 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053752 ID - info:doi/10.2196/62779 ER - TY - JOUR AU - Borg, Alexander AU - Georg, Carina AU - Jobs, Benjamin AU - Huss, Viking AU - Waldenlind, Kristin AU - Ruiz, Mini AU - Edelbring, Samuel AU - Skantze, Gabriel AU - Parodis, Ioannis PY - 2025/3/3 TI - Virtual Patient Simulations Using Social Robotics Combined With Large Language Models for Clinical Reasoning Training in Medical Education: Mixed Methods Study JO - J Med Internet Res SP - e63312 VL - 27 KW - virtual patients KW - clinical reasoning KW - large language models KW - social robotics KW - medical education KW - sustainable learning KW - medical students N2 - Background: Virtual patients (VPs) are computer-based simulations of clinical scenarios used in health professions education to address various learning outcomes, including clinical reasoning (CR). CR is a crucial skill for health care practitioners, and its inadequacy can compromise patient safety. Recent advancements in large language models (LLMs) and social robots have introduced new possibilities for enhancing VP interactivity and realism. However, their application in VP simulations has been limited, and no studies have investigated the effectiveness of combining LLMs with social robots for CR training. Objective: The aim of the study is to explore the potential added value of a social robotic VP platform combined with an LLM compared to a conventional computer-based VP modality for CR training of medical students. Methods: A Swedish explorative proof-of-concept study was conducted between May and July 2023, combining quantitative and qualitative methodology. In total, 15 medical students from Karolinska Institutet and an international exchange program completed a VP case in a social robotic platform and a computer-based semilinear platform. Students? self-perceived VP experience focusing on CR training was assessed using a previously developed index, and paired 2-tailed t test was used to compare mean scores (scales from 1 to 5) between the platforms. Moreover, in-depth interviews were conducted with 8 medical students. Results: The social robotic platform was perceived as more authentic (mean 4.5, SD 0.7 vs mean 3.9, SD 0.5; odds ratio [OR] 2.9, 95% CI 0.0-1.0; P=.04) and provided a beneficial overall learning effect (mean 4.4, SD 0.6 versus mean 4.1, SD 0.6; OR 3.7, 95% CI 0.1-0.5; P=.01) compared with the computer-based platform. Qualitative analysis revealed 4 themes, wherein students experienced the social robot as superior to the computer-based platform in training CR, communication, and emotional skills. Limitations related to technical and user-related aspects were identified, and suggestions for improvements included enhanced facial expressions and VP cases simulating multiple personalities. Conclusions: A social robotic platform enhanced by an LLM may provide an authentic and engaging learning experience for medical students in the context of VP simulations for training CR. Beyond its limitations, several aspects of potential improvement were identified for the social robotic platform, lending promise for this technology as a means toward the attainment of learning outcomes within medical education curricula. UR - https://www.jmir.org/2025/1/e63312 UR - http://dx.doi.org/10.2196/63312 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053778 ID - info:doi/10.2196/63312 ER - TY - JOUR AU - Fathalla, M. Ahmed AU - Chiang, Cherie AU - Audehm, Ralph AU - Gorelik, Alexandra AU - Chang, Shanton AU - Yates, J. Christopher AU - Snow, Steve AU - Barmanray, Rahul AU - Price, Sarah AU - Collins, Lucy AU - Wark, D. John PY - 2025/2/25 TI - Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study JO - JMIR Res Protoc SP - e57511 VL - 14 KW - community-based fracture capture bone hub KW - osteoporosis KW - virtual communities of practice KW - continuing professional development KW - primary care physicians KW - web-based learning platform KW - case-based education N2 - Background: The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program?s design and content, showing promising potential. Objective: We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants? interactions, satisfaction levels, and overall experience. Methods: Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs? knowledge and confidence after engagement with the CFC Learning Hub. Results: Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. Conclusions: The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs? needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. International Registered Report Identifier (IRRID): DERR1-10.2196/57511 UR - https://www.researchprotocols.org/2025/1/e57511 UR - http://dx.doi.org/10.2196/57511 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57511 ER - TY - JOUR AU - Potter, Alison AU - Munsch, Chris AU - Watson, Elaine AU - Hopkins, Emily AU - Kitromili, Sofia AU - O'Neill, Cameron Iain AU - Larbie, Judy AU - Niittymaki, Essi AU - Ramsay, Catriona AU - Burke, Joshua AU - Ralph, Neil PY - 2025/2/19 TI - Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study JO - J Med Internet Res SP - e66157 VL - 27 KW - digital education KW - health professions education KW - research priorities KW - umbrella review KW - Delphi KW - artificial intelligence KW - AI N2 - Background: In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness. Objective: This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education. Methods: We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method. Results: A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals? education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions? digital education be defined and standardized? Conclusions: This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education. UR - https://www.jmir.org/2025/1/e66157 UR - http://dx.doi.org/10.2196/66157 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969988 ID - info:doi/10.2196/66157 ER - TY - JOUR AU - Chow, L. James C. AU - Li, Kay PY - 2025/2/18 TI - Developing Effective Frameworks for Large Language Model?Based Medical Chatbots: Insights From Radiotherapy Education With ChatGPT JO - JMIR Cancer SP - e66633 VL - 11 KW - artificial intelligence KW - AI KW - AI in medical education KW - radiotherapy chatbot KW - large language models KW - LLMs KW - medical chatbots KW - health care AI KW - ethical AI in health care KW - personalized learning KW - natural language processing KW - NLP KW - radiotherapy education KW - AI-driven learning tools UR - https://cancer.jmir.org/2025/1/e66633 UR - http://dx.doi.org/10.2196/66633 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66633 ER - TY - JOUR AU - Kitapcioglu, Dilek AU - Aksoy, Emin Mehmet AU - Ozkan, Ekin Arun AU - Usseli, Tuba AU - Cabuk Colak, Dilan AU - Torun, Tugrul PY - 2025/2/14 TI - Enhancing Immersion in Virtual Reality?Based Advanced Life Support Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e68272 VL - 13 KW - artificial intelligence KW - voice recognition KW - serious gaming KW - immersion KW - virtual reality N2 - Background: Serious game?based training modules are pivotal for simulation-based health care training. With advancements in artificial intelligence (AI) and natural language processing, voice command interfaces offer an intuitive alternative to traditional virtual reality (VR) controllers in VR applications. Objective: This study aims to compare AI-supported voice command interfaces and traditional VR controllers in terms of user performance, exam scores, presence, and confidence in advanced cardiac life support (ACLS) training. Methods: A total of 62 volunteer students from Acibadem Mehmet Ali Aydinlar University Vocational School for Anesthesiology, aged 20-22 years, participated in the study. All the participants completed a pretest consisting of 10 multiple-choice questions about ACLS. Following the pretest, participants were randomly divided into 2 groups: the voice command group (n=31) and the VR controller group (n=31). The voice command group members completed the VR-based ACLS serious game in training mode twice, using an AI-supported voice command as the game interface. The VR controller group members also completed the VR-based ACLS serious game in training mode twice, but they used VR controllers as the game interface. The participants completed a survey to assess their level of presence and confidence during gameplay. Following the survey, participants completed the exam module of the VR-based serious gaming module. At the final stage of the study, participants completed a posttest, which had the same content as the pretest. VR-based exam scores of the voice command and VR controller groups were compared using a 2-tailed, independent-samples t test, and linear regression analysis was conducted to examine the effect of presence and confidence rating. Results: Both groups showed an improvement in performance from pretest to posttest, with no significant difference in the magnitude of improvement between the 2 groups (P=.83). When comparing presence ratings, there was no significant difference between the voice command group (mean 5.18, SD 0.83) and VR controller group (mean 5.42, SD 0.75; P=.25). However, when comparing VR-based exam scores, the VR controller group (mean 80.47, SD 13.12) significantly outperformed the voice command group (mean 66.70, SD 21.65; P=.005), despite both groups having similar time allocations for the exam (voice command group: mean 18.59, SD 5.28 minutes and VR controller group: mean 17.3, SD 4.83 minutes). Confidence levels were similar between the groups (voice command group: mean 3.79, SD 0.77 and VR controller group: mean 3.60, SD 0.72), but the voice command group displayed a significant overconfidence bias (voice command group: mean 0.09, SD 0.24 and VR controller group: mean ?0.09, SD 0.18; P=.002). Conclusions: VR-based ACLS training demonstrated effectiveness; however, the use of voice commands did not result in improved performance. Further research should explore ways to optimize AI?s role in education through VR. Trial Registration: ClinicalTrials.gov NCT06458452; https://clinicaltrials.gov/ct2/show/NCT06458452 UR - https://games.jmir.org/2025/1/e68272 UR - http://dx.doi.org/10.2196/68272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68272 ER - TY - JOUR AU - Basheer N, Amitha AU - Jodalli, Praveen AU - Shetty, Shishir AU - Shenoy, Ramya AU - Rao, Ashwini AU - Pai, Mithun AU - Gowdar, Murugendrappa Inderjit AU - Almalki, Abdulrahman Sultan PY - 2025/2/13 TI - Development and Validation of the ?Basic Oral Health Assessment Tool? (BOHAT) for Nondental Health Care Professionals to Use With the Indian Adult Population: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e63480 VL - 14 KW - oral health assessment tool KW - oral health KW - screening KW - nondental health care professionals KW - primary health centers KW - India KW - tool validation KW - health care training KW - mixed methods research N2 - Background: Oral health is a significant indicator of general health, well-being, and quality of life. The prevention of oral health problems requires periodic inspection of the oral cavity. Routine oral health examinations at the individual level appears to be one way to deliver quality oral health care but are too often missed as an opportunity for improved oral health in the nondental health care setting in India. This is because of limited training and inaccessible or lack of specialized oral health assessment tools. Objective: This study will focus on the development, validation, and implementation of the Basic Oral Health Assessment Tool (BOHAT) to improve the oral health assessment capabilities of nondental health care professionals and thus contribute to improved overall health outcomes of the Indian adult population. Methods: This study will be a mixed methods, multistage study conducted in 3 stages. The study will be conducted with 708 nondental health care professionals in 33 Primary Health Centers (PHCs) of Mangalore Taluk, Karnataka. Ethical approval was sought from the institutional ethics committee of Manipal College of Dental Sciences Mangalore. Informed consent will be obtained from every participant prior to the study. A literature review and qualitative interviews will be used for item and domain generation with respect to BOHAT, and an expert panel review and pilot testing will be used to refine the items and domains. Finally, statistical analyses will be conducted to validate the reliability and consistency. The second phase will involve capacity building and user experience exploration through comprehensive training for nondental health professionals using audio and visual aids, with hands-on learning methodologies including relevant feedback processes in the form of focus group discussions. The third stage will check the effectiveness of BOHAT regarding the changes in knowledge, attitudes, and practices through pre- and posttraining questionnaires, which will then be followed by a retention analysis 3 months later. Results: As of January 20, 2025, the study is in its preliminary phase: ?Substage A: Item and Domain?Development.? We have received institutional ethics committee and Institutional Protocol Approval Committee approval for the study. Data collection procedures have not started yet. The study is progressing as per the planned timeline. Conclusions: The BOHAT study holds considerable potential to promote oral health care through collaborative and interdisciplinary approaches. It will facilitate early diagnosis, timely referrals, and comprehensive care by integrating assessment actions for oral health into routine practices of nondental primary health care professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/63480 UR - https://www.researchprotocols.org/2025/1/e63480 UR - http://dx.doi.org/10.2196/63480 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63480 ER - TY - JOUR AU - Ichikawa, Tsunagu AU - Olsen, Elizabeth AU - Vinod, Arathi AU - Glenn, Noah AU - Hanna, Karim AU - Lund, C. Gregg AU - Pierce-Talsma, Stacey PY - 2025/2/11 TI - Generative Artificial Intelligence in Medical Education?Policies and Training at US Osteopathic Medical Schools: Descriptive Cross-Sectional Survey JO - JMIR Med Educ SP - e58766 VL - 11 KW - artificial intelligence KW - medical education KW - faculty development KW - policy KW - AI KW - training KW - United States KW - school KW - university KW - college KW - institution KW - osteopathic KW - osteopathy KW - curriculum KW - student KW - faculty KW - administrator KW - survey KW - cross-sectional N2 - Background: Interest has recently increased in generative artificial intelligence (GenAI), a subset of artificial intelligence that can create new content. Although the publicly available GenAI tools are not specifically trained in the medical domain, they have demonstrated proficiency in a wide range of medical assessments. The future integration of GenAI in medicine remains unknown. However, the rapid availability of GenAI with a chat interface and the potential risks and benefits are the focus of great interest. As with any significant medical advancement or change, medical schools must adapt their curricula to equip students with the skills necessary to become successful physicians. Furthermore, medical schools must ensure that faculty members have the skills to harness these new opportunities to increase their effectiveness as educators. How medical schools currently fulfill their responsibilities is unclear. Colleges of Osteopathic Medicine (COMs) in the United States currently train a significant proportion of the total number of medical students. These COMs are in academic settings ranging from large public research universities to small private institutions. Therefore, studying COMs will offer a representative sample of the current GenAI integration in medical education. Objective: This study aims to describe the policies and training regarding the specific aspect of GenAI in US COMs, targeting students, faculty, and administrators. Methods: Web-based surveys were sent to deans and Student Government Association (SGA) presidents of the main campuses of fully accredited US COMs. The dean survey included questions regarding current and planned policies and training related to GenAI for students, faculty, and administrators. The SGA president survey included only those questions related to current student policies and training. Results: Responses were received from 81% (26/32) of COMs surveyed. This included 47% (15/32) of the deans and 50% (16/32) of the SGA presidents (with 5 COMs represented by both the deans and the SGA presidents). Most COMs did not have a policy on the student use of GenAI, as reported by the dean (14/15, 93%) and the SGA president (14/16, 88%). Of the COMs with no policy, 79% (11/14) had no formal plans for policy development. Only 1 COM had training for students, which focused entirely on the ethics of using GenAI. Most COMs had no formal plans to provide mandatory (11/14, 79%) or elective (11/15, 73%) training. No COM had GenAI policies for faculty or administrators. Eighty percent had no formal plans for policy development. Furthermore, 33.3% (5/15) of COMs had faculty or administrator GenAI training. Except for examination question development, there was no training to increase faculty or administrator capabilities and efficiency or to decrease their workload. Conclusions: The survey revealed that most COMs lack GenAI policies and training for students, faculty, and administrators. The few institutions with policies or training were extremely limited in scope. Most institutions without current training or policies had no formal plans for development. The lack of current policies and training initiatives suggests inadequate preparedness for integrating GenAI into the medical school environment, therefore, relegating the responsibility for ethical guidance and training to the individual COM member. UR - https://mededu.jmir.org/2025/1/e58766 UR - http://dx.doi.org/10.2196/58766 ID - info:doi/10.2196/58766 ER - TY - JOUR AU - Hoyt, Garrik AU - Bakshi, Shekhar Chandra AU - Basu, Paramita PY - 2025/2/11 TI - Integration of an Audiovisual Learning Resource in a Podiatric Medical Infectious Disease Course: Multiple Cohort Pilot Study JO - JMIR Med Educ SP - e55206 VL - 11 KW - learning retention KW - preclinical education KW - podiatric medical education KW - audiovisual learning resources KW - multimedia-based learning resource KW - animation-supported learning tools KW - mnemonics KW - spaced repetition N2 - Background: Improved long-term learning retention leads to higher exam scores and overall course grades, which is crucial for success in preclinical coursework in any podiatric medicine curriculum. Audiovisual mnemonics, in conjunction with text-based materials and an interactive user interface, have been shown to increase memory retention and higher order thinking. Objective: This pilot study aims to evaluate the effectiveness of integrating web-based multimedia learning resources for improving student engagement and increasing learning retention. Methods: A quasi-experimental study was conducted with 2 cohorts totaling 158 second-year podiatric medical students. The treatment group had access to Picmonic?s audiovisual resources, while the control group followed traditional instruction methods. Exam scores, final course grades, and user interactions with Picmonic were analyzed. Logistic regression and correlation analyses were conducted to examine the relationships between Picmonic access, performance outcomes, and student engagement. Results: The treatment group (n=91) had significantly higher average exam scores (P<.001) and final course grades (P<.001) than the control group (n=67). Effect size for the average final grades (d=0.96) indicated the practical significance of these differences. Logistic regression analysis revealed a positive association between Picmonic access with an odds ratio of 2.72 with a 95% confidence interval, indicating that it is positively associated with the likelihood of achieving high final grades. Correlation analysis revealed a positive relationship (r=0.25, P=.02) between the number of in-video questions answered and students? final grades. Survey responses reflected increased student engagement, comprehension, and higher user satisfaction (3.71 out of 5 average rating) with the multimedia-based resources compared to traditional instructional resources. Conclusions: This pilot study underscores the positive impact of animation-supported web-based instruction on preclinical medical education. The treatment group, equipped with Picmonic, exhibited improved learning outcomes, enhanced engagement, and high satisfaction. These results contribute to the discourse on innovative educational methods and highlight the potential of multimedia-based learning resources to enrich medical curricula. Despite certain limitations, this research suggests that animation-supported audiovisual instruction offers a valuable avenue for enhancing student learning experiences in medical education. UR - https://mededu.jmir.org/2025/1/e55206 UR - http://dx.doi.org/10.2196/55206 ID - info:doi/10.2196/55206 ER - TY - JOUR AU - Chang, Wen AU - Lin, Chun-Chih AU - Crilly, Julia AU - Lee, Hui-Ling AU - Chen, Li-Chin AU - Han, Chin-Yen PY - 2025/2/11 TI - Virtual Reality Simulation for Undergraduate Nursing Students for Care of Patients With Infectious Diseases: Mixed Methods Study JO - JMIR Med Educ SP - e64780 VL - 11 KW - virtual reality KW - infection control KW - learning motivation KW - learning attitudes KW - nursing education N2 - Background: Virtual reality simulation (VRS) teaching offers nursing students a safe, immersive learning environment with immediate feedback, enhancing learning outcomes. Before the COVID-19 pandemic, nursing students had limited training and opportunities to care for patients in isolation units with infectious diseases. However, the pandemic highlighted the ongoing global priority of providing care for patients with infectious diseases. Objective: This study aims to (1) examine the effectiveness of VRS in preparing nursing students to care for patients with infectious diseases by assessing its impact on their theoretical knowledge, learning motivation, and attitudes; and (2) evaluate their experiences with VRS. Methods: This 2-phased mixed methods study recruited third-year undergraduate nursing students enrolled in the Integrated Emergency and Critical Care course at a university in Taiwan. Phase 1 used a quasi-experimental design to address objective 1 by comparing the learning outcomes of students in the VRS teaching program (experimental group) with those in the traditional teaching program (control group). Tools included an infection control written test, the Instructional Materials Motivation Survey, and a learning attitude questionnaire. The experimental group participated in a VRS lesson titled ?Caring for a Patient with COVID-19 in the Negative Pressure Unit? as part of the infection control unit. In phase 2, semistructured interviews were conducted to address objective 2, exploring students? learning experiences. Results: A total of 107 students participated in phase 1, and 18 students participated in phase 2. Both the VRS and control groups showed significant improvements in theoretical knowledge scores (for the VRS group t46=?7.47; P<.001, for the control group t59=?4.04; P<.001). However, compared with the control group, the VRS group achieved significantly higher theoretical knowledge scores (t98.13=2.70; P=.008) and greater learning attention (t105=2.30; P=.02) at T1. Additionally, the VRS group demonstrated a statistically significant higher regression coefficient for learning confidence compared with the control group (?=.29; P=.03). The students? learning experiences in the VRS group were categorized into 4 themes: Applying Professional Knowledge to Patient Care, Enhancing Infection Control Skills, Demonstrating Patient Care Confidence, and Engaging in Real Clinical Cases. The core theme identified was Strengthening Clinical Patient Care Competencies. Conclusions: The findings suggest that VRS teaching significantly enhanced undergraduate nursing students? infection control knowledge, learning attention, and confidence. Qualitative insights reinforced the quantitative results, highlighting the holistic benefits of VRS teaching in nursing education, including improved learning outcomes. The positive impact on student motivation and attitudes indicates a potentially transformative approach to nursing education, particularly in the post?COVID-19 era, where digital and remote learning tools play an increasingly vital role. UR - https://mededu.jmir.org/2025/1/e64780 UR - http://dx.doi.org/10.2196/64780 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64780 ER - TY - JOUR AU - Davoody, Nadia AU - Stathakarou, Natalia AU - Swain, Cara AU - Bonacina, Stefano PY - 2025/2/10 TI - Exploring the Impact of the COVID-19 Pandemic on Learning Experience, Mental Health, Adaptability, and Resilience Among Health Informatics Master?s Students: Focus Group Study JO - JMIR Med Educ SP - e63708 VL - 11 KW - COVID-19 pandemic KW - eHealth KW - blended learning KW - health informatics KW - higher education adaptation N2 - Background: The shift to online education due to the COVID-19 pandemic posed significant challenges and opportunities for students, affecting their academic performance, mental well-being, and engagement. Objective: This study aimed to explore the overall learning experience among health informatics master?s students at Karolinska Institutet, Sweden, and the strategies they used to overcome learning challenges posed by the COVID-19 pandemic. Methods: Through 3 structured focus groups, this study explored health informatics master?s students? experiences of shifting learning environments for classes that started in 2019, 2020, and 2021. All focus group sessions were recorded and transcribed verbatim. Inductive content analysis was used to analyze the data. Results: The results highlight the benefits of increased autonomy and flexibility and identify challenges such as technical difficulties, diminished social interactions, and psychological impacts. This study underscores the importance of effective online educational strategies, technological preparedness, and support systems to enhance student learning experiences during emergencies. The findings of this study highlight implications for educators, students, and higher education institutions to embrace adaptation and foster innovation. Implications for educators, students, and higher education institutions include the need for educators to stay current with the latest educational technologies and design teaching strategies and pedagogical approaches suited to both online and in-person settings to effectively foster student engagement. Students must be informed about the technological requirements for online learning and adequately prepared to meet them. Institutions play a critical role in ensuring equitable access to technology, guiding and supporting educators in adopting innovative tools and methods, and offering mental health resources to assist students in overcoming the challenges of evolving educational environments. Conclusions: This research contributes to understanding the complexities of transitioning to online learning in urgent circumstances and offers insights for better preparing educational institutions for future pandemics. UR - https://mededu.jmir.org/2025/1/e63708 UR - http://dx.doi.org/10.2196/63708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63708 ER - TY - JOUR AU - Chudoung, Ubon AU - Saengon, Wilaipon AU - Peonim, Vichan AU - Worasuwannarak, Wisarn PY - 2025/2/10 TI - Comparison of Learning Outcomes Among Medical Students in Thailand to Determine the Right Time to Teach Forensic Medicine: Retrospective Study JO - JMIR Med Educ SP - e57634 VL - 11 KW - multiple-choice question KW - MCQ KW - forensic medicine KW - preclinic KW - clinic KW - medical student N2 - Background: Forensic medicine requires background medical knowledge and the ability to apply it to legal cases. Medical students have different levels of medical knowledge and are therefore likely to perform differently when learning forensic medicine. However, different medical curricula in Thailand deliver forensic medicine courses at different stages of medical study; most curricula deliver these courses in the clinical years, while others offer them in the preclinical years. This raises questions about the differences in learning effectiveness. Objective: We aimed to compare the learning outcomes of medical students in curricula that either teach forensic medicine at the clinical level or teach it at the preclinical level. Methods: This was a 5-year retrospective study that compared multiple-choice question (MCQ) scores in a forensic medicine course for fifth- and third-year medical students. The fifth-year students? program was different from that of the third-year students, but both programs were offered by Mahidol University. The students were taught forensic medicine by the same instructors, used similar content, and were evaluated via examinations of similar difficulty. Of the 1063 medical students included in this study, 782 were fifth-year clinical students, and 281 were third-year preclinical students. Results: The average scores of the fifth- and third-year medical students were 76.09% (SD 6.75%) and 62.94% (SD 8.33%), respectively. The difference was statistically significant (Kruskal-Wallis test: P<.001). Additionally, the average score of fifth-year medical students was significantly higher than that of third-year students in every academic year (all P values were <.001). Conclusions: Teaching forensic medicine during the preclinical years may be too early, and preclinical students may not understand the clinical content sufficiently. Attention should be paid to ensuring that students have the adequate clinical background before teaching subjects that require clinical applications, especially in forensic medicine. UR - https://mededu.jmir.org/2025/1/e57634 UR - http://dx.doi.org/10.2196/57634 ID - info:doi/10.2196/57634 ER - TY - JOUR AU - Elhassan, Elwaleed Safia AU - Sajid, Raihan Muhammad AU - Syed, Mariam Amina AU - Fathima, Afreen Sidrah AU - Khan, Shehroz Bushra AU - Tamim, Hala PY - 2025/1/30 TI - Assessing Familiarity, Usage Patterns, and Attitudes of Medical Students Toward ChatGPT and Other Chat-Based AI Apps in Medical Education: Cross-Sectional Questionnaire Study JO - JMIR Med Educ SP - e63065 VL - 11 KW - ChatGPT KW - artificial intelligence KW - large language model KW - medical students KW - ethics KW - chat-based KW - AI apps KW - medical education KW - social media KW - attitude KW - AI N2 - Background: There has been a rise in the popularity of ChatGPT and other chat-based artificial intelligence (AI) apps in medical education. Despite data being available from other parts of the world, there is a significant lack of information on this topic in medical education and research, particularly in Saudi Arabia. Objective: The primary objective of the study was to examine the familiarity, usage patterns, and attitudes of Alfaisal University medical students toward ChatGPT and other chat-based AI apps in medical education. Methods: This was a cross-sectional study conducted from October 8, 2023, through November 22, 2023. A questionnaire was distributed through social media channels to medical students at Alfaisal University who were 18 years or older. Current Alfaisal University medical students in years 1 through 6, of both genders, were exclusively targeted by the questionnaire. The study was approved by Alfaisal University Institutional Review Board. A ?2 test was conducted to assess the relationships between gender, year of study, familiarity, and reasons for usage. Results: A total of 293 responses were received, of which 95 (32.4%) were from men and 198 (67.6%) were from women. There were 236 (80.5%) responses from preclinical students and 57 (19.5%) from clinical students, respectively. Overall, males (n=93, 97.9%) showed more familiarity with ChatGPT compared to females (n=180, 90.09%; P=.03). Additionally, males also used Google Bard and Microsoft Bing ChatGPT more than females (P<.001). Clinical-year students used ChatGPT significantly more for general writing purposes compared to preclinical students (P=.005). Additionally, 136 (46.4%) students believed that using ChatGPT and other chat-based AI apps for coursework was ethical, 86 (29.4%) were neutral, and 71 (24.2%) considered it unethical (all Ps>.05). Conclusions: Familiarity with and usage of ChatGPT and other chat-based AI apps were common among the students of Alfaisal University. The usage patterns of these apps differ between males and females and between preclinical and clinical-year students. UR - https://mededu.jmir.org/2025/1/e63065 UR - http://dx.doi.org/10.2196/63065 ID - info:doi/10.2196/63065 ER - TY - JOUR AU - Baetzner, Sabine Anke AU - Hill, Yannick AU - Roszipal, Benjamin AU - Gerwann, Solène AU - Beutel, Matthias AU - Birrenbach, Tanja AU - Karlseder, Markus AU - Mohr, Stefan AU - Salg, Alexander Gabriel AU - Schrom-Feiertag, Helmut AU - Frenkel, Ottilie Marie AU - Wrzus, Cornelia PY - 2025/1/27 TI - Mass Casualty Incident Training in Immersive Virtual Reality: Quasi-Experimental Evaluation of Multimethod Performance Indicators JO - J Med Internet Res SP - e63241 VL - 27 KW - prehospital decision-making KW - disaster medicine KW - emergency medicine KW - mass casualty incident KW - medical education KW - eye tracking KW - emergency simulation KW - virtual reality N2 - Background: Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. Objective: This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. Methods: A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking?based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51% MFRs vs 37/76, 49% non-MFRs) and a knowledge test with patient vignettes. Results: Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman ?=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. Conclusions: iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers? feedback and provide trainees with guidance on evaluating and reflecting on their own performance. UR - https://www.jmir.org/2025/1/e63241 UR - http://dx.doi.org/10.2196/63241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63241 ER - TY - JOUR AU - Brown, Joan AU - De-Oliveira, Sophia AU - Mitchell, Christopher AU - Cesar, Carmen Rachel AU - Ding, Li AU - Fix, Melissa AU - Stemen, Daniel AU - Yacharn, Krisda AU - Wong, Fum Se AU - Dhillon, Anahat PY - 2025/1/24 TI - Barriers to and Facilitators of Implementing Team-Based Extracorporeal Membrane Oxygenation Simulation Study: Exploratory Analysis JO - JMIR Med Educ SP - e57424 VL - 11 KW - intensive care unit KW - ICU KW - teamwork in the ICU KW - team dynamics KW - collaboration KW - interprofessional collaboration KW - simulation KW - simulation training KW - ECMO KW - extracorporeal membrane oxygenation KW - life support KW - cardiorespiratory dysfunction KW - cardiorespiratory KW - cardiology KW - respiratory KW - heart KW - lungs N2 - Introduction: Extracorporeal membrane oxygenation (ECMO) is a critical tool in the care of severe cardiorespiratory dysfunction. Simulation training for ECMO has become standard practice. Therefore, Keck Medicine of the University of California (USC) holds simulation-training sessions to reinforce and improve providers knowledge. Objective: This study aimed to understand the impact of simulation training approaches on interprofessional collaboration. We believed simulation-based ECMO training would improve interprofessional collaboration through increased communication and enhance teamwork. Methods: This was a single-center, mixed methods study of the Cardiac and Vascular Institute Intensive Care Unit at Keck Medicine of USC conducted from September 2021 to April 2023. Simulation training was offered for 1 hour monthly to the clinical team focused on the collaboration and decision-making needed to evaluate the initiation of ECMO therapy. Electronic surveys were distributed before, after, and 3 months post training. The survey evaluated teamwork and the effectiveness of training, and focus groups were held to understand social environment factors. Additionally, trainee and peer evaluation focus groups were held to understand socioenvironmental factors. Results: In total, 37 trainees attended the training simulation from August 2021 to August 2022. Using 27 records for exploratory factor analysis, the standardized Cronbach ? was 0.717. The survey results descriptively demonstrated a positive shift in teamwork ability. Qualitative themes identified improved confidence and decision-making. Conclusions: The study design was flawed, indicating improvement opportunities for future research on simulation training in the clinical setting. The paper outlines what to avoid when designing and implementing studies that assess an educational intervention in a complex clinical setting. The hypothesis deserves further exploration and is supported by the results of this study. UR - https://mededu.jmir.org/2025/1/e57424 UR - http://dx.doi.org/10.2196/57424 ID - info:doi/10.2196/57424 ER - TY - JOUR AU - Grüneberg, Catharina AU - Bäuerle, Alexander AU - Karunakaran, Sophia AU - Darici, Dogus AU - Dörrie, Nora AU - Teufel, Martin AU - Benson, Sven AU - Robitzsch, Anita PY - 2025/1/24 TI - Medical Students? Acceptance of Tailored e?Mental Health Apps to Foster Their Mental Health: Cross-Sectional Study JO - JMIR Med Educ SP - e58183 VL - 11 KW - eHealth KW - medical education KW - medical students KW - tailored interventions KW - UTAUT KW - intention to use KW - e?mental health apps KW - app KW - foster KW - cross-sectional study KW - mental health problems KW - physician KW - well-being KW - mobile apps KW - acceptance KW - assessment KW - mental health apps N2 - Background: Despite the high prevalence of mental health problems among medical students and physicians, help-seeking remains low. Digital mental health approaches offer beneficial opportunities to increase well-being, for example, via mobile apps. Objective: This study aimed to assess the acceptance, and its underlying predictors, of tailored e?mental health apps among medical students by focusing on stress management and the promotion of personal skills. Methods: From November 2022 to July 2023, a cross-sectional study was conducted with 245 medical students at the University of Duisburg-Essen, Germany. Sociodemographic, mental health, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The general acceptance of tailored e?mental health apps among medical students was high (mean 3.72, SD 0.92). Students with a job besides medical school reported higher acceptance (t107.3=?2.16; P=.03; Padj=.027; Cohen d=4.13) as well as students with higher loads of anxiety symptoms (t92.4=2.36; P=.02; Padj=.03; Cohen d=0.35). The t values were estimated using a 2-tailed t test. Regression analysis revealed that acceptance was significantly predicted by anxiety symptoms (?=.11; P=.045), depressive symptoms (?=?.11; P=.05), internet anxiety (?=?.12; P=.01), digital overload (?=.1; P=.03), and the 3 UTAUT core predictors?performance expectancy (?=.24; P<.001), effort expectancy (?=.26; P<.001), and social influence (?=.43; P<.001). Conclusions: The high acceptance of e?mental health apps among medical students and its predictors lay a valuable basis for the development and implementation of tailored e?mental health apps within medical education to foster their mental health. More research using validated measures is needed to replicate our findings and to further investigate medical students? specific needs and demands regarding the framework of tailored e?mental health apps. UR - https://mededu.jmir.org/2025/1/e58183 UR - http://dx.doi.org/10.2196/58183 ID - info:doi/10.2196/58183 ER - TY - JOUR AU - Nykiel-Bailey, Sydney AU - Burrows, Kathryn AU - Szafarowicz, E. Bianca AU - Moquin, Rachel PY - 2025/1/21 TI - Faculty Perceptions on the Roles of Mentoring, Advising, and Coaching in an Anesthesiology Residency Program: Mixed Methods Study JO - JMIR Med Educ SP - e60255 VL - 11 KW - coaching KW - faculty perceptions KW - mentoring KW - perception KW - medical education KW - anesthesia KW - modality KW - support KW - Washington University KW - university KW - coaching skills KW - training KW - culture change KW - culture KW - flexibility KW - systematic framework N2 - Background: Mentoring, advising, and coaching are essential components of resident education and professional development. Despite their importance, there is limited literature exploring how anesthesiology faculty perceive these practices and their role in supporting residents. Objective: This study aims to investigate anesthesiology faculty perspectives on the significance, implantation strategies, and challenges associated with mentorship, advising, and coaching in resident education. Methods: A comprehensive survey was administrated to 93 anesthesiology faculty members at Washington University School of Medicine. The survey incorporated quantitative Likert-scale questions and qualitative short-answer responses to assess faculty perceptions of the value, preferred formats, essential skills, and capacity for fulfilling multiple roles in these support practices. Additional areas of focus included the impact of staffing shortages, training requirements, and the potential of these practices to enhance faculty recruitment and retention. Results: The response rate was 44% (n=41). Mentoring was identified as the most important aspect, with 88% (n=36) of faculty respondents indicating its significance, followed by coaching, which was highlighted by 78% (n=32) of respondents. The majority felt 1 faculty member can effectively hold multiple roles for a given trainee. The respondents desired additional training for roles and found roles to be rewarding. All roles were seen as facilitating recruitment and retention. Barriers included faculty burnout; confusion between roles; time constraints; and desire for specialized training, especially in coaching skills. Conclusions: Implementing structured mentoring, advising, and coaching can profoundly impact resident education but requires role clarity, protected time, culture change, leadership buy-in, and faculty development. Targeted training and operational investments could enable programs to actualize immense benefits from high-quality resident support modalities. Respondents emphasized that resident needs evolve over time, necessitating flexibility in appropriate faculty guidance. While coaching demands unique skills, advising hinges on expertise and mentoring depends on relationship-building. Systematic frameworks of coaching, mentoring, and advising programs could unlock immense potential. However, realizing this vision demands surmounting barriers such as burnout, productivity pressures, confusion about logistics, and culture change. Ultimately, prioritizing resident support through high-quality personalized guidance can recenter graduate medical education. UR - https://mededu.jmir.org/2025/1/e60255 UR - http://dx.doi.org/10.2196/60255 ID - info:doi/10.2196/60255 ER - TY - JOUR AU - Vanka, Anita AU - Johnston, T. Katherine AU - Delbanco, Tom AU - DesRoches, M. Catherine AU - Garcia, Annalays AU - Salmi, Liz AU - Blease, Charlotte PY - 2025/1/20 TI - Guidelines for Patient-Centered Documentation in the Era of Open Notes: Qualitative Study JO - JMIR Med Educ SP - e59301 VL - 11 KW - open notes KW - patient-centered documentation skills KW - medical student education KW - 21st Century Cures Act N2 - Background: Patients in the United States have recently gained federally mandated, free, and ready electronic access to clinicians? computerized notes in their medical records (?open notes?). This change from longstanding practice can benefit patients in clinically important ways, but studies show some patients feel judged or stigmatized by words or phrases embedded in their records. Therefore, it is imperative that clinicians adopt documentation techniques that help both to empower patients and minimize potential harms. Objective: At a time when open and transparent communication among patients, families, and clinicians can spread more easily throughout medical practice, this inquiry aims to develop informed guidelines for documentation in medical records. Methods: Through a series of focus groups, preliminary guidelines for documentation language in medical records were developed by health professionals and patients. Using a structured focus group decision guide, we conducted 4 group meetings with different sets of 27 participants: physicians experienced with writing open notes (n=5), patients accustomed to reviewing their notes (n=8), medical student educators (n=7), and resident physicians (n=7). To generate themes, we used an iterative coding process. First-order codes were grouped into second-order themes based on the commonality of meanings. Results: The participants identified 10 important guidelines as a preliminary framework for developing notes sensitive to patients? needs. Conclusions: The process identified 10 discrete themes that can help clinicians use and spread patient-centered documentation. UR - https://mededu.jmir.org/2025/1/e59301 UR - http://dx.doi.org/10.2196/59301 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59301 ER - TY - JOUR AU - Teng, Peng AU - Xu, Youran AU - Qian, Kaoliang AU - Lu, Ming AU - Hu, Jun PY - 2025/1/17 TI - Case-Based Virtual Reality Simulation for Severe Pelvic Trauma Clinical Skill Training in Medical Students: Design and Pilot Study JO - JMIR Med Educ SP - e59850 VL - 11 KW - case-based learning KW - virtual reality KW - pelvic fracture KW - severe pelvic trauma KW - hemodynamic instability KW - clinical skill training KW - VR KW - pelvic trauma KW - medical student KW - pilot study KW - orthopedic surgery KW - theoretical teaching KW - acceptability N2 - Background: Teaching severe pelvic trauma poses a significant challenge in orthopedic surgery education due to the necessity of both clinical reasoning and procedural operational skills for mastery. Traditional methods of instruction, including theoretical teaching and mannequin practice, face limitations due to the complexity, the unpredictability of treatment scenarios, the scarcity of typical cases, and the abstract nature of traditional teaching, all of which impede students? knowledge acquisition. Objective: This study aims to introduce a novel experimental teaching methodology for severe pelvic trauma, integrating virtual reality (VR) technology as a potent adjunct to existing teaching practices. It evaluates the acceptability, perceived ease of use, and perceived usefulness among users and investigates its impact on knowledge, skills, and confidence in managing severe pelvic trauma before and after engaging with the software. Methods: A self-designed questionnaire was distributed to 40 students, and qualitative interviews were conducted with 10 teachers to assess the applicability and acceptability. A 1-group pretest-posttest design was used to evaluate learning outcomes across various domains, including diagnosis and treatment, preliminary diagnosis, disease treatment sequencing, emergency management of hemorrhagic shock, and external fixation of pelvic fractures. Results: A total of 40 students underwent training, with 95% (n=38) affirming that the software effectively simulated real-patient scenarios. All participants (n=40, 100%) reported that completing the simulation necessitated making the same decisions as doctors in real life and found the VR simulation interesting and useful. Teacher interviews revealed that 90% (9/10) recognized the VR simulation?s ability to replicate complex clinical cases, resulting in enhanced training effectiveness. Notably, there was a significant improvement in the overall scores for managing hemorrhagic shock (t39=37.6; 95% CI 43.6-48.6; P<.001) and performing external fixation of pelvic fractures (t39=24.1; 95% CI 53.4-63.3; P<.001) from pre- to postsimulation. Conclusions: The introduced case-based VR simulation of skill-training methodology positively influences medical students? clinical reasoning, operative skills, and self-confidence. It offers an efficient strategy for conserving resources while providing quality education for both educators and learners. UR - https://mededu.jmir.org/2025/1/e59850 UR - http://dx.doi.org/10.2196/59850 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59850 ER - TY - JOUR AU - Wang, Ying-Mei AU - Shen, Hung-Wei AU - Chen, Tzeng-Ji AU - Chiang, Shu-Chiung AU - Lin, Ting-Guan PY - 2025/1/17 TI - Performance of ChatGPT-3.5 and ChatGPT-4 in the Taiwan National Pharmacist Licensing Examination: Comparative Evaluation Study JO - JMIR Med Educ SP - e56850 VL - 11 KW - artificial intelligence KW - ChatGPT KW - chat generative pre-trained transformer KW - GPT-4 KW - medical education KW - educational measurement KW - pharmacy licensure KW - Taiwan KW - Taiwan national pharmacist licensing examination KW - learning model KW - AI KW - Chatbot KW - pharmacist KW - evaluation and comparison study KW - pharmacy KW - statistical analyses KW - medical databases KW - medical decision-making KW - generative AI KW - machine learning N2 - Background: OpenAI released versions ChatGPT-3.5 and GPT-4 between 2022 and 2023. GPT-3.5 has demonstrated proficiency in various examinations, particularly the United States Medical Licensing Examination. However, GPT-4 has more advanced capabilities. Objective: This study aims to examine the efficacy of GPT-3.5 and GPT-4 within the Taiwan National Pharmacist Licensing Examination and to ascertain their utility and potential application in clinical pharmacy and education. Methods: The pharmacist examination in Taiwan consists of 2 stages: basic subjects and clinical subjects. In this study, exam questions were manually fed into the GPT-3.5 and GPT-4 models, and their responses were recorded; graphic-based questions were excluded. This study encompassed three steps: (1) determining the answering accuracy of GPT-3.5 and GPT-4, (2) categorizing question types and observing differences in model performance across these categories, and (3) comparing model performance on calculation and situational questions. Microsoft Excel and R software were used for statistical analyses. Results: GPT-4 achieved an accuracy rate of 72.9%, overshadowing GPT-3.5, which achieved 59.1% (P<.001). In the basic subjects category, GPT-4 significantly outperformed GPT-3.5 (73.4% vs 53.2%; P<.001). However, in clinical subjects, only minor differences in accuracy were observed. Specifically, GPT-4 outperformed GPT-3.5 in the calculation and situational questions. Conclusions: This study demonstrates that GPT-4 outperforms GPT-3.5 in the Taiwan National Pharmacist Licensing Examination, particularly in basic subjects. While GPT-4 shows potential for use in clinical practice and pharmacy education, its limitations warrant caution. Future research should focus on refining prompts, improving model stability, integrating medical databases, and designing questions that better assess student competence and minimize guessing. UR - https://mededu.jmir.org/2025/1/e56850 UR - http://dx.doi.org/10.2196/56850 ID - info:doi/10.2196/56850 ER - TY - JOUR AU - Zhang, Dandan AU - Fu, MuLi AU - Zhang, Jianzhong AU - Li, Yuxuan AU - Chen, Li AU - Chen, Yong-Jun AU - Zhong, Zhefeng AU - Zhang, Yin-Ping PY - 2025/1/17 TI - Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial JO - J Med Internet Res SP - e63131 VL - 27 KW - virtual reality simulation KW - isolation ward KW - preparedness KW - pandemic KW - nurse N2 - Background: During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses? clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited. Objective: This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings. Methods: This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments. Results: After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=?0.30, P=.75; Cohen d=?0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks. Conclusions: This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses? practical skills and pandemic preparedness. Trial Registration: Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0 UR - https://www.jmir.org/2025/1/e63131 UR - http://dx.doi.org/10.2196/63131 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63131 ER - TY - JOUR AU - Wei, Boxiong PY - 2025/1/16 TI - Performance Evaluation and Implications of Large Language Models in Radiology Board Exams: Prospective Comparative Analysis JO - JMIR Med Educ SP - e64284 VL - 11 KW - large language models KW - LLM KW - artificial intelligence KW - AI KW - GPT-4 KW - radiology exams KW - medical education KW - diagnostics KW - medical training KW - radiology KW - ultrasound N2 - Background: Artificial intelligence advancements have enabled large language models to significantly impact radiology education and diagnostic accuracy. Objective: This study evaluates the performance of mainstream large language models, including GPT-4, Claude, Bard, Tongyi Qianwen, and Gemini Pro, in radiology board exams. Methods: A comparative analysis of 150 multiple-choice questions from radiology board exams without images was conducted. Models were assessed on their accuracy for text-based questions and were categorized by cognitive levels and medical specialties using ?2 tests and ANOVA. Results: GPT-4 achieved the highest accuracy (83.3%, 125/150), significantly outperforming all other models. Specifically, Claude achieved an accuracy of 62% (93/150; P<.001), Bard 54.7% (82/150; P<.001), Tongyi Qianwen 70.7% (106/150; P=.009), and Gemini Pro 55.3% (83/150; P<.001). The odds ratios compared to GPT-4 were 0.33 (95% CI 0.18?0.60) for Claude, 0.24 (95% CI 0.13?0.44) for Bard, and 0.25 (95% CI 0.14?0.45) for Gemini Pro. Tongyi Qianwen performed relatively well with an accuracy of 70.7% (106/150; P=0.02) and had an odds ratio of 0.48 (95% CI 0.27?0.87) compared to GPT-4. Performance varied across question types and specialties, with GPT-4 excelling in both lower-order and higher-order questions, while Claude and Bard struggled with complex diagnostic questions. Conclusions: GPT-4 and Tongyi Qianwen show promise in medical education and training. The study emphasizes the need for domain-specific training datasets to enhance large language models? effectiveness in specialized fields like radiology. UR - https://mededu.jmir.org/2025/1/e64284 UR - http://dx.doi.org/10.2196/64284 ID - info:doi/10.2196/64284 ER - TY - JOUR AU - Kim, JaeYong AU - Vajravelu, Narayan Bathri PY - 2025/1/16 TI - Assessing the Current Limitations of Large Language Models in Advancing Health Care Education JO - JMIR Form Res SP - e51319 VL - 9 KW - large language model KW - generative pretrained transformer KW - health care education KW - health care delivery KW - artificial intelligence KW - LLM KW - ChatGPT KW - AI UR - https://formative.jmir.org/2025/1/e51319 UR - http://dx.doi.org/10.2196/51319 ID - info:doi/10.2196/51319 ER - TY - JOUR AU - Kim, Minha AU - Son, Hi Meong AU - Moon, Suhyeon AU - Cha, Chul Won AU - Jo, Joon Ik AU - Yoon, Hee PY - 2025/1/16 TI - A Mixed Reality?Based Telesupervised Ultrasound Education Platform on 5G Network Compared to Direct Supervision: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e63448 VL - 13 KW - ultrasonography KW - telemedicine KW - medical education KW - distance learning KW - fifth-generation network KW - mixed reality KW - ultrasound education KW - hospital KW - randomized pilot trial KW - pilot study KW - doctor KW - telesupervision KW - head-mounted display KW - primary outcomes KW - user experience KW - self-confidence KW - image quality KW - educational intervention KW - training experience KW - South Korea KW - telehealth N2 - Background: Ultrasound education is transitioning from in-person training to remote methods using mixed reality (MR) and 5G networks. Previous studies are mainly experimental, lacking randomized controlled trials in direct training scenarios. Objective: This study aimed to compare an MR-based telesupervised ultrasound education platform on private 5G networks with traditional in-person training for novice doctors. Methods: Conducted at a tertiary academic hospital from November to December 2023, the prospective unblinded randomized controlled pilot study assigned doctors without prior abdominal ultrasound education experience to either the telesupervision group (TG; n=20) or direct supervision group (DG; n=20). Participants received a 15-minute video lecture, conducted ultrasound on a phantom, and had 18 images scored by 2 blinded experts. Additionally, the TG received 5 minutes of training on the basic operation of a head-mounted display. Communication between doctors in the TG and supervisors was facilitated through a head-mounted display, whereas those in the DG interacted directly with supervisors. Primary outcomes were image quality scores, while secondary outcomes included procedure time, number of supervisor interventions, user experience using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), System Usability Scale (SUS), and self-confidence through pre- and postsurveys. Results: Image quality scores and procedure times showed no significant differences between the groups (TG: 66.8 [SD 10.3] vs DG: 66.8 [SD 10.4], P=.84; TG: 23.8 [SD 8.0] min vs DG: 24.0 [SD 8.1] min, P=.95, respectively). However, the TG engaged in more educational interventions (TG: 4.0 [SD 2.5] vs DG: 0.8 [SD 1.1], P<.001), reflecting a more interactive training environment. TG participants reported lower NASA-TLX scores for mental demand (43.8 [SD 24.8] vs 60.6 [SD 22.4], P=.03), effort (43.1 [SD 22.9] vs 67.9 [SD 17], P<.001), and frustration (26.9 [SD 20.3] vs 45.2 [SD 27.8], P=.02), indicating a reduced cognitive load compared to the DG. The mean SUS score was also higher in the TG (66.6 [SD 9.1] vs 60.2 [SD 10.4], P=.046), suggesting better usability. Both groups showed significant improvements in confidence, with the TG showing notably greater improvement in abdominal ultrasound proficiency (pre-education TG: 1.6 [SD 0.9] vs DG: 1.7 [SD 0.9], P=.73; post-education TG: 3.8 [SD 0.9] vs DG: 2.8 [SD 1.0], P=.006). Conclusions: Although no significant differences in image quality scores were observed between groups, considerable differences in positive educational interactions, workload, and usability were evident. These findings emphasize the platform?s potential to enhance the ultrasound training experience, suggesting more interactive and efficient learning. Trial Registration: ClinicalTrials.gov NCT06171828; https://clinicaltrials.gov/study/NCT06171828 UR - https://games.jmir.org/2025/1/e63448 UR - http://dx.doi.org/10.2196/63448 ID - info:doi/10.2196/63448 ER - TY - JOUR AU - Kaewboonlert, Naritsaret AU - Poontananggul, Jiraphon AU - Pongsuwan, Natthipong AU - Bhakdisongkhram, Gun PY - 2025/1/13 TI - Factors Associated With the Accuracy of Large Language Models in Basic Medical Science Examinations: Cross-Sectional Study JO - JMIR Med Educ SP - e58898 VL - 11 KW - accuracy KW - performance KW - artificial intelligence KW - AI KW - ChatGPT KW - large language model KW - LLM KW - difficulty index KW - basic medical science examination KW - cross-sectional study KW - medical education KW - datasets KW - assessment KW - medical science KW - tool KW - Google N2 - Background: Artificial intelligence (AI) has become widely applied across many fields, including medical education. Content validation and its answers are based on training datasets and the optimization of each model. The accuracy of large language model (LLMs) in basic medical examinations and factors related to their accuracy have also been explored. Objective: We evaluated factors associated with the accuracy of LLMs (GPT-3.5, GPT-4, Google Bard, and Microsoft Bing) in answering multiple-choice questions from basic medical science examinations. Methods: We used questions that were closely aligned with the content and topic distribution of Thailand?s Step 1 National Medical Licensing Examination. Variables such as the difficulty index, discrimination index, and question characteristics were collected. These questions were then simultaneously input into ChatGPT (with GPT-3.5 and GPT-4), Microsoft Bing, and Google Bard, and their responses were recorded. The accuracy of these LLMs and the associated factors were analyzed using multivariable logistic regression. This analysis aimed to assess the effect of various factors on model accuracy, with results reported as odds ratios (ORs). Results: The study revealed that GPT-4 was the top-performing model, with an overall accuracy of 89.07% (95% CI 84.76%?92.41%), significantly outperforming the others (P<.001). Microsoft Bing followed with an accuracy of 83.69% (95% CI 78.85%?87.80%), GPT-3.5 at 67.02% (95% CI 61.20%?72.48%), and Google Bard at 63.83% (95% CI 57.92%?69.44%). The multivariable logistic regression analysis showed a correlation between question difficulty and model performance, with GPT-4 demonstrating the strongest association. Interestingly, no significant correlation was found between model accuracy and question length, negative wording, clinical scenarios, or the discrimination index for most models, except for Google Bard, which showed varying correlations. Conclusions: The GPT-4 and Microsoft Bing models demonstrated equal and superior accuracy compared to GPT-3.5 and Google Bard in the domain of basic medical science. The accuracy of these models was significantly influenced by the item?s difficulty index, indicating that the LLMs are more accurate when answering easier questions. This suggests that the more accurate models, such as GPT-4 and Bing, can be valuable tools for understanding and learning basic medical science concepts. UR - https://mededu.jmir.org/2025/1/e58898 UR - http://dx.doi.org/10.2196/58898 ID - info:doi/10.2196/58898 ER - TY - JOUR AU - Rjoop, Anwar AU - Al-Qudah, Mohammad AU - Alkhasawneh, Raja AU - Bataineh, Nesreen AU - Abdaljaleel, Maram AU - Rjoub, A. Moayad AU - Alkhateeb, Mustafa AU - Abdelraheem, Mohammad AU - Al-Omari, Salem AU - Bani-Mari, Omar AU - Alkabalan, Anas AU - Altulaih, Saoud AU - Rjoub, Iyad AU - Alshimi, Rula PY - 2025/1/10 TI - Awareness and Attitude Toward Artificial Intelligence Among Medical Students and Pathology Trainees: Survey Study JO - JMIR Med Educ SP - e62669 VL - 11 KW - artificial intelligence KW - AI KW - deep learning KW - medical schools KW - pathology KW - Jordan KW - medical education KW - awareness KW - attitude KW - medical students KW - pathology trainees KW - national survey study KW - medical practice KW - training KW - web-based survey KW - survey KW - questionnaire N2 - Background: Artificial intelligence (AI) is set to shape the future of medical practice. The perspective and understanding of medical students are critical for guiding the development of educational curricula and training. Objective: This study aims to assess and compare medical AI-related attitudes among medical students in general medicine and in one of the visually oriented fields (pathology), along with illuminating their anticipated role of AI in the rapidly evolving landscape of AI-enhanced health care. Methods: This was a cross-sectional study that used a web-based survey composed of a closed-ended questionnaire. The survey addressed medical students at all educational levels across the 5 public medical schools, along with pathology residents in 4 residency programs in Jordan. Results: A total of 394 respondents participated (328 medical students and 66 pathology residents). The majority of respondents (272/394, 69%) were already aware of AI and deep learning in medicine, mainly relying on websites for information on AI, while only 14% (56/394) were aware of AI through medical schools. There was a statistically significant difference in awareness among respondents who consider themselves tech experts compared with those who do not (P=.03). More than half of the respondents believed that AI could be used to diagnose diseases automatically (213/394, 54.1% agreement), with medical students agreeing more than pathology residents (P=.04). However, more than one-third expressed fear about recent AI developments (167/394, 42.4% agreed). Two-thirds of respondents disagreed that their medical schools had educated them about AI and its potential use (261/394, 66.2% disagreed), while 46.2% (182/394) expressed interest in learning about AI in medicine. In terms of pathology-specific questions, 75.4% (297/394) agreed that AI could be used to identify pathologies in slide examinations automatically. There was a significant difference between medical students and pathology residents in their agreement (P=.001). Overall, medical students and pathology trainees had similar responses. Conclusions: AI education should be introduced into medical school curricula to improve medical students? understanding and attitudes. Students agreed that they need to learn about AI?s applications, potential hazards, and legal and ethical implications. This is the first study to analyze medical students? views and awareness of AI in Jordan, as well as the first to include pathology residents? perspectives. The findings are consistent with earlier research internationally. In comparison with prior research, these attitudes are similar in low-income and industrialized countries, highlighting the need for a global strategy to introduce AI instruction to medical students everywhere in this era of rapidly expanding technology. UR - https://mededu.jmir.org/2025/1/e62669 UR - http://dx.doi.org/10.2196/62669 ID - info:doi/10.2196/62669 ER - TY - JOUR AU - Mühling, Tobias AU - Schreiner, Verena AU - Appel, Marc AU - Leutritz, Tobias AU - König, Sarah PY - 2025/1/10 TI - Comparing Virtual Reality?Based and Traditional Physical Objective Structured Clinical Examination (OSCE) Stations for Clinical Competency Assessments: Randomized Controlled Trial JO - J Med Internet Res SP - e55066 VL - 27 KW - virtual reality KW - VR KW - objective structured clinical examination KW - OSCE KW - medical education KW - technological proficiency KW - assessment KW - clinical competence KW - item characteristics KW - discrimination power KW - acceptance KW - technical feasibility KW - effectiveness KW - comparative study KW - physical stations KW - medical students KW - standardized patients KW - cost-effectiveness N2 - Background: Objective structured clinical examinations (OSCEs) are a widely recognized and accepted method to assess clinical competencies but are often resource-intensive. Objective: This study aimed to evaluate the feasibility and effectiveness of a virtual reality (VR)?based station (VRS) compared with a traditional physical station (PHS) in an already established curricular OSCE. Methods: Fifth-year medical students participated in an OSCE consisting of 10 stations. One of the stations, emergency medicine, was offered in 2 modalities: VRS and PHS. Students were randomly assigned to 1 of the 2 modalities. We used 2 distinct scenarios to prevent content leakage among participants. Student performance and item characteristics were analyzed, comparing the VRS with PHS as well as with 5 other case-based stations. Student perceptions of the VRS were collected through a quantitative and qualitative postexamination online survey, which included a 5-point Likert scale ranging from 1 (minimum) to 5 (maximum), to evaluate the acceptance and usability of the VR system. Organizational and technical feasibility as well as cost-effectiveness were also evaluated. Results: Following randomization and exclusions of invalid data sets, 57 and 66 participants were assessed for the VRS and PHS, respectively. The feasibility evaluation demonstrated smooth implementation of both VR scenarios (septic and anaphylactic shock) with 93% (53/57) of students using the VR technology without issues. The difficulty levels of the VRS scenarios (septic shock: P=.67; anaphylactic shock: P=.58) were comparable to the average difficulty of all stations (P=.68) and fell within the reference range (0.4-0.8). In contrast, VRS demonstrated above-average values for item discrimination (septic shock: r'=0.40; anaphylactic shock: r'=0.33; overall r'=0.30; with values >0.3 considered good) and discrimination index (septic shock: D=0.25; anaphylactic shock: D=0.26; overall D=0.16, with 0.2-0.3 considered mediocre and <0.2 considered poor). Apart from some hesitancy toward its broader application in future practical assessments (mean 3.07, SD 1.37 for VRS vs mean 3.65, SD 1.18 for PHS; P=.03), there were no other differences in perceptions between VRS and PHS. Thematic analysis highlighted the realistic portrayal of medical emergencies and fair assessment conditions provided by the VRS. Regarding cost-effectiveness, initial development of the VRS can be offset by long-term savings in recurring expenses like standardized patients and consumables. Conclusions: Integration of the VRS into the current OSCE framework proved feasible both technically and organizationally, even within the strict constraints of short examination phases and schedules. The VRS was accepted and positively received by students across various levels of technological proficiency, including those with no prior VR experience. Notably, the VRS demonstrated comparable or even superior item characteristics, particularly in terms of discrimination power. Although challenges remain, such as technical reliability and some acceptance concerns, VR remains promising in applications of clinical competence assessment. UR - https://www.jmir.org/2025/1/e55066 UR - http://dx.doi.org/10.2196/55066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55066 ER - TY - JOUR AU - Ebnali Harari, Rayan AU - Altaweel, Abdullah AU - Anderson, Erik AU - Pozner, Charles AU - Grossmann, Rafael AU - Goldsmith, Andrew AU - Shokoohi, Hamid PY - 2025/1/6 TI - Augmented Reality in Enhancing Operating Room Crisis Checklist Adherence: Randomized Comparative Efficacy Study JO - JMIR XR Spatial Comput SP - e60792 VL - 2 KW - augmented reality KW - operating room KW - crisis checklist KW - checklist KW - guideline adherence KW - quality improvement KW - patient safety KW - cardiac arrest KW - hypotension KW - hyperthermia KW - critical care KW - emergency department N2 - Background: Effective crisis management in operating rooms (ORs) is crucial for patient safety. Despite their benefits, adherence to OR crisis checklists is often limited, highlighting the need for innovative solutions. Objective: The objective of this study was to evaluate the efficacy of augmented reality (AR)-enhanced checklists in improving protocol adherence, compared to traditional paper checklists and no checklist scenarios during simulated OR crises. Methods: This study was a randomized comparative efficacy study comparing the utility of AR checklists, paper checklists, and no checklist scenarios using 4 validated and simulated OR crises scenarios: asystolic cardiac arrest, air embolism, unexplained hypotension/hypoxia, and malignant hyperthermia. The study took place in a simulated OR setting and had applicability to the standard procedures in ORs, critical care units, and urgent care scenarios in the emergency department. To form the 24 OR teams, 50 professionals including 24 anesthesiologists, 24 nurses, 1 surgeon, and 1 scrub nurse from two academic hospitals were included. The primary outcome measured was the failure to adhere (FTA) rate for critical actions during simulated OR crises. Adherence was determined using retrospective video analysis involving 595 key processes evaluated across 24 surgical teams. Interrater reliability was assessed using a Cohen ?. Secondary outcomes included checklist usability and cognitive load, as measured by the low-frequency to high-frequency (LF/HF) ratio of the heart rate variability. Results: The AR checklist group showed a significantly lower FTA rate (mean 15.1%, SD 5.77%) compared to the paper checklist (mean 8.32%, SD 5.65%; t23=?2.08; P=.048) and the no checklist groups (mean 29.81%, SD 5.59%; t23=?6.47; P<.001). The AR checklist also resulted in a higher LF/HF ratio for anesthesiologists (F2,46=4.88; P=.02), showing a potential increase in the level of cognitive load. Survey data indicated positive receptions for both AR and paper checklists. Conclusions: These results suggest that AR checklists could offer a viable method for enhancing adherence to critical care protocols. Although, further research is needed to fully assess their impact on clinical outcomes and to address any associated increase in cognitive load. UR - https://xr.jmir.org/2025/1/e60792 UR - http://dx.doi.org/10.2196/60792 ID - info:doi/10.2196/60792 ER - TY - JOUR AU - Burrell, Joanna AU - Baker, Felicity AU - Bennion, Russell Matthew PY - 2025/1/6 TI - Resilience Training Web App for National Health Service Keyworkers: Pilot Usability Study JO - JMIR Med Educ SP - e51101 VL - 11 KW - resilience KW - workplace stress KW - National Health Service KW - NHS keyworker KW - digital learning KW - digital health KW - usability KW - feasibility KW - mental health KW - pilot study KW - learning KW - training KW - exercise KW - primary care provider KW - health care professional KW - occupational health KW - worker KW - hospital KW - emergency KW - survey KW - questionnaire KW - mobile phone N2 - Background: It is well established that frontline health care staff are particularly at risk of stress. Resilience is important to help staff to manage daily challenges and to protect against burnout. Objective: This study aimed to assess the usability and user perceptions of a resilience training web app developed to support health care keyworkers in understanding their own stress response and to help them put into place strategies to manage stress and to build resilience. Methods: Nurses (n=7) and other keyworkers (n=1), the target users for the resilience training web app, participated in the usability evaluation. Participants completed a pretraining questionnaire capturing basic demographic information and then used the training before completing a posttraining feedback questionnaire exploring the impact and usability of the web app. Results: From a sample of 8 keyworkers, 6 (75%) rated their current role as ?sometimes? stressful. All 8 (100%) keyworkers found the training easy to understand, and 5 of 7 (71%) agreed that the training increased their understanding of both stress and resilience. Further, 6 of 8 (75%) agreed that the resilience model had helped them to understand what resilience is. Many of the keyworkers (6/8, 75%) agreed that the content was relevant to them. Furthermore, 6 of 8 (75%) agreed that they were likely to act to develop their resilience following completion of the training. Conclusions: This study tested the usability of a web app for resilience training specifically targeting National Health Service keyworkers. This work preceded a larger scale usability study, and it is hoped this study will help guide other studies to develop similar programs in clinical settings. UR - https://mededu.jmir.org/2025/1/e51101 UR - http://dx.doi.org/10.2196/51101 ID - info:doi/10.2196/51101 ER - TY - JOUR AU - Bland, Tyler PY - 2025/1/6 TI - Enhancing Medical Student Engagement Through Cinematic Clinical Narratives: Multimodal Generative AI?Based Mixed Methods Study JO - JMIR Med Educ SP - e63865 VL - 11 KW - artificial intelligence KW - cinematic clinical narratives KW - cinemeducation KW - medical education KW - narrative learning KW - AI KW - medical student KW - pharmacology KW - preclinical education KW - long-term retention KW - AI tools KW - GPT-4 KW - image KW - applicability N2 - Background: Medical students often struggle to engage with and retain complex pharmacology topics during their preclinical education. Traditional teaching methods can lead to passive learning and poor long-term retention of critical concepts. Objective: This study aims to enhance the teaching of clinical pharmacology in medical school by using a multimodal generative artificial intelligence (genAI) approach to create compelling, cinematic clinical narratives (CCNs). Methods: We transformed a standard clinical case into an engaging, interactive multimedia experience called ?Shattered Slippers.? This CCN used various genAI tools for content creation: GPT-4 for developing the storyline, Leonardo.ai and Stable Diffusion for generating images, Eleven Labs for creating audio narrations, and Suno for composing a theme song. The CCN integrated narrative styles and pop culture references to enhance student engagement. It was applied in teaching first-year medical students about immune system pharmacology. Student responses were assessed through the Situational Interest Survey for Multimedia and examination performance. The target audience comprised first-year medical students (n=40), with 18 responding to the Situational Interest Survey for Multimedia survey (n=18). Results: The study revealed a marked preference for the genAI-enhanced CCNs over traditional teaching methods. Key findings include the majority of surveyed students preferring the CCN over traditional clinical cases (14/18), as well as high average scores for triggered situational interest (mean 4.58, SD 0.53), maintained interest (mean 4.40, SD 0.53), maintained-feeling interest (mean 4.38, SD 0.51), and maintained-value interest (mean 4.42, SD 0.54). Students achieved an average score of 88% on examination questions related to the CCN material, indicating successful learning and retention. Qualitative feedback highlighted increased engagement, improved recall, and appreciation for the narrative style and pop culture references. Conclusions: This study demonstrates the potential of using a multimodal genAI-driven approach to create CCNs in medical education. The ?Shattered Slippers? case effectively enhanced student engagement and promoted knowledge retention in complex pharmacological topics. This innovative method suggests a novel direction for curriculum development that could improve learning outcomes and student satisfaction in medical education. Future research should explore the long-term retention of knowledge and the applicability of learned material in clinical settings, as well as the potential for broader implementation of this approach across various medical education contexts. UR - https://mededu.jmir.org/2025/1/e63865 UR - http://dx.doi.org/10.2196/63865 ID - info:doi/10.2196/63865 ER - TY - JOUR AU - Zong, Hui AU - Wu, Rongrong AU - Cha, Jiaxue AU - Wang, Jiao AU - Wu, Erman AU - Li, Jiakun AU - Zhou, Yi AU - Zhang, Chi AU - Feng, Weizhe AU - Shen, Bairong PY - 2024/12/27 TI - Large Language Models in Worldwide Medical Exams: Platform Development and Comprehensive Analysis JO - J Med Internet Res SP - e66114 VL - 26 KW - large language models KW - LLMs KW - generative pretrained transformer KW - ChatGPT KW - medical exam KW - medical education KW - artifical intelligence KW - AI N2 - Background: Large language models (LLMs) are increasingly integrated into medical education, with transformative potential for learning and assessment. However, their performance across diverse medical exams globally has remained underexplored. Objective: This study aims to introduce MedExamLLM, a comprehensive platform designed to systematically evaluate the performance of LLMs on medical exams worldwide. Specifically, the platform seeks to (1) compile and curate performance data for diverse LLMs on worldwide medical exams; (2) analyze trends and disparities in LLM capabilities across geographic regions, languages, and contexts; and (3) provide a resource for researchers, educators, and developers to explore and advance the integration of artificial intelligence in medical education. Methods: A systematic search was conducted on April 25, 2024, in the PubMed database to identify relevant publications. Inclusion criteria encompassed peer-reviewed, English-language, original research articles that evaluated at least one LLM on medical exams. Exclusion criteria included review articles, non-English publications, preprints, and studies without relevant data on LLM performance. The screening process for candidate publications was independently conducted by 2 researchers to ensure accuracy and reliability. Data, including exam information, data process information, model performance, data availability, and references, were manually curated, standardized, and organized. These curated data were integrated into the MedExamLLM platform, enabling its functionality to visualize and analyze LLM performance across geographic, linguistic, and exam characteristics. The web platform was developed with a focus on accessibility, interactivity, and scalability to support continuous data updates and user engagement. Results: A total of 193 articles were included for final analysis. MedExamLLM comprised information for 16 LLMs on 198 medical exams conducted in 28 countries across 15 languages from the year 2009 to the year 2023. The United States accounted for the highest number of medical exams and related publications, with English being the dominant language used in these exams. The Generative Pretrained Transformer (GPT) series models, especially GPT-4, demonstrated superior performance, achieving pass rates significantly higher than other LLMs. The analysis revealed significant variability in the capabilities of LLMs across different geographic and linguistic contexts. Conclusions: MedExamLLM is an open-source, freely accessible, and publicly available online platform providing comprehensive performance evaluation information and evidence knowledge about LLMs on medical exams around the world. The MedExamLLM platform serves as a valuable resource for educators, researchers, and developers in the fields of clinical medicine and artificial intelligence. By synthesizing evidence on LLM capabilities, the platform provides valuable insights to support the integration of artificial intelligence into medical education. Limitations include potential biases in the data source and the exclusion of non-English literature. Future research should address these gaps and explore methods to enhance LLM performance in diverse contexts. UR - https://www.jmir.org/2024/1/e66114 UR - http://dx.doi.org/10.2196/66114 UR - http://www.ncbi.nlm.nih.gov/pubmed/39729356 ID - info:doi/10.2196/66114 ER - TY - JOUR AU - Miyazaki, Yuki AU - Hata, Masahiro AU - Omori, Hisaki AU - Hirashima, Atsuya AU - Nakagawa, Yuta AU - Eto, Mitsuhiro AU - Takahashi, Shun AU - Ikeda, Manabu PY - 2024/12/24 TI - Performance of ChatGPT-4o on the Japanese Medical Licensing Examination: Evalution of Accuracy in Text-Only and Image-Based Questions JO - JMIR Med Educ SP - e63129 VL - 10 KW - medical education KW - artificial intelligence KW - clinical decision-making KW - GPT-4o KW - medical licensing examination KW - Japan KW - images KW - accuracy KW - AI technology KW - application KW - decision-making KW - image-based KW - reliability KW - ChatGPT UR - https://mededu.jmir.org/2024/1/e63129 UR - http://dx.doi.org/10.2196/63129 ID - info:doi/10.2196/63129 ER - TY - JOUR AU - Zechner, Olivia AU - Schrom-Feiertag, Helmut AU - Wespi, Rafael AU - Pretolesi, Daniele AU - Nguyen, Quynh AU - Tscheligi, Manfred PY - 2024/12/24 TI - Enhancing Mixed Reality Simulation Training Technology With Real-Time Performance Visualization: Mixed Methods Study With Medical First Responders JO - JMIR XR Spatial Comput SP - e57655 VL - 1 KW - mixed reality KW - immersive technologies KW - simulation training KW - simulation KW - paramedic KW - medical first responders KW - human performance KW - stress KW - stress monitoring KW - human-centered design N2 - Background: Mixed reality (MR) simulation training is emerging in paramedical education as a way to practice responding to stress-intensive scenarios like mass casualty incidents in a safe and controlled environment. Current training platforms, however, lack real-time stress and human performance monitoring tools. Objective: The study aims to enhance MR training for medical first responders through real-time evaluation of performance and stress levels, leveraging biosignal monitoring and advanced analytics to allow instructors to tailor feedback and maintain optimal challenge and safety levels. Methods: The study includes a structured, multiphase approach including initial requirement gathering (structured interviews and cocreation workshops), an online design survey, iterative prototype development, and a field trial (including training observations and interviews). Data were collected from 5 end user consortium members across Europe. Quantitative data from checklists were analyzed using frequencies and percentages to understand feature usage and event occurrences. Qualitative data from semistructured interviews and cocreation workshops were transcribed, coded, and subjected to thematic analysis to identify patterns and insights into the usability and effectiveness of the enhanced features in the MR training. Results: The study identified a number of requirements that medical first responders have for an MR training system, including requirements not included in currently available solutions. A total of 80 performance metrics were initially identified and refined to a set of 54 metrics, which were categorized into key performance indicator groups such as scene safety, triage performance, and communication. Requirements for smart wearables to monitor stress levels are provided and highlight the importance of a user-centered design process to provide users with effective tools that fit their needs. Stress visualization preferences are described in the form of a dashboard as well as in virtual environments surrounding the avatar. Using an iterative design process and user feedback, a training system was developed, integrating real-time performance tracking and stress monitoring. The field trial provided insights into the practical use of these features during a real training exercise, showed interaction preferences between trainer and trainees, and highlighted further improvement opportunities. Conclusions: This research enhances MR training for paramedics by integrating real-time performance metrics and stress indicators based on a human-centered design approach that aligns with end user needs, thereby laying the foundation for developing more effective and immersive training solutions for high-stress professions. UR - https://xr.jmir.org/2024/1/e57655 UR - http://dx.doi.org/10.2196/57655 ID - info:doi/10.2196/57655 ER - TY - JOUR AU - Wang, Y. Ellen AU - Qian, Daniel AU - Zhang, Lijin AU - Li, S-K Brian AU - Ko, Brian AU - Khoury, Michael AU - Renavikar, Meghana AU - Ganesan, Avani AU - Caruso, J. Thomas PY - 2024/12/23 TI - Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study JO - JMIR Med Educ SP - e60767 VL - 10 KW - virtual reality KW - technology assessment KW - graduate medical education trainees KW - medical education KW - technology adoption KW - Technology Acceptance Model KW - factor analysis KW - VR KW - TAM KW - United Theory of Acceptance and Use of Technology KW - UTAUT N2 - Background: Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. Objective: The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Methods: Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. Results: In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. Conclusions: This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model?s reliability within specialties in different geographic locations. UR - https://mededu.jmir.org/2024/1/e60767 UR - http://dx.doi.org/10.2196/60767 ID - info:doi/10.2196/60767 ER - TY - JOUR AU - Ogundiya, Oluwadamilola AU - Rahman, Jasmine Thahmina AU - Valnarov-Boulter, Ioan AU - Young, Michael Tim PY - 2024/12/19 TI - Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review JO - J Med Internet Res SP - e60312 VL - 26 KW - digital health KW - digital medical education KW - health education KW - medical education KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: The last 25 years have seen enormous progression in digital technologies across the whole of the health service, including health education. The rapid evolution and use of web-based and digital techniques have been significantly transforming this field since the beginning of the new millennium. These advancements continue to progress swiftly, even more so after the COVID-19 pandemic. Objective: This narrative review aims to outline and discuss the developments that have taken place in digital medical education across the defined time frame. In addition, evidence for potential opportunities and challenges facing digital medical education in the near future was collated for analysis. Methods: Literature reviews were conducted using PubMed, Web of Science Core Collection, Scopus, Google Scholar, and Embase. The participants and learners in this study included medical students, physicians in training or continuing professional development, nurses, paramedics, and patients. Results: Evidence of the significant steps in the development of digital medical education in the past 25 years was presented and analyzed in terms of application, impact, and implications for the future. The results were grouped into the following themes for discussion: learning management systems; telemedicine (in digital medical education); mobile health; big data analytics; the metaverse, augmented reality, and virtual reality; the COVID-19 pandemic; artificial intelligence; and ethics and cybersecurity. Conclusions: Major changes and developments in digital medical education have occurred from around the start of the new millennium. Key steps in this journey include technical developments in teleconferencing and learning management systems, along with a marked increase in mobile device use for accessing learning over this time. While the pace of evolution in digital medical education accelerated during the COVID-19 pandemic, further rapid progress has continued since the resolution of the pandemic. Many of these changes are currently being widely used in health education and other fields, such as augmented reality, virtual reality, and artificial intelligence, providing significant future potential. The opportunities these technologies offer must be balanced against the associated challenges in areas such as cybersecurity, the integrity of web-based assessments, ethics, and issues of digital privacy to ensure that digital medical education continues to thrive in the future. UR - https://www.jmir.org/2024/1/e60312 UR - http://dx.doi.org/10.2196/60312 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60312 ER - TY - JOUR AU - Nicolau, Abel AU - Jorge, Inês AU - Vieira-Marques, Pedro AU - Sa-Couto, Carla PY - 2024/12/19 TI - Influence of Training With Corrective Feedback Devices on Cardiopulmonary Resuscitation Skills Acquisition and Retention: Systematic Review and Meta-Analysis JO - JMIR Med Educ SP - e59720 VL - 10 KW - cardiopulmonary resuscitation KW - CPR quality KW - resuscitation training KW - corrective feedback devices KW - skills acquisition KW - skills retention KW - systematic review KW - evidence-based research KW - meta-analysis KW - feedback devices KW - PRISMA N2 - Background: Several studies related to the use of corrective feedback devices in cardiopulmonary resuscitation training, with different populations, training methodologies, and equipment, present distinct results regarding the influence of this technology. Objective: This systematic review and meta-analysis aimed to examine the impact of corrective feedback devices in cardiopulmonary resuscitation skills acquisition and retention for laypeople and health care professionals. Training duration was also studied. Methods: The search was conducted in PubMed, Web of Science, and Scopus from January 2015 to December 2023. Eligible randomized controlled trials compared technology-based training incorporating corrective feedback with standard training. Outcomes of interest were the quality of chest compression?related components. The risk of bias was assessed using the Cochrane tool. A meta-analysis was used to explore the heterogeneity of the selected studies. Results: In total, 20 studies were included. Overall, it was reported that corrective feedback devices used during training had a positive impact on both skills acquisition and retention. Medium to high heterogeneity was observed. Conclusions: This systematic review and meta-analysis suggest that corrective feedback devices enhance skills acquisition and retention over time. Considering the medium to high heterogeneity observed, these findings should be interpreted with caution. More standardized, high-quality studies are needed. Trial Registration: PROSPERO CRD42021240953; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=240953 UR - https://mededu.jmir.org/2024/1/e59720 UR - http://dx.doi.org/10.2196/59720 UR - http://www.ncbi.nlm.nih.gov/pubmed/39699935 ID - info:doi/10.2196/59720 ER - TY - JOUR AU - Roos, Jonas AU - Martin, Ron AU - Kaczmarczyk, Robert PY - 2024/12/17 TI - Evaluating Bard Gemini Pro and GPT-4 Vision Against Student Performance in Medical Visual Question Answering: Comparative Case Study JO - JMIR Form Res SP - e57592 VL - 8 KW - medical education KW - visual question answering KW - image analysis KW - large language model KW - LLM KW - student KW - performance KW - comparative KW - case study KW - artificial intelligence KW - AI KW - ChatGPT KW - effectiveness KW - diagnostic KW - training KW - accuracy KW - utility KW - image-based KW - question KW - image KW - AMBOSS KW - English KW - German KW - question and answer KW - Python KW - AI in health care KW - health care N2 - Background: The rapid development of large language models (LLMs) such as OpenAI?s ChatGPT has significantly impacted medical research and education. These models have shown potential in fields ranging from radiological imaging interpretation to medical licensing examination assistance. Recently, LLMs have been enhanced with image recognition capabilities. Objective: This study aims to critically examine the effectiveness of these LLMs in medical diagnostics and training by assessing their accuracy and utility in answering image-based questions from medical licensing examinations. Methods: This study analyzed 1070 image-based multiple-choice questions from the AMBOSS learning platform, divided into 605 in English and 465 in German. Customized prompts in both languages directed the models to interpret medical images and provide the most likely diagnosis. Student performance data were obtained from AMBOSS, including metrics such as the ?student passed mean? and ?majority vote.? Statistical analysis was conducted using Python (Python Software Foundation), with key libraries for data manipulation and visualization. Results: GPT-4 1106 Vision Preview (OpenAI) outperformed Bard Gemini Pro (Google), correctly answering 56.9% (609/1070) of questions compared to Bard?s 44.6% (477/1070), a statistically significant difference (?2?=32.1, P<.001). However, GPT-4 1106 left 16.1% (172/1070) of questions unanswered, significantly higher than Bard?s 4.1% (44/1070; ?2?=83.1, P<.001). When considering only answered questions, GPT-4 1106?s accuracy increased to 67.8% (609/898), surpassing both Bard (477/1026, 46.5%; ?2?=87.7, P<.001) and the student passed mean of 63% (674/1070, SE 1.48%; ?2?=4.8, P=.03). Language-specific analysis revealed both models performed better in German than English, with GPT-4 1106 showing greater accuracy in German (282/465, 60.65% vs 327/605, 54.1%; ?2?=4.4, P=.04) and Bard Gemini Pro exhibiting a similar trend (255/465, 54.8% vs 222/605, 36.7%; ?2?=34.3, P<.001). The student majority vote achieved an overall accuracy of 94.5% (1011/1070), significantly outperforming both artificial intelligence models (GPT-4 1106: ?2?=408.5, P<.001; Bard Gemini Pro: ?2?=626.6, P<.001). Conclusions: Our study shows that GPT-4 1106 Vision Preview and Bard Gemini Pro have potential in medical visual question-answering tasks and to serve as a support for students. However, their performance varies depending on the language used, with a preference for German. They also have limitations in responding to non-English content. The accuracy rates, particularly when compared to student responses, highlight the potential of these models in medical education, yet the need for further optimization and understanding of their limitations in diverse linguistic contexts remains critical. UR - https://formative.jmir.org/2024/1/e57592 UR - http://dx.doi.org/10.2196/57592 ID - info:doi/10.2196/57592 ER - TY - JOUR AU - Liu, Xuan AU - Chi, Xiaotong AU - Chen, Ming AU - Sun, Wen AU - Li, Jia PY - 2024/12/10 TI - Spillover Effects of Paid Functions on Physicians? Unpaid Knowledge Activities: Quasi-Experimental Approach JO - J Med Internet Res SP - e58688 VL - 26 KW - health knowledge contribution KW - economic incentives KW - diversity KW - propensity score matching KW - multi-period difference in differences N2 - Background: To promote sustained contributions by physicians to online health care communities, these platforms have introduced a content payment model that offers economic incentives for physicians? online knowledge activities. However, the impact of these paid features on unpaid knowledge activities remains unexplored. Objective: This study investigated how the introduction of economic incentives in online medical communities affects physicians? unpaid knowledge activities in the community. Methods: The data for this study were obtained from the Haodf Online platform in China, which has implemented paid scenarios for its science popularization function, providing economic benefits to physicians. The dataset, which comprises panel data, includes 7453 physicians who participated in both paid and unpaid knowledge contributions on the website. This study examined the impact of paid knowledge activities on physicians? free knowledge contributions, focusing on dimensions including knowledge quantity, quality, and diversity. To address the timing discrepancies in physicians? participation in paid activities, we used a quasi-experimental design that combined the approach of propensity score matching and multi-period difference in differences. Results: In the balance test results of the propensity score matching, the absolute values of the SDs of all matching variables were mostly <5% after matching, ensuring the accuracy of the results obtained from the difference in differences method. This study found that participation in paid knowledge activities had a positive spillover effect on physicians? free knowledge contributions, which manifested in the increase in post quantity (473.1%; P<.001), article length (108%; P=.009), function word frequency (0.6%; P=.001), causal word frequency (0.2%; P<.001), and content information entropy (6.6%; P=.006). The paid function led to a decrease in the consistency between titles and content (?115.5%; P<.001). Conclusions: The findings of this study contribute to the existing literature on the impact of economic incentives in the medical context. For the platform, providing economic incentives to physicians can have positive significance in promoting the development of the platform?s knowledge ecosystem and can effectively encourage physicians to contribute to both paid and free knowledge activities. This study provides a valuable reference for the platform to introduce a paid knowledge model, which is beneficial to the sustainable development of the platform. UR - https://www.jmir.org/2024/1/e58688 UR - http://dx.doi.org/10.2196/58688 UR - http://www.ncbi.nlm.nih.gov/pubmed/39656521 ID - info:doi/10.2196/58688 ER - TY - JOUR AU - Oliveira, de Nathalia Hanany Silva AU - Oliveira, de Renata Fonsêca Sousa AU - Soares, Pontes Juliana AU - Castro, de Janete Lima PY - 2024/12/9 TI - Sustainability of Interprofessional Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e60763 VL - 13 KW - college education KW - health training KW - interprofessional education KW - IPE KW - sustainability KW - collaborative practice KW - training of human resources in health KW - undergraduate medical education KW - students KW - student learners KW - professional development KW - health care professional training N2 - Background: Interprofessional education (IPE) is an approach that can improve health care quality, contribute to the qualification of health care professionals, and train undergraduate students. Although this strategy has made significant progress in the last decade, integration, sustainability, and institutional growth are still priorities worldwide. Thus, maintaining strategies is essential for their full development and evolution. Objective: This study aimed to identify discussions about the sustainability of IPE and map its actions or strategies (or both). Methods: The scoping review will follow the Joanna Briggs Institute methodology. This scoping review protocol follows the JBI Reviewers? Manual, with 6 stages: identifying the research question; identifying relevant studies; study selection; data extraction and coding; analysis and interpretation of results; and consultation with stakeholders. Two independent and blind reviewers will evaluate and select studies available in English, Portuguese, and Spanish based on the eligibility criteria. Searches will be conducted on LILACS, Embase, Scopus, PubMed/MEDLINE, ERIC, Web of Science, CINAHL, Google Scholar databases; ProQuest Dissertations & Theses Global, and Brazilian Digital Library of Theses and Dissertations. The main research question is as follows: What have been the sustainability strategies for IPE actions? This scoping review will incorporate studies (empirical or theoretical-reflective) that address strategies or actions (or both) for IPE sustainability. They must present a quantitative, qualitative, or mixed methods approach and be available in full text. Data on strategies or actions for IPE sustainability will be extracted and inserted into a spreadsheet for analysis. Quantitative data will be analyzed using descriptive statistics, while qualitative analysis will identify meanings and patterns through thematic analysis. Thus, the aim is to present the compiled findings in tables and charts. Results: The database search was conducted on March 22, 2024. In April and May 2024, duplicate studies were excluded. From July to November 2024, study selection will be carried out. In December 2024, data extraction and tabulation will take place, as well as consultation with stakeholders. The aim is to publish the results in scientific journals in January 2025. Conclusions: This protocol will guide this scoping review to identify discussions on the sustainability of IPE and map its actions or strategies (or both); summarize the definitions and institutions that develop or promote IPE; and present the main recommendations for the area under study. Additionally, possible research gaps can be identified to guide future studies. This review will shed light on existing knowledge gaps and the current state of research, which could provide support for future research, programs, and policy responses to foster collaboration and interprofessional practice and, consequently, improve the quality of user care. This information will be useful in supporting decision-making by government officials, managers, teachers, facilitators, and students in the implementation, maintenance, and development of IPE. Trial Registration: Open Science Framework 5VNJS; https://osf.io/5vnjs/ International Registered Report Identifier (IRRID): DERR1-10.2196/60763 UR - https://www.researchprotocols.org/2024/1/e60763 UR - http://dx.doi.org/10.2196/60763 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60763 ER - TY - JOUR AU - Yokokawa, Daiki AU - Shikino, Kiyoshi AU - Nishizaki, Yuji AU - Fukui, Sho AU - Tokuda, Yasuharu PY - 2024/12/5 TI - Evaluation of a Computer-Based Morphological Analysis Method for Free-Text Responses in the General Medicine In-Training Examination: Algorithm Validation Study JO - JMIR Med Educ SP - e52068 VL - 10 KW - General Medicine In-Training Examination KW - free-text response KW - morphological analysis KW - Situation, Background, Assessment, and Recommendation KW - video-based question N2 - Background: The General Medicine In-Training Examination (GM-ITE) tests clinical knowledge in a 2-year postgraduate residency program in Japan. In the academic year 2021, as a domain of medical safety, the GM-ITE included questions regarding the diagnosis from medical history and physical findings through video viewing and the skills in presenting a case. Examinees watched a video or audio recording of a patient examination and provided free-text responses. However, the human cost of scoring free-text answers may limit the implementation of GM-ITE. A simple morphological analysis and word-matching model, thus, can be used to score free-text responses. Objective: This study aimed to compare human versus computer scoring of free-text responses and qualitatively evaluate the discrepancies between human- and machine-generated scores to assess the efficacy of machine scoring. Methods: After obtaining consent for participation in the study, the authors used text data from residents who voluntarily answered the GM-ITE patient reproduction video-based questions involving simulated patients. The GM-ITE used video-based questions to simulate a patient?s consultation in the emergency room with a diagnosis of pulmonary embolism following a fracture. Residents provided statements for the case presentation. We obtained human-generated scores by collating the results of 2 independent scorers and machine-generated scores by converting the free-text responses into a word sequence through segmentation and morphological analysis and matching them with a prepared list of correct answers in 2022. Results: Of the 104 responses collected?63 for postgraduate year 1 and 41 for postgraduate year 2?39 cases remained for final analysis after excluding invalid responses. The authors found discrepancies between human and machine scoring in 14 questions (7.2%); some were due to shortcomings in machine scoring that could be resolved by maintaining a list of correct words and dictionaries, whereas others were due to human error. Conclusions: Machine scoring is comparable to human scoring. It requires a simple program and calibration but can potentially reduce the cost of scoring free-text responses. UR - https://mededu.jmir.org/2024/1/e52068 UR - http://dx.doi.org/10.2196/52068 ID - info:doi/10.2196/52068 ER - TY - JOUR AU - Sun, Wan-Na AU - Hsieh, Min-Chai AU - Wang, Wei-Fang PY - 2024/12/5 TI - Nurses? Knowledge and Skills After Use of an Augmented Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial JO - J Med Internet Res SP - e57327 VL - 26 KW - augmented reality KW - technology intervention KW - randomized controlled trial KW - advanced cardiac life support KW - nursing education N2 - Background: Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. Objective: This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. Methods: This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. Results: All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). Conclusions: AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. Trial Registration: ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285 UR - https://www.jmir.org/2024/1/e57327 UR - http://dx.doi.org/10.2196/57327 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57327 ER - TY - JOUR AU - Jiang, Nan AU - Zhang, Yuelun AU - Liang, Siyu AU - Lyu, Xiaohong AU - Chen, Shi AU - Huang, Xiaoming AU - Pan, Hui PY - 2024/12/5 TI - Effectiveness of Virtual Simulations Versus Mannequins and Real Persons in Medical and Nursing Education: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e56195 VL - 26 KW - artificial intelligence KW - clinical virtual simulation KW - medical education KW - meta-analysis KW - nursing education KW - virtual patient KW - virtual reality N2 - Background: Virtual simulation (VS) is a developing education approach with the recreation of reality using digital technology. The teaching effectiveness of VSs compared to mannequins and real persons (RPs) has never been investigated in medical and nursing education. Objective: This study aims to compare VSs and mannequins or RPs in improving the following clinical competencies: knowledge, procedural skills, clinical reasoning, and communication skills. Methods: Following Cochrane methodology, a meta-analysis was conducted on the effectiveness of VSs in pre- and postregistration medical or nursing participants. The Cochrane Library, PubMed, Embase, and Educational Resource Information Centre databases were searched to identify English-written randomized controlled trials up to August 2024. Two authors independently selected studies, extracted data, and assessed the risk of bias. All pooled estimates were based on random-effects models and assessed by trial sequential analyses. Leave-one-out, subgroup, and univariate meta-regression analyses were performed to explore sources of heterogeneity. Results: A total of 27 studies with 1480 participants were included. Overall, there were no significant differences between VSs and mannequins or RPs in improving knowledge (standard mean difference [SMD]=0.08; 95% CI ?0.30 to 0.47; I2=67%; P=.002), procedural skills (SMD=?0.12; 95% CI ?0.47 to 0.23; I2=75%; P<.001), clinical reasoning (SMD=0.29; 95% CI ?0.26 to 0.85; I2=88%; P<.001), and communication skills (SMD=?0.02; 95% CI: ?0.62 to 0.58; I2=86%; P<.001). Trial sequential analysis for clinical reasoning indicated an insufficient sample size for a definitive judgment. For procedural skills, subgroup analyses showed that VSs were less effective among nursing participants (SMD=?0.55; 95% CI ?1.07 to ?0.03; I2=69%; P=.04). Univariate meta-regression detected a positive effect of publication year (?=.09; P=.02) on communication skill scores. Conclusions: Given favorable cost-utility plus high flexibility regarding time and space, VSs are viable alternatives to traditional face-to-face learning modalities. The comparative effectiveness of VSs deserves to be followed up with the emergence of new technology. In addition, further investigation of VSs with different design features will provide novel insights to drive education reform. Trial Registration: PROSPERO CRD42023466622; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466622 UR - https://www.jmir.org/2024/1/e56195 UR - http://dx.doi.org/10.2196/56195 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56195 ER - TY - JOUR AU - Robertson, Sandra AU - Thomson, Katie AU - Bannigan, Katrina PY - 2024/11/27 TI - Characteristics of Student-Led Clinics in the Allied Health Professions: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e58084 VL - 13 KW - student-run clinic KW - student-facilitated clinic KW - allied health profession KW - interprofessional KW - higher education KW - university KW - tertiary education KW - preregistration KW - social care environment KW - practice based learning N2 - Background: Student-led clinics can provide students from allied health professions with the opportunity to gain valuable placement experience as an integral component of their preregistration program, enabling them to develop their competencies, professional skills, and administrative and leadership skills. Student-led clinics have the capacity to help meet the demand for appropriate practice-based learning opportunities, as there is an expectation that all allied health professions students should have high-quality learning experiences, ensuring the future workforce is fit for purpose. An overview of existing student-led clinics will increase our understanding of key characteristics, assisting education providers who may be considering the development of their own clinics. This will include key factors to ensure that this model of practice-based learning meets the needs of service users, students, and education providers. Objective: This scoping review aims to increase our understanding of the characteristics of student-led clinics by answering the questions (1) what student-led clinics exist in the allied health professions, and (2) what are their characteristics? Methods: This scoping review has been developed in conjunction with Joanna Briggs Institute methodology. We will consider studies and publications that include student-led clinics as an integral part of the preregistration curriculum for allied health professions students as defined by the Health and Care Professions Council. An extensive search of electronic databases will be conducted, including PubMed, MEDLINE, and CINAHL, among others. Search strategies, including the identified keywords and index terms, will be modified for each included database used. Reference lists of all included evidence will be screened for additional relevant studies. Studies published in English with no date limitations will be included. Relevant sources will be imported into Covidence for screening conducted by 2 reviewers (SR and KB). Data extraction will be conducted by 2 reviewers using a piloted data extraction tool, and data will be charted and tabulated using the Template for Intervention Description and Replication (TIDieR) checklist. Data will be presented with a narrative summary and illustrated by graphs and figures. The scoping review will be reported in conjunction with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews) and the STORIES (Structured Approach to the Reporting In health care education of Evidence Synthesis) statement for health care education evidence synthesis. Results: An initial limited search was conducted in February 2024. The study will be conducted in 2025. Publication of the results is expected in late 2025. Conclusions: This scoping review will provide key information regarding the characteristics of student-led clinics and will be of interest to preregistration education programs within the allied health professions who have an interest in exploring opportunities to address placement capacity issues. International Registered Report Identifier (IRRID): PRR1-10.2196/58084 UR - https://www.researchprotocols.org/2024/1/e58084 UR - http://dx.doi.org/10.2196/58084 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58084 ER - TY - JOUR AU - Bonnin, Gabriel AU - Kröber, Svea AU - Schneider, Silvia AU - Margraf, Jürgen AU - Pflug, Verena AU - Gerlach, L. Alexander AU - Slotta, Timo AU - Christiansen, Hanna AU - Albrecht, Björn AU - Chavanon, Mira-Lynn AU - Hirschfeld, Gerrit AU - In-Albon, Tina AU - Thielsch, T. Meinald AU - von Brachel, Ruth PY - 2024/11/27 TI - A Blended Learning Course on the Diagnostics of Mental Disorders: Multicenter Cluster Randomized Noninferiority Trial JO - J Med Internet Res SP - e54176 VL - 26 KW - diagnosis KW - structured clinical interviews KW - blended learning KW - dissemination KW - therapist training KW - clinical interview KW - clinical diagnosis KW - clinical practice KW - psychology students KW - diagnostic test KW - health personnel KW - mental health services KW - mental health N2 - Background: Clinical diagnoses determine if and how therapists treat their patients. As misdiagnoses can have severe adverse effects, disseminating evidence-based diagnostic skills into clinical practice is highly important. Objective: This study aimed to develop and evaluate a blended learning course in a multicenter cluster randomized controlled trial. Methods: Undergraduate psychology students (N=350) enrolled in 18 university courses at 3 universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants? performances in a clinical diagnostic interview after the courses. The secondary outcomes were diagnostic knowledge and participants? reactions to the courses. All outcomes were analyzed on the individual participant level using noninferiority testing. Results: Compared with the synchronous course (74.6% pass rate), participation in the blended learning course (89% pass rate) increased the likelihood of successfully passing the behavioral test (odds ratio 2.77, 95% CI 1.55-5.13), indicating not only noninferiority but superiority of the blended learning course. Furthermore, superiority of the blended learning over the synchronous course could be found regarding diagnostic knowledge (?=.13, 95% CI 0.01-0.26), course clarity (?=.40, 95% CI 0.27-0.53), course structure (?=.18, 95% CI 0.04-0.32), and informativeness (?=.19, 95% CI 0.06-0.32). Conclusions: Blended learning can help to improve the diagnostic skills and knowledge of (future) clinicians and thus make an important contribution to improving mental health care. Trial Registration: ClinicalTrials.gov NCT05294094; https://clinicaltrials.gov/study/NCT05294094 UR - https://www.jmir.org/2024/1/e54176 UR - http://dx.doi.org/10.2196/54176 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54176 ER - TY - JOUR AU - Busca, Erica AU - Caristia, Silvia AU - Bidone, Palmira Sara AU - Bolamperti, Alessia AU - Campagna, Sara AU - Cattaneo, Arianna AU - Lea, Rosaria AU - Montani, Doriana AU - Scalogna, Antonio AU - Bassi, Erika AU - Dal Molin, Alberto PY - 2024/11/26 TI - Serious Game for the Nursing Assessment of Home-Dwelling Older Adults: Development and Validation Study JO - JMIR Serious Games SP - e52644 VL - 12 KW - nursing education KW - serious game KW - simulation training KW - validation study KW - home-dwelling older adults KW - continuing education KW - nursing students KW - Family and Community Nursing KW - validity N2 - Background: The use of serious games (SGs) in nursing education is increasing, with the COVID-19 pandemic significantly accelerating their development. A key feature of SGs is their flexibility, allowing students to train at any place and time as needed. Recently, there has been a shift from developing disease-specific SGs to games focused on broader health issues. However, there has been a lack of proposals to enhance nursing interventions in home and frail care settings. The REACtion project developed a SG to improve students? understanding and clinical reasoning in caring for home-dwelling older adults. Objective: This study aims to describe the development of ?REACtion Game? (RG) and explore its validity as an educational tool. A multidisciplinary team created a SG that simulates the assessment process of older adults in home settings by nurses. It features web-based scenarios, clickable objects, and a menu with tools, and medical records to enhance nursing students? knowledge and clinical reasoning skills. Methods: A prospective, observational study was conducted using the Dutch Society for Simulation in Healthcare?s framework to validate the game. Further, 5 experts in home health care nursing evaluated content validity, while 30 students assessed construct validity, face validity, concurrent validity (by comparing game scores with those from the Nursing Clinical Reasoning Scale), game quality, and usability. Data were collected through self-administered web-based questionnaires and the debriefings of each match played. The students were enrolled in 2 postgraduate nursing programs: a master of science in nursing degree and a first-level continuing education in family and community nursing. Results: Experts rated the content validity highly after revisions (universal agreement calculation method of scale-level content validity index=0.97). The sample consisted of 30 students, predominantly women (n=20, 67%) and aged younger than 45 years (n=23, 77%) with no prior experience in SG. Almost all students had a positive impression of RG as an attractive and useful method for learning new knowledge. Participants found the cases, scenarios, and dialogues realistic (face validity) and of high quality, though usability aspects such as instructions clarity and intelligibility of game progression were less favored. Construct validity showed general agreement on the game?s educational value, with family and community nursing students reporting more consistent alignment with educational goals. Overall, RG scores correlated positively with time spent playing but showed limited correlation with Nursing Clinical Reasoning Scale scores. Conclusions: This study developed and validated a nursing education game, especially valuable as simulation is underused in some curricula. Created during the pandemic, it offered a digital learning environment. Although the game shows potential, further testing is needed for usability, concurrent validity, and functional improvements. Future research should involve larger samples to fully validate the game and assess its impact on academic achievement. UR - https://games.jmir.org/2024/1/e52644 UR - http://dx.doi.org/10.2196/52644 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52644 ER - TY - JOUR AU - Wooldridge, S. Jennalee AU - Soriano, C. Emily AU - Chu, Gage AU - Shirazi, Anaheed AU - Shapiro, Desiree AU - Patterson, Marta AU - Kim, Hyun-Chung AU - Herbert, S. Matthew PY - 2024/11/26 TI - Optimizing Compassion Training in Medical Trainees Using an Adjunct mHealth App: A Preliminary Single-Arm Feasibility and Acceptability Study JO - JMIR Form Res SP - e60670 VL - 8 KW - mobile phone KW - compassion KW - empathy KW - mHealth KW - mobile health KW - medical student KW - medical resident KW - mHealth app KW - app KW - medical trainee KW - training KW - feasibility KW - acceptability KW - pilot KW - mindfulness KW - self-compassion KW - smartphone app KW - applicability N2 - Background: While structured compassion training programs have shown promise for increasing compassion among medical trainees, a major challenge is applying the concepts and practices taught during the program into the complex, dynamic, time-pressured, and often hectic hospital workplace. Objective: The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of Compassion Coach, a mobile health (mHealth) smartphone app designed to bolster a 6-week mindfulness and self-compassion training program for medical trainees. Methods: In Compassion Coach, notifications to remind, encourage, and measure the perceived impact of informal mindfulness and compassion practices taught during the program were delivered at 7 AM, 12 PM, and 7 PM, respectively, 3 times per week over the course of the training program. The app also contained a library of guided audio formal mindfulness and compassion practices to allow quick and easy access. In this pilot study, we collected data from 29 medical students and residents who downloaded Compassion Coach and completed surveys assessing perceived effectiveness and acceptability. Engagement with the Compassion Coach app was passively tracked through notification response rate and library resource access over time. Results: The average response rate to notifications was 58% (SD 29%; range 12%-98%), with a significant decline over time (P=.009; odds ratio 0.98, 95% CI 0.96-0.99). Across all participants and occasions, the majority agreed the informal practices prompted by Compassion Coach helped them feel grounded and centered (110/150, 73%), improved compassion (29/41, 71%), reduced burnout (106/191, 56%), and improved their mood (133/191, 70%). In total, 16 (55%) of the 29 participants accessed guided audio recordings on average 3 (SD 3.4) times throughout the program. At the posttreatment time point, most participants (13/18, 72%) indicated that Compassion Coach helped them engage in compassion practices in daily life, and half (9/18, 50%) indicated that Compassion Coach helped improve interactions with patients. Conclusions: Overall, preliminary results of Compassion Coach are encouraging and suggest the integration of a smartphone app with an ongoing mindfulness and self-compassion training program may bolster the effects of the program on medical trainees. However, there was variability in engagement with Compassion Coach and perceived helpfulness. Additional research is indicated to optimize this novel mHealth approach and conduct a study powered to formally evaluate effects. UR - https://formative.jmir.org/2024/1/e60670 UR - http://dx.doi.org/10.2196/60670 UR - http://www.ncbi.nlm.nih.gov/pubmed/39589766 ID - info:doi/10.2196/60670 ER - TY - JOUR AU - Huang, Ting-Yun AU - Hsieh, Hsing Pei AU - Chang, Yung-Chun PY - 2024/11/21 TI - Performance Comparison of Junior Residents and ChatGPT in the Objective Structured Clinical Examination (OSCE) for Medical History Taking and Documentation of Medical Records: Development and Usability Study JO - JMIR Med Educ SP - e59902 VL - 10 KW - large language model KW - medical history taking KW - clinical documentation KW - simulation-based evaluation KW - OSCE standards KW - LLM N2 - Background: This study explores the cutting-edge abilities of large language models (LLMs) such as ChatGPT in medical history taking and medical record documentation, with a focus on their practical effectiveness in clinical settings?an area vital for the progress of medical artificial intelligence. Objective: Our aim was to assess the capability of ChatGPT versions 3.5 and 4.0 in performing medical history taking and medical record documentation in simulated clinical environments. The study compared the performance of nonmedical individuals using ChatGPT with that of junior medical residents. Methods: A simulation involving standardized patients was designed to mimic authentic medical history?taking interactions. Five nonmedical participants used ChatGPT versions 3.5 and 4.0 to conduct medical histories and document medical records, mirroring the tasks performed by 5 junior residents in identical scenarios. A total of 10 diverse scenarios were examined. Results: Evaluation of the medical documentation created by laypersons with ChatGPT assistance and those created by junior residents was conducted by 2 senior emergency physicians using audio recordings and the final medical records. The assessment used the Objective Structured Clinical Examination benchmarks in Taiwan as a reference. ChatGPT-4.0 exhibited substantial enhancements over its predecessor and met or exceeded the performance of human counterparts in terms of both checklist and global assessment scores. Although the overall quality of human consultations remained higher, ChatGPT-4.0?s proficiency in medical documentation was notably promising. Conclusions: The performance of ChatGPT 4.0 was on par with that of human participants in Objective Structured Clinical Examination evaluations, signifying its potential in medical history and medical record documentation. Despite this, the superiority of human consultations in terms of quality was evident. The study underscores both the promise and the current limitations of LLMs in the realm of clinical practice. UR - https://mededu.jmir.org/2024/1/e59902 UR - http://dx.doi.org/10.2196/59902 ID - info:doi/10.2196/59902 ER - TY - JOUR AU - Lee, Allison AU - Goodman, Stephanie AU - Chen, Miao Chen AU - Landau, Ruth AU - Chatterji, Madhabi PY - 2024/11/19 TI - Electronic Feedback Alone Versus Electronic Feedback Plus in-Person Debriefing for a Serious Game Designed to Teach Novice Anesthesiology Residents to Perform General Anesthesia for Cesarean Delivery: Randomized Controlled Trial JO - JMIR Serious Games SP - e59047 VL - 12 KW - general anesthesia KW - cesarean delivery KW - multiple choice questions KW - serious game KW - debriefing KW - feedback KW - anesthesia KW - anesthesiology KW - anesthesiologist KW - anesthetist KW - cesarean KW - EmergenCSim KW - randomized controlled trial N2 - Background: EmergenCSim is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia for emergent cesarean delivery for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared with using electronic feedback alone. Objective: We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. Methods: Novice first-year anesthesiology residents (CA-1; n=51) (1) watched a recorded lecture on general anesthesia for emergent cesarean delivery, (2) took a 26-item multiple-choice question pretest, and (3) played EmergenCSim (maximum score of 196.5). They were randomized to either the control group that experienced the electronic feedback alone (group EF, n=26) or the intervention group that experienced the SG-embedded electronic feedback and an in-person debriefing (group IPD+EF, n=25). All participants played the SG a second time, with instructions to try to increase their score, and then they took a 26-item multiple-choice question posttest. Pre- and posttests (maximum score of 26 points each) were validated parallel forms. Results: For groups EF and IPD+EF, respectively, mean pretest scores were 18.6 (SD 2.5) and 19.4 (SD 2.3), and mean posttest scores were 22.6 (SD 2.2) and 22.1 (SD 1.6; F1,49=1.8, P=.19). SG scores for groups EF and IPD+EF, respectively, were?mean first play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean second play SG scores of 163.1 (SE 2.9) and 173.3 (SE 2.9; F1,49=137.7, P<.001). Conclusions: Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools. UR - https://games.jmir.org/2024/1/e59047 UR - http://dx.doi.org/10.2196/59047 ID - info:doi/10.2196/59047 ER - TY - JOUR AU - Hamarash, Qadir Mariwan AU - Ibrahim, Radhwan AU - Yaas, Hussein Marghoob AU - Abdulghani, Faris Mohammed AU - Al Mushhadany, Osama PY - 2024/11/19 TI - Comparative Effectiveness of Health Communication Strategies in Nursing: A Mixed Methods Study of Internet, mHealth, and Social Media Versus Traditional Methods JO - JMIR Nursing SP - e55744 VL - 7 KW - nursing education KW - nursing KW - nursing students KW - communication modalities KW - internet-based resources KW - nursing curriculum KW - mHealth clinical learning KW - mHealth KW - mobile health KW - social media N2 - Background: Effective communication is vital in health care, especially for nursing students who are the future of health care delivery. In Iraq?s nursing education landscape, characterized by challenges such as resource constraints and infrastructural limitations, understanding communication modalities is crucial. Objective: This mixed methods study conducted in 2 nursing colleges aims to explore and compare the effectiveness of health communication on the web, through mobile health (mHealth) applications, and via social media among nursing students in Iraq. The research addresses a gap in understanding communication modalities specific to Iraq and explores the perspectives, experiences, and challenges faced by nursing students. Methods: Qualitative interviews were conducted with a purposive sample (n=30), and a structured survey was distributed to a larger sample (n=300) representing diverse educational programs. The study used a nuanced approach to gather insights into the preferences and usage patterns of nursing students regarding communication modalities. The study was conducted between January 12, 2023, and May 5, 2023. Results: Qualitative findings highlighted nursing students? reliance on the web for educational materials, the significant role of mHealth applications in clinical skill development, and the emergence of social media platforms as community-building tools. Quantitative results revealed high-frequency web use (276/300, 92%) for educational purposes, regular mHealth application usage (204/300, 68%) in clinical settings, and active engagement on social media platforms (240/300, 80%). Traditional methods such as face-to-face interactions (216/300, 72%) and practical experiences (255/300, 85%) were preferred for developing essential skills. Conclusions: The study underscores nursing students? preference for an integrated approach, recognizing the complementary strengths of traditional and digital methods. Challenges include concerns about information accuracy and ethical considerations in digital spaces. The findings emphasize the need for curriculum adjustments that seamlessly integrate diverse communication modalities to create a dynamic learning environment. Educators play a crucial role in shaping this integration, emphasizing the enduring value of face-to-face interactions and practical experiences while harnessing the benefits of digital resources. Clear guidelines on professional behavior online are essential. Overall, the study expands the understanding of communication modalities among nursing students in Iraq and provides valuable insights for health care education stakeholders globally. UR - https://nursing.jmir.org/2024/1/e55744 UR - http://dx.doi.org/10.2196/55744 ID - info:doi/10.2196/55744 ER - TY - JOUR AU - Zhou, You AU - Li, Si-Jia AU - Tang, Xing-Yi AU - He, Yi-Chen AU - Ma, Hao-Ming AU - Wang, Ao-Qi AU - Pei, Run-Yuan AU - Piao, Mei-Hua PY - 2024/11/19 TI - Using ChatGPT in Nursing: Scoping Review of Current Opinions JO - JMIR Med Educ SP - e54297 VL - 10 KW - ChatGPT KW - large language model KW - nursing KW - artificial intelligence KW - scoping review KW - generative AI KW - nursing education N2 - Background: Since the release of ChatGPT in November 2022, this emerging technology has garnered a lot of attention in various fields, and nursing is no exception. However, to date, no study has comprehensively summarized the status and opinions of using ChatGPT across different nursing fields. Objective: We aim to synthesize the status and opinions of using ChatGPT according to different nursing fields, as well as assess ChatGPT?s strengths, weaknesses, and the potential impacts it may cause. Methods: This scoping review was conducted following the framework of Arksey and O?Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive literature research was conducted in 4 web-based databases (PubMed, Embase, Web of Science, and CINHAL) to identify studies reporting the opinions of using ChatGPT in nursing fields from 2022 to September 3, 2023. The references of the included studies were screened manually to further identify relevant studies. Two authors conducted studies screening, eligibility assessments, and data extraction independently. Results: A total of 30 studies were included. The United States (7 studies), Canada (5 studies), and China (4 studies) were countries with the most publications. In terms of fields of concern, studies mainly focused on ?ChatGPT and nursing education? (20 studies), ?ChatGPT and nursing practice? (10 studies), and ?ChatGPT and nursing research, writing, and examination? (6 studies). Six studies addressed the use of ChatGPT in multiple nursing fields. Conclusions: As an emerging artificial intelligence technology, ChatGPT has great potential to revolutionize nursing education, nursing practice, and nursing research. However, researchers, institutions, and administrations still need to critically examine its accuracy, safety, and privacy, as well as academic misconduct and potential ethical issues that it may lead to before applying ChatGPT to practice. UR - https://mededu.jmir.org/2024/1/e54297 UR - http://dx.doi.org/10.2196/54297 ID - info:doi/10.2196/54297 ER - TY - JOUR AU - Mørk, Gry AU - Bonsaksen, Tore AU - Larsen, Sønnik Ole AU - Kunnikoff, Martin Hans AU - Lie, Stangeland Silje PY - 2024/11/19 TI - Virtual Reality Simulation in Undergraduate Health Care Education Programs: Usability Study JO - JMIR Med Educ SP - e56844 VL - 10 KW - 360° videos KW - health professions education KW - virtual reality KW - usability study KW - undergraduates KW - university KW - students KW - simulation N2 - Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360° videos in VR headsets, followed by peer debrief and group discussions, may strengthen students? social and emotional learning. Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway. Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions. Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60%), while occupational therapy students less often had prior experience (37%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers. Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking. UR - https://mededu.jmir.org/2024/1/e56844 UR - http://dx.doi.org/10.2196/56844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56844 ER - TY - JOUR AU - Hertel, Kay Amanda AU - Ajlan, S. Radwan PY - 2024/11/13 TI - Impact of Ophthalmic Knowledge Assessment Program Scores and Surgical Volume on Subspecialty Fellowship Application in Ophthalmology Residency: Retrospective Cohort Study JO - JMIR Med Educ SP - e60940 VL - 10 KW - residency KW - fellowship KW - ophthalmology KW - OKAP KW - surgical training KW - ophthalmology resident KW - ophthalmology residency program KW - examination KW - surgical volume exposure KW - fellowship training KW - surgical volume KW - exposure KW - Ophthalmic Knowledge Assessment Program N2 - Background: Ophthalmology residents take the Ophthalmic Knowledge Assessment Program (OKAP) exam annually, which provides percentile rank for multiple categories and the total score. In addition, ophthalmology residency training programs have multiple subspecialty rotations with defined minimum procedure requirements. However, residents? surgical volumes vary, with some residents exceeding their peers in specific subspecialty rotations. Objective: This study aims to identify if there is a difference in OKAP examination scores and surgical volume exposure during ophthalmology residency training between nonfellowship and fellowship applicants and among various subspecialties. Methods: A retrospective review of OKAP scores and surgical procedure numbers of graduating residents in an accredited academic ophthalmology residency program in the Midwest United States was conducted. Data were collected from 2012 to 2022. Results: A total of 31 residents were identified. Most residents decided to pursue fellowship training upon graduation (20/31, 65% residents), and the rest chose to practice comprehensive ophthalmology (11/31, 35% residents). A total of 18/31 residents had OKAP score reports available. The fellowship group outperformed the nonfellowship group in multiple subsections and the total exam (P=.04). Those pursuing fellowship training in glaucoma performed higher on the Glaucoma section (P=.004) and the total exam (P=.005). Residents pursuing cornea performed higher on nearly all subsections, including External Disease and Cornea (P=.02) and the total exam (P=.007). The majority of the surgical volume exposure was identical between fellowship and nonfellowship groups. Those who pursued glaucoma fellowship performed more glaucoma filtering and shunting procedures (P=.03). Residents going into pediatrics fellowship were primary surgeons in more strabismus cases (P=.01), assisted in fewer strabismus cases (P<.001), and had no difference in the total number of strabismus surgeries. Conclusions: In our program, residents pursuing fellowship training had higher OKAP scores on multiple sections and the total exam. There was no significant difference in the overall surgical volume averages between fellowship and nonfellowship groups, but few differences existed in subspecialty procedures among fellowship applicants. Larger multicenter studies are needed to clarify the relationship between OKAP scores and ophthalmology fellowship decisions nationwide. UR - https://mededu.jmir.org/2024/1/e60940 UR - http://dx.doi.org/10.2196/60940 ID - info:doi/10.2196/60940 ER - TY - JOUR AU - Pang, MengWei AU - Lu, WeiYu AU - Huang, Chuling AU - Lin, Meixiu AU - Ran, Jiangsheng AU - Tang, Xiaomei AU - Huang, YuanDing AU - Yang, Sheng AU - Song, Jinlin PY - 2024/11/11 TI - Development of an Interprofessional Education Project in Dentistry Based on the Positive Behavior Support Theory: Pilot Curriculum Development and Validation Study JO - JMIR Form Res SP - e50389 VL - 8 KW - innovative interprofessional education KW - dentistry KW - dental technology KW - positive behavior support KW - IPE KW - positive behavior KW - training system KW - dental education KW - N2 - Background: Effective interprofessional education (IPE) can facilitate teamwork between dentists and dental technicians, thereby enabling the efficient provision of high-quality dental care. Objective: This study aimed to design and assess an IPE module named Project 35, which was offered to dental and dental technology students early in their undergraduate training as a precursor to a more comprehensive IPE curriculum in dentistry and dental technology. Methods: Leveraging positive behavior support (PBS) theory, Project 35 was devised as an innovation and entrepreneurship educational training framework. It used project-based learning to cultivate teamwork skills and to promote the professional development of dental and dental technology students. The pilot study was designed to present the IPE module and preliminarily assess its validity. In survey 1, which was conducted immediately after the course, the dental and dental technology students? self-reported skill acquisition and attitudes were assessed and compared. Survey 2, conducted 1 year after the course, focused on the comparative benefits of Project 35 training for dental technology students versus an untrained group. Results: A total of 66 students, including 36 dental students and 30 dental technology students who had undertaken the training, were recruited. Project 35 training improved teamwork skills for students in both disciplines comparably, and the students recognized the training as highly valuable and effective. The mean values for all items indicating skills improvement of students ranged from 4.13 (SD 0.797) to 4.63 (SD 0.495) for dental students and from 4.13 (SD 0.869) to 4.74 (SD 0.619) for dental technology students. Among the dental technology students, the trained group showed greater independent and innovative approaches and was more optimistic about the future of the profession than the nontrained group (P<.05). Conclusions: Despite the small sample size, the validity of the Project 35 training system was evident, and the success of our pilot study provides a sound basis for the future development of IPE in clinical dental and dental technology education programs. UR - https://formative.jmir.org/2024/1/e50389 UR - http://dx.doi.org/10.2196/50389 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50389 ER - TY - JOUR AU - Wang, Leyao AU - Wan, Zhiyu AU - Ni, Congning AU - Song, Qingyuan AU - Li, Yang AU - Clayton, Ellen AU - Malin, Bradley AU - Yin, Zhijun PY - 2024/11/7 TI - Applications and Concerns of ChatGPT and Other Conversational Large Language Models in Health Care: Systematic Review JO - J Med Internet Res SP - e22769 VL - 26 KW - large language model KW - ChatGPT KW - artificial intelligence KW - natural language processing KW - health care KW - summarization KW - medical knowledge inquiry KW - reliability KW - bias KW - privacy N2 - Background: The launch of ChatGPT (OpenAI) in November 2022 attracted public attention and academic interest to large language models (LLMs), facilitating the emergence of many other innovative LLMs. These LLMs have been applied in various fields, including health care. Numerous studies have since been conducted regarding how to use state-of-the-art LLMs in health-related scenarios. Objective: This review aims to summarize applications of and concerns regarding conversational LLMs in health care and provide an agenda for future research in this field. Methods: We used PubMed, ACM, and the IEEE digital libraries as primary sources for this review. We followed the guidance of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to screen and select peer-reviewed research articles that (1) were related to health care applications and conversational LLMs and (2) were published before September 1, 2023, the date when we started paper collection. We investigated these papers and classified them according to their applications and concerns. Results: Our search initially identified 820 papers according to targeted keywords, out of which 65 (7.9%) papers met our criteria and were included in the review. The most popular conversational LLM was ChatGPT (60/65, 92% of papers), followed by Bard (Google LLC; 1/65, 2% of papers), LLaMA (Meta; 1/65, 2% of papers), and other LLMs (6/65, 9% papers). These papers were classified into four categories of applications: (1) summarization, (2) medical knowledge inquiry, (3) prediction (eg, diagnosis, treatment recommendation, and drug synergy), and (4) administration (eg, documentation and information collection), and four categories of concerns: (1) reliability (eg, training data quality, accuracy, interpretability, and consistency in responses), (2) bias, (3) privacy, and (4) public acceptability. There were 49 (75%) papers using LLMs for either summarization or medical knowledge inquiry, or both, and there are 58 (89%) papers expressing concerns about either reliability or bias, or both. We found that conversational LLMs exhibited promising results in summarization and providing general medical knowledge to patients with a relatively high accuracy. However, conversational LLMs such as ChatGPT are not always able to provide reliable answers to complex health-related tasks (eg, diagnosis) that require specialized domain expertise. While bias or privacy issues are often noted as concerns, no experiments in our reviewed papers thoughtfully examined how conversational LLMs lead to these issues in health care research. Conclusions: Future studies should focus on improving the reliability of LLM applications in complex health-related tasks, as well as investigating the mechanisms of how LLM applications bring bias and privacy issues. Considering the vast accessibility of LLMs, legal, social, and technical efforts are all needed to address concerns about LLMs to promote, improve, and regularize the application of LLMs in health care. UR - https://www.jmir.org/2024/1/e22769 UR - http://dx.doi.org/10.2196/22769 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/22769 ER - TY - JOUR AU - Bicknell, T. Brenton AU - Butler, Danner AU - Whalen, Sydney AU - Ricks, James AU - Dixon, J. Cory AU - Clark, B. Abigail AU - Spaedy, Olivia AU - Skelton, Adam AU - Edupuganti, Neel AU - Dzubinski, Lance AU - Tate, Hudson AU - Dyess, Garrett AU - Lindeman, Brenessa AU - Lehmann, Soleymani Lisa PY - 2024/11/6 TI - ChatGPT-4 Omni Performance in USMLE Disciplines and Clinical Skills: Comparative Analysis JO - JMIR Med Educ SP - e63430 VL - 10 KW - large language model KW - ChatGPT KW - medical education KW - USMLE KW - AI in medical education KW - medical student resources KW - educational technology KW - artificial intelligence in medicine KW - clinical skills KW - LLM KW - medical licensing examination KW - medical students KW - United States Medical Licensing Examination KW - ChatGPT 4 Omni KW - ChatGPT 4 KW - ChatGPT 3.5 N2 - Background: Recent studies, including those by the National Board of Medical Examiners, have highlighted the remarkable capabilities of recent large language models (LLMs) such as ChatGPT in passing the United States Medical Licensing Examination (USMLE). However, there is a gap in detailed analysis of LLM performance in specific medical content areas, thus limiting an assessment of their potential utility in medical education. Objective: This study aimed to assess and compare the accuracy of successive ChatGPT versions (GPT-3.5, GPT-4, and GPT-4 Omni) in USMLE disciplines, clinical clerkships, and the clinical skills of diagnostics and management. Methods: This study used 750 clinical vignette-based multiple-choice questions to characterize the performance of successive ChatGPT versions (ChatGPT 3.5 [GPT-3.5], ChatGPT 4 [GPT-4], and ChatGPT 4 Omni [GPT-4o]) across USMLE disciplines, clinical clerkships, and in clinical skills (diagnostics and management). Accuracy was assessed using a standardized protocol, with statistical analyses conducted to compare the models? performances. Results: GPT-4o achieved the highest accuracy across 750 multiple-choice questions at 90.4%, outperforming GPT-4 and GPT-3.5, which scored 81.1% and 60.0%, respectively. GPT-4o?s highest performances were in social sciences (95.5%), behavioral and neuroscience (94.2%), and pharmacology (93.2%). In clinical skills, GPT-4o?s diagnostic accuracy was 92.7% and management accuracy was 88.8%, significantly higher than its predecessors. Notably, both GPT-4o and GPT-4 significantly outperformed the medical student average accuracy of 59.3% (95% CI 58.3?60.3). Conclusions: GPT-4o?s performance in USMLE disciplines, clinical clerkships, and clinical skills indicates substantial improvements over its predecessors, suggesting significant potential for the use of this technology as an educational aid for medical students. These findings underscore the need for careful consideration when integrating LLMs into medical education, emphasizing the importance of structured curricula to guide their appropriate use and the need for ongoing critical analyses to ensure their reliability and effectiveness. UR - https://mededu.jmir.org/2024/1/e63430 UR - http://dx.doi.org/10.2196/63430 ID - info:doi/10.2196/63430 ER - TY - JOUR AU - Bhavaraju, L. Vasudha AU - Panchanathan, Sarada AU - Willis, C. Brigham AU - Garcia-Filion, Pamela PY - 2024/11/6 TI - Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study JO - JMIR Med Educ SP - e53337 VL - 10 KW - clinical informatics KW - electronic health record KW - pediatric resident KW - COVID-19 KW - competence-based medical education KW - pediatric KW - children KW - SARS-CoV-2 KW - clinic KW - urban KW - diagnosis KW - health informatics KW - EHR KW - individualized learning plan N2 - Background: Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee?s experiences using existing tools. Objective: This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. Methods: This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020?2022) were compared with class and graduated resident (classes of 2016?2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Results: Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. Conclusions: This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education. UR - https://mededu.jmir.org/2024/1/e53337 UR - http://dx.doi.org/10.2196/53337 ID - info:doi/10.2196/53337 ER - TY - JOUR AU - Neher, N. Andrea AU - Wespi, Rafael AU - Rapphold, D. Benjamin AU - Sauter, C. Thomas AU - Kämmer, E. Juliane AU - Birrenbach, Tanja PY - 2024/11/4 TI - Interprofessional Team Training With Virtual Reality: Acceptance, Learning Outcome, and Feasibility Evaluation Study JO - JMIR Serious Games SP - e57117 VL - 12 KW - medical education KW - simulation KW - virtual reality KW - VR KW - emergency medicine KW - interprofessional team training KW - nursing students KW - medical students KW - evaluation study KW - assessment KW - effectiveness KW - patient care KW - simulation-based training KW - hemorrhage KW - epileptic seizure KW - headache N2 - Background: Effective interprofessional teamwork is vital for ensuring high-quality patient care, especially in emergency medicine. However, interprofessional education often fails to facilitate meaningful interaction among health care disciplines. It is therefore imperative to afford early opportunities for cultivating interprofessional teamwork skills. While in-person simulation-based training has been shown to improve performance, this is resource-intensive, especially if it involves multiple professions. Virtual reality (VR)?based training is an innovative instructional approach that demands fewer resources and offers the flexibility of location-independent learning. Objective: This study aimed to develop and evaluate the acceptance, learning outcome, and feasibility of an interprofessional team (INTEAM) training course that included a VR simulation of a neurological emergency case. Methods: This 1-group study used a pre- and posttest design to evaluate the 2-hour INTEAM training course for nursing and medical students. The course included an e-learning part, VR simulation, and debriefing. The main learning objectives were derived from the entrustable professional activity 6, namely to handle a common problem in emergency medicine (headache due to subarachnoid hemorrhage and epileptic seizure) that requires interprofessional collaboration, including a structured handover. We used validated and self-constructed questionnaires, pre- and posttests, and open questions to assess the acceptance, learning outcome, and feasibility of the course. Results: The data of 42 students (21 nursing and 21 medical students) were analyzed and showed good usability in the System Usability Scale (median 72.5, IQR 65?80). The perception of usefulness (median 6, IQR 5.8?6.9) and ease of use (median 5.9, IQR 5.1?6.3) was good among all students. There was a significant increase in the handover performance from pre- (median 8, IQR 6?9) to posttraining (median 8, IQR 7?9; z=?2.01; P=.045; r=0.33) and of the confidence in caring for patients with seizures (median 3, IQR 2?3 and median 3.5, IQR 3?4, respectively; z=?3.8; P<.001; r=0.60). In 67% (14/21) of the simulations, technical issues occurred, but all simulations could be carried out completely. Conclusions: The new INTEAM training course was well received by nursing and medical students. The handover skills and confidence in caring for patients with seizures were improved after the course. Despite technical challenges with the VR simulations, none required termination, and this demonstrates that our approach is feasible. These promising results encourage the use of VR simulations for team training in the education of nursing and medical students. UR - https://games.jmir.org/2024/1/e57117 UR - http://dx.doi.org/10.2196/57117 ID - info:doi/10.2196/57117 ER - TY - JOUR AU - Karabacak, Mert AU - Ozcan, Zeynep AU - Ozkara, Berksu Burak AU - Furkan, Sude Zeynep AU - Bisdas, Sotirios PY - 2024/10/31 TI - A Pilot Project to Promote Research Competency in Medical Students Through Journal Clubs: Mixed Methods Study JO - JMIR Med Educ SP - e51173 VL - 10 KW - medical student KW - research KW - peer education KW - student society KW - journal club KW - skills KW - scientific investigation KW - undergraduate KW - student-led KW - initiative KW - resources KW - research training KW - competency KW - continuing education KW - research improvement KW - motivation KW - mentor KW - mentorship KW - medical education N2 - Background: Undergraduate medical students often lack hands-on research experience and fundamental scientific research skills, limiting their exposure to the practical aspects of scientific investigation. The Cerrahpasa Neuroscience Society introduced a program to address this deficiency and facilitate student-led research. Objective: The primary goal of this initiative was to enhance medical students? research output by enabling them to generate and publish peer-reviewed papers within the framework of this pilot project. The project aimed to provide an accessible, global model for research training through structured journal clubs, mentorship from experienced peers, and resource access. Methods: In January 2022, a total of 30 volunteer students from various Turkish medical schools participated in this course-based undergraduate research experience program. Students self-organized into 2 groups according to their preferred study type: original research or systematic review. Two final-year students with prior research experience led the project, developing training modules using selected materials. The project was implemented entirely online, with participants completing training modules before using their newly acquired theoretical knowledge to perform assigned tasks. Results: Based on student feedback, the project timeline was adjusted to allow for greater flexibility in meeting deadlines. Despite these adjustments, participants successfully completed their tasks, applying the theoretical knowledge they had gained to their respective assignments. As of April 2024, the initiative has culminated in 3 published papers and 3 more under peer review. The project has also seen an increase in student interest in further involvement and self-paced learning. Conclusions: This initiative leverages globally accessible resources for research training, effectively fostering research competency among participants. It has successfully demonstrated the potential for undergraduates to contribute to medical research output and paved the way for a self-sustaining, student-led research program. Despite some logistical challenges, the project provided valuable insights for future implementations, showcasing the potential for students to engage in meaningful, publishable research. UR - https://mededu.jmir.org/2024/1/e51173 UR - http://dx.doi.org/10.2196/51173 ID - info:doi/10.2196/51173 ER - TY - JOUR AU - Mun, Michelle AU - Chanchlani, Sonia AU - Lyons, Kayley AU - Gray, Kathleen PY - 2024/10/31 TI - Transforming the Future of Digital Health Education: Redesign of a Graduate Program Using Competency Mapping JO - JMIR Med Educ SP - e54112 VL - 10 KW - digital health KW - digital transformation KW - health care KW - clinical informatics KW - competencies KW - graduate education UR - https://mededu.jmir.org/2024/1/e54112 UR - http://dx.doi.org/10.2196/54112 ID - info:doi/10.2196/54112 ER - TY - JOUR AU - Elhariry, Maiar AU - Malhotra, Kashish AU - Goyal, Kashish AU - Bardus, Marco AU - Team, CoMICs SIMBA and AU - Kempegowda, Punith PY - 2024/10/30 TI - A SIMBA CoMICs Initiative to Cocreating and Disseminating Evidence-Based, Peer-Reviewed Short Videos on Social Media: Mixed Methods Prospective Study JO - JMIR Med Educ SP - e52924 VL - 10 KW - influencers KW - social media KW - public engagement KW - apps KW - healthcare KW - medical students KW - online medical information KW - simulation KW - peer-reviewed information N2 - Background: Social media is a powerful platform for disseminating health information, yet it is often riddled with misinformation. Further, few guidelines exist for producing reliable, peer-reviewed content. This study describes a framework for creating and disseminating evidence-based videos on polycystic ovary syndrome (PCOS) and thyroid conditions to improve health literacy and tackle misinformation. Objective: The study aims to evaluate the creation, dissemination, and impact of evidence-based, peer-reviewed short videos on PCOS and thyroid disorders across social media. It also explores the experiences of content creators and assesses audience engagement. Methods: This mixed methods prospective study was conducted between December 2022 and May 2023 and comprised five phases: (1) script generation, (2) video creation, (3) cross-platform publication, (4) process evaluation, and (5) impact evaluation. The SIMBA-CoMICs (Simulation via Instant Messaging for Bedside Application?Combined Medical Information Cines) initiative provides a structured process where medical concepts are simplified and converted to visually engaging videos. The initiative recruited medical students interested in making visually appealing and scientifically accurate videos for social media. The students were then guided to create video scripts based on frequently searched PCOS- and thyroid-related topics. Once experts confirmed the accuracy of the scripts, the medical students produced the videos. The videos were checked by clinical experts and experts with lived experience to ensure clarity and engagement. The SIMBA-CoMICs team then guided the students in editing these videos to fit platform requirements before posting them on TikTok, Instagram, YouTube, and Twitter. Engagement metrics were tracked over 2 months. Content creators were interviewed, and thematic analysis was performed to explore their experiences. Results: The 20 videos received 718 likes, 120 shares, and 54,686 views across all platforms, with TikTok (19,458 views) and Twitter (19,678 views) being the most popular. Engagement increased significantly, with follower growth ranging from 5% on Twitter to 89% on TikTok. Thematic analysis of interviews with 8 out of 38 participants revealed 4 key themes: views on social media, advice for using social media, reasons for participating, and reflections on the project. Content creators highlighted the advantages of social media, such as large outreach (12 references), convenience (10 references), and accessibility to opportunities (7 references). Participants appreciated the nonrestrictive participation criteria, convenience (8 references), and the ability to record from home using prewritten scripts (6 references). Further recommendations to improve the content creation experience included awareness of audience demographics (9 references), sharing content on multiple platforms (5 references), and collaborating with organizations (3 references). Conclusions: This study demonstrates the effectiveness of the SIMBA CoMICs initiative in training medical students to create accurate medical information on PCOS and thyroid disorders for social media dissemination. The model offers a scalable solution to combat misinformation and improve health literacy. UR - https://mededu.jmir.org/2024/1/e52924 UR - http://dx.doi.org/10.2196/52924 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52924 ER - TY - JOUR AU - Tao, Wenjuan AU - Yang, Jinming AU - Qu, Xing PY - 2024/10/28 TI - Utilization of, Perceptions on, and Intention to Use AI Chatbots Among Medical Students in China: National Cross-Sectional Study JO - JMIR Med Educ SP - e57132 VL - 10 KW - medical education KW - artificial intelligence KW - UTAUT model KW - utilization KW - medical students KW - cross-sectional study KW - AI chatbots KW - China KW - acceptance KW - electronic survey KW - social media KW - medical information KW - risk KW - training KW - support N2 - Background: Artificial intelligence (AI) chatbots are poised to have a profound impact on medical education. Medical students, as early adopters of technology and future health care providers, play a crucial role in shaping the future of health care. However, little is known about the utilization of, perceptions on, and intention to use AI chatbots among medical students in China. Objective: This study aims to explore the utilization of, perceptions on, and intention to use generative AI chatbots among medical students in China, using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. By conducting a national cross-sectional survey, we sought to identify the key determinants that influence medical students? acceptance of AI chatbots, thereby providing a basis for enhancing their integration into medical education. Understanding these factors is crucial for educators, policy makers, and technology developers to design and implement effective AI-driven educational tools that align with the needs and expectations of future health care professionals. Methods: A web-based electronic survey questionnaire was developed and distributed via social media to medical students across the country. The UTAUT was used as a theoretical framework to design the questionnaire and analyze the data. The relationship between behavioral intention to use AI chatbots and UTAUT predictors was examined using multivariable regression. Results: A total of 693 participants were from 57 universities covering 21 provinces or municipalities in China. Only a minority (199/693, 28.72%) reported using AI chatbots for studying, with ChatGPT (129/693, 18.61%) being the most commonly used. Most of the participants used AI chatbots for quickly obtaining medical information and knowledge (631/693, 91.05%) and increasing learning efficiency (594/693, 85.71%). Utilization behavior, social influence, facilitating conditions, perceived risk, and personal innovativeness showed significant positive associations with the behavioral intention to use AI chatbots (all P values were <.05). Conclusions: Chinese medical students hold positive perceptions toward and high intentions to use AI chatbots, but there are gaps between intention and actual adoption. This highlights the need for strategies to improve access, training, and support and provide peer usage examples to fully harness the potential benefits of chatbot technology. UR - https://mededu.jmir.org/2024/1/e57132 UR - http://dx.doi.org/10.2196/57132 ID - info:doi/10.2196/57132 ER - TY - JOUR AU - Wang, Shuang AU - Yang, Liuying AU - Li, Min AU - Zhang, Xinghe AU - Tai, Xiantao PY - 2024/10/10 TI - Medical Education and Artificial Intelligence: Web of Science?Based Bibliometric Analysis (2013-2022) JO - JMIR Med Educ SP - e51411 VL - 10 KW - artificial intelligence KW - medical education KW - bibliometric analysis KW - CiteSpace KW - VOSviewer N2 - Background: Incremental advancements in artificial intelligence (AI) technology have facilitated its integration into various disciplines. In particular, the infusion of AI into medical education has emerged as a significant trend, with noteworthy research findings. Consequently, a comprehensive review and analysis of the current research landscape of AI in medical education is warranted. Objective: This study aims to conduct a bibliometric analysis of pertinent papers, spanning the years 2013?2022, using CiteSpace and VOSviewer. The study visually represents the existing research status and trends of AI in medical education. Methods: Articles related to AI and medical education, published between 2013 and 2022, were systematically searched in the Web of Science core database. Two reviewers scrutinized the initially retrieved papers, based on their titles and abstracts, to eliminate papers unrelated to the topic. The selected papers were then analyzed and visualized for country, institution, author, reference, and keywords using CiteSpace and VOSviewer. Results: A total of 195 papers pertaining to AI in medical education were identified from 2013 to 2022. The annual publications demonstrated an increasing trend over time. The United States emerged as the most active country in this research arena, and Harvard Medical School and the University of Toronto were the most active institutions. Prolific authors in this field included Vincent Bissonnette, Charlotte Blacketer, Rolando F Del Maestro, Nicole Ledows, Nykan Mirchi, Alexander Winkler-Schwartz, and Recai Yilamaz. The paper with the highest citation was ?Medical Students? Attitude Towards Artificial Intelligence: A Multicentre Survey.? Keyword analysis revealed that ?radiology,? ?medical physics,? ?ehealth,? ?surgery,? and ?specialty? were the primary focus, whereas ?big data? and ?management? emerged as research frontiers. Conclusions: The study underscores the promising potential of AI in medical education research. Current research directions encompass radiology, medical information management, and other aspects. Technological progress is expected to broaden these directions further. There is an urgent need to bolster interregional collaboration and enhance research quality. These findings offer valuable insights for researchers to identify perspectives and guide future research directions. UR - https://mededu.jmir.org/2024/1/e51411 UR - http://dx.doi.org/10.2196/51411 ID - info:doi/10.2196/51411 ER - TY - JOUR AU - Hofstetter, Sebastian AU - Zilezinski, Max AU - Behr, Dominik AU - Kraft, Bernhard AU - Buhtz, Christian AU - Paulicke, Denny AU - Wolf, Anja AU - Klus, Christina AU - Stoevesandt, Dietrich AU - Schwarz, Karsten AU - Jahn, Patrick PY - 2024/10/9 TI - Integrating Digital Assistive Technologies Into Care Processes: Mixed Methods Study JO - JMIR Med Educ SP - e54083 VL - 10 KW - digital assistive technologies KW - education concept KW - intention to use KW - learning effects KW - digital transformation N2 - Background: Current challenges in patient care have increased research on technology use in nursing and health care. Digital assistive technologies (DATs) are one option that can be incorporated into care processes. However, how the application of DATs should be introduced to nurses and care professionals must be clarified. No structured and effective education concepts for the patient-oriented integration of DATs in the nursing sector are currently available. Objective: This study aims to examine how a structured and guided integration and education concept, herein termed the sensitization, evaluative introduction, qualification, and implementation (SEQI) education concept, can support the integration of DATs into nursing practices. Methods: This study used an explanatory, sequential study design with a mixed methods approach. The SEQI intervention was run in 26 long-term care facilities oriented toward older adults in Germany after a 5-day training course in each. The participating care professionals were asked to test 1 of 6 DATs in real-world practice over 3 days. Surveys (n=112) were then administered that recorded the intention to use DATs at 3 measurement points, and guided qualitative interviews with care professionals (n=12) were conducted to evaluate the learning concepts and effects of the intervention. Results: As this was a pilot study, no sample size calculation was carried out, and P values were not reported. The participating care professionals were generally willing to integrate DATs?as an additional resource?into nursing processes even before the 4-stage SEQI intervention was presented. However, the intervention provided additional background knowledge and sensitized care professionals to the digital transformation, enabling them to evaluate how DATs fit in the health care sector, what qualifies these technologies for correct application, and what promotes their use. The care professionals expressed specific ideas and requirements for both technology-related education concepts and nursing DATs. Conclusions: Actively matching technical support, physical limitations, and patients? needs is crucial when selecting DATs and integrating them into nursing processes. To this end, using a structured process such as SEQI that strengthens care professionals? ability to integrate DATs can help improve the benefits of such technology in the health care setting. Practical, application-oriented learning can promote the long-term implementation of DATs. UR - https://mededu.jmir.org/2024/1/e54083 UR - http://dx.doi.org/10.2196/54083 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54083 ER - TY - JOUR AU - Wu, Zelin AU - Gan, Wenyi AU - Xue, Zhaowen AU - Ni, Zhengxin AU - Zheng, Xiaofei AU - Zhang, Yiyi PY - 2024/10/3 TI - Performance of ChatGPT on Nursing Licensure Examinations in the United States and China: Cross-Sectional Study JO - JMIR Med Educ SP - e52746 VL - 10 KW - artificial intelligence KW - ChatGPT KW - nursing licensure examination KW - nursing KW - LLMs KW - large language models KW - nursing education KW - AI KW - nursing student KW - large language model KW - licensing KW - observation KW - observational study KW - China KW - USA KW - United States of America KW - auxiliary tool KW - accuracy rate KW - theoretical N2 - Background: The creation of large language models (LLMs) such as ChatGPT is an important step in the development of artificial intelligence, which shows great potential in medical education due to its powerful language understanding and generative capabilities. The purpose of this study was to quantitatively evaluate and comprehensively analyze ChatGPT?s performance in handling questions for the National Nursing Licensure Examination (NNLE) in China and the United States, including the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the NNLE. Objective: This study aims to examine how well LLMs respond to the NCLEX-RN and the NNLE multiple-choice questions (MCQs) in various language inputs. To evaluate whether LLMs can be used as multilingual learning assistance for nursing, and to assess whether they possess a repository of professional knowledge applicable to clinical nursing practice. Methods: First, we compiled 150 NCLEX-RN Practical MCQs, 240 NNLE Theoretical MCQs, and 240 NNLE Practical MCQs. Then, the translation function of ChatGPT 3.5 was used to translate NCLEX-RN questions from English to Chinese and NNLE questions from Chinese to English. Finally, the original version and the translated version of the MCQs were inputted into ChatGPT 4.0, ChatGPT 3.5, and Google Bard. Different LLMs were compared according to the accuracy rate, and the differences between different language inputs were compared. Results: The accuracy rates of ChatGPT 4.0 for NCLEX-RN practical questions and Chinese-translated NCLEX-RN practical questions were 88.7% (133/150) and 79.3% (119/150), respectively. Despite the statistical significance of the difference (P=.03), the correct rate was generally satisfactory. Around 71.9% (169/235) of NNLE Theoretical MCQs and 69.1% (161/233) of NNLE Practical MCQs were correctly answered by ChatGPT 4.0. The accuracy of ChatGPT 4.0 in processing NNLE Theoretical MCQs and NNLE Practical MCQs translated into English was 71.5% (168/235; P=.92) and 67.8% (158/233; P=.77), respectively, and there was no statistically significant difference between the results of text input in different languages. ChatGPT 3.5 (NCLEX-RN P=.003, NNLE Theoretical P<.001, NNLE Practical P=.12) and Google Bard (NCLEX-RN P<.001, NNLE Theoretical P<.001, NNLE Practical P<.001) had lower accuracy rates for nursing-related MCQs than ChatGPT 4.0 in English input. English accuracy was higher when compared with ChatGPT 3.5?s Chinese input, and the difference was statistically significant (NCLEX-RN P=.02, NNLE Practical P=.02). Whether submitted in Chinese or English, the MCQs from the NCLEX-RN and NNLE demonstrated that ChatGPT 4.0 had the highest number of unique correct responses and the lowest number of unique incorrect responses among the 3 LLMs. Conclusions: This study, focusing on 618 nursing MCQs including NCLEX-RN and NNLE exams, found that ChatGPT 4.0 outperformed ChatGPT 3.5 and Google Bard in accuracy. It excelled in processing English and Chinese inputs, underscoring its potential as a valuable tool in nursing education and clinical decision-making. UR - https://mededu.jmir.org/2024/1/e52746 UR - http://dx.doi.org/10.2196/52746 ID - info:doi/10.2196/52746 ER - TY - JOUR AU - Ba, Hongjun AU - Zhang, Lili AU - He, Xiufang AU - Li, Shujuan PY - 2024/9/30 TI - Knowledge Mapping and Global Trends in the Field of the Objective Structured Clinical Examination: Bibliometric and Visual Analysis (2004-2023) JO - JMIR Med Educ SP - e57772 VL - 10 KW - Objective Structured Clinical Examination KW - OSCE KW - medical education assessment KW - bibliometric analysis KW - academic collaboration KW - health care professional training KW - medical education KW - medical knowledge KW - medical training KW - medical student N2 - Background: The Objective Structured Clinical Examination (OSCE) is a pivotal tool for assessing health care professionals and plays an integral role in medical education. Objective: This study aims to map the bibliometric landscape of OSCE research, highlighting trends and key influencers. Methods: A comprehensive literature search was conducted for materials related to OSCE from January 2004 to December 2023, using the Web of Science Core Collection database. Bibliometric analysis and visualization were performed with VOSviewer and CiteSpace software tools. Results: Our analysis indicates a consistent increase in OSCE-related publications over the study period, with a notable surge after 2019, culminating in a peak of activity in 2021. The United States emerged as a significant contributor, responsible for 30.86% (1626/5268) of total publications and amassing 44,051 citations. Coauthorship network analysis highlighted robust collaborations, particularly between the United States and the United Kingdom. Leading journals in this domain?BMC Medical Education, Medical Education, Academic Medicine, and Medical Teacher?featured the highest volume of papers, while The Lancet garnered substantial citations, reflecting its high impact factor (to be verified for accuracy). Prominent authors in the field include Sondra Zabar, Debra Pugh, Timothy J Wood, and Susan Humphrey-Murto, with Ronaldo M Harden, Brian D Hodges, and George E Miller being the most cited. The analysis of key research terms revealed a focus on ?education,? ?performance,? ?competence,? and ?skills,? indicating these are central themes in OSCE research. Conclusions: The study underscores a dynamic expansion in OSCE research and international collaboration, spotlighting influential countries, institutions, authors, and journals. These elements are instrumental in steering the evolution of medical education assessment practices and suggest a trajectory for future research endeavors. Future work should consider the implications of these findings for medical education and the potential areas for further investigation, particularly in underrepresented regions or emerging competencies in health care training. UR - https://mededu.jmir.org/2024/1/e57772 UR - http://dx.doi.org/10.2196/57772 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57772 ER - TY - JOUR AU - Claman, Daniel AU - Sezgin, Emre PY - 2024/9/27 TI - Artificial Intelligence in Dental Education: Opportunities and Challenges of Large Language Models and Multimodal Foundation Models JO - JMIR Med Educ SP - e52346 VL - 10 KW - artificial intelligence KW - large language models KW - dental education KW - GPT KW - ChatGPT KW - periodontal health KW - AI KW - LLM KW - LLMs KW - chatbot KW - natural language KW - generative pretrained transformer KW - innovation KW - technology KW - large language model UR - https://mededu.jmir.org/2024/1/e52346 UR - http://dx.doi.org/10.2196/52346 ID - info:doi/10.2196/52346 ER - TY - JOUR AU - Perotte, Rimma AU - Berns, Alyssa AU - Shaker, Lana AU - Ophaswongse, Chayapol AU - Underwood, Joseph AU - Hajicharalambous, Christina PY - 2024/9/23 TI - Creation of an Automated and Comprehensive Resident Progress System for Residents and to Save Hours of Faculty Time: Mixed Methods Study JO - JMIR Form Res SP - e53314 VL - 8 KW - progress dashboard KW - informatics in medical education KW - residency learning management system KW - residency progress system KW - residency education system KW - summarization KW - administrative burden KW - medical education KW - resident KW - residency KW - resident data KW - longitudinal KW - pilot study KW - competency KW - dashboards KW - dashboard KW - faculty KW - residents N2 - Background: It is vital for residents to have a longitudinal view of their educational progression, and it is crucial for the medical education team to have a clear way to track resident progress over time. Current tools for aggregating resident data are difficult to use and do not provide a comprehensive way to evaluate and display resident educational advancement. Objective: This study aims to describe the creation and assessment of a system designed to improve the longitudinal presentation, quality, and synthesis of educational progress for trainees. We created a new system for residency progress management with 3 goals in mind, that are (1) a long-term and centralized location for residency education data, (2) a clear and intuitive interface that is easy to access for both the residents and faculty involved in medical education, and (3) automated data input, transformation, and analysis. We present evaluations regarding whether residents find the system useful, and whether faculty like the system and perceive that it helps them save time with administrative duties. Methods: The system was created using a suite of Google Workspace tools including Forms, Sheets, Gmail, and a collection of Apps Scripts triggered at various times and events. To assess whether the system had an effect on the residents, we surveyed and asked them to self-report on how often they accessed the system and interviewed them as to whether they found it useful. To understand what the faculty thought of the system, we conducted a 14-person focus group and asked the faculty to self-report their time spent preparing for residency progress meetings before and after the system debut. Results: The system went live in February 2022 as a quality improvement project, evolving through multiple iterations of feedback. The authors found that the system was accessed differently by different postgraduate years (PGY), with the most usage reported in the PGY1 class (weekly), and the least amount of usage in the PGY3 class (once or twice). However, all of the residents reported finding the system useful, specifically for aggregating all of their evaluations in the same place. Faculty members felt that the system enabled a more high-quality biannual clinical competency committee meeting and they reported a combined time savings of 8 hours in preparation for each clinical competency committee as a result of reviewing resident data through the system. Conclusions: Our study reports on the creation of an automated, instantaneous, and comprehensive resident progress management system. The system has been shown to be well-liked by both residents and faculty. Younger PGY classes reported more frequent system usage than older PGY classes. Faculty reported that it helped facilitate more meaningful discussion of training progression and reduced the administrative burden by 8 hours per biannual session. UR - https://formative.jmir.org/2024/1/e53314 UR - http://dx.doi.org/10.2196/53314 UR - http://www.ncbi.nlm.nih.gov/pubmed/39312292 ID - info:doi/10.2196/53314 ER - TY - JOUR AU - Yamamoto, Akira AU - Koda, Masahide AU - Ogawa, Hiroko AU - Miyoshi, Tomoko AU - Maeda, Yoshinobu AU - Otsuka, Fumio AU - Ino, Hideo PY - 2024/9/23 TI - Enhancing Medical Interview Skills Through AI-Simulated Patient Interactions: Nonrandomized Controlled Trial JO - JMIR Med Educ SP - e58753 VL - 10 KW - medical interview KW - generative pretrained transformer KW - large language model KW - simulation-based learning KW - OSCE KW - artificial intelligence KW - medical education KW - simulated patients KW - nonrandomized controlled trial N2 - Background: Medical interviewing is a critical skill in clinical practice, yet opportunities for practical training are limited in Japanese medical schools, necessitating urgent measures. Given advancements in artificial intelligence (AI) technology, its application in the medical field is expanding. However, reports on its application in medical interviews in medical education are scarce. Objective: This study aimed to investigate whether medical students? interview skills could be improved by engaging with AI-simulated patients using large language models, including the provision of feedback. Methods: This nonrandomized controlled trial was conducted with fourth-year medical students in Japan. A simulation program using large language models was provided to 35 students in the intervention group in 2023, while 110 students from 2022 who did not participate in the intervention were selected as the control group. The primary outcome was the score on the Pre-Clinical Clerkship Objective Structured Clinical Examination (pre-CC OSCE), a national standardized clinical skills examination, in medical interviewing. Secondary outcomes included surveys such as the Simulation-Based Training Quality Assurance Tool (SBT-QA10), administered at the start and end of the study. Results: The AI intervention group showed significantly higher scores on medical interviews than the control group (AI group vs control group: mean 28.1, SD 1.6 vs 27.1, SD 2.2; P=.01). There was a trend of inverse correlation between the SBT-QA10 and pre-CC OSCE scores (regression coefficient ?2.0 to ?2.1). No significant safety concerns were observed. Conclusions: Education through medical interviews using AI-simulated patients has demonstrated safety and a certain level of educational effectiveness. However, at present, the educational effects of this platform on nonverbal communication skills are limited, suggesting that it should be used as a supplementary tool to traditional simulation education. UR - https://mededu.jmir.org/2024/1/e58753 UR - http://dx.doi.org/10.2196/58753 UR - http://www.ncbi.nlm.nih.gov/pubmed/39312284 ID - info:doi/10.2196/58753 ER - TY - JOUR AU - Halim, Freda AU - Widysanto, Allen AU - Wahjoepramono, Perdana Petra Octavian AU - Candrawinata, Siulinda Valeska AU - Budihardja, Setiawan Andi AU - Irawan, Andry AU - Sudirman, Taufik AU - Christina, Natalia AU - Koerniawan, Sutanto Heru AU - Tobing, Lumban Jephtah Furano AU - Sungono, Veli AU - Marlina, Mona AU - Wahjoepramono, Julianta Eka PY - 2024/8/30 TI - Objective Comparison of the First-Person?View Live Streaming Method Versus Face-to-Face Teaching Method in Improving Wound Suturing Skills for Skin Closure in Surgical Clerkship Students: Randomized Controlled Trial JO - JMIR Med Educ SP - e52631 VL - 10 KW - teaching method KW - live streaming KW - first-person view KW - face-to-face KW - simple wound suturing N2 - Background: The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person?view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills. Objective: This study aims to objectively assess the effectiveness of the first-person?view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students. Methods: A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed. Results: A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant?s pre-experiment and postexperiment DOPS scores revealed that the LS method?s outcome is comparable to the FTF method?s outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students? surgical skills. Conclusions: First-person?view LS training sessions could enhance students? ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method. Trial Registration: ClinicalTrials.gov NCT06221917; https://clinicaltrials.gov/study/NCT06221917 UR - https://mededu.jmir.org/2024/1/e52631 UR - http://dx.doi.org/10.2196/52631 ID - info:doi/10.2196/52631 ER - TY - JOUR AU - Lawrence, Katharine AU - Levine, L. Defne PY - 2024/8/29 TI - The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees JO - JMIR Med Educ SP - e54173 VL - 10 KW - digital health KW - digital determinants of health KW - digital health competencies KW - medical education curriculum KW - competency development KW - digital health education KW - training competencies KW - digital health skills KW - digital care delivery KW - health professions training UR - https://mededu.jmir.org/2024/1/e54173 UR - http://dx.doi.org/10.2196/54173 ID - info:doi/10.2196/54173 ER - TY - JOUR AU - Rahadiani, Pratiwi AU - Kekalih, Aria AU - Soemantri, Diantha AU - Krisnamurti, Budi Desak Gede PY - 2024/8/22 TI - Exploring HTML5 Package Interactive Content in Supporting Learning Through Self-Paced Massive Open Online Courses on Healthy Aging: Mixed Methods Study JO - JMIR Med Educ SP - e45468 VL - 10 KW - HTML5 package KW - H5P KW - students? perspectives KW - students? acceptance KW - massive open online courses KW - MOOCs KW - healthy aging KW - self-paced MOOC KW - student KW - perception KW - acceptance KW - opinion KW - attitude KW - MOOC KW - self-paced KW - self-guided KW - online course KW - online learning KW - geriatric KW - gerontology KW - gerontological KW - learning N2 - Background: The rapidly aging population and the growth of geriatric medicine in the field of internal medicine are not supported by sufficient gerontological training in many health care disciplines. There is rising awareness about the education and training needed to adequately prepare health care professionals to address the needs of the older adult population. Massive open online courses (MOOCs) might be the best alternative method of learning delivery in this context. However, the diversity of MOOC participants poses a challenge for MOOC providers to innovate in developing learning content that suits the needs and characters of participants. Objective: The primary outcome of this study was to explore students? perceptions and acceptance of HTML5 package (H5P) interactive content in self-paced MOOCs and its association with students? characteristics and experience in using MOOCs. Methods: This study used a cross-sectional design, combining qualitative and quantitative approaches. Participants, predominantly general practitioners from various regions of Indonesia with diverse educational backgrounds and age groups, completed pretests, engaged with H5P interactive content, and participated in forum discussions and posttests. Data were retrieved from the online questionnaire attached to a selected MOOC course. Students? perceptions and acceptance of H5P interactive content were rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Data were analyzed using SPSS (IBM Corp) to examine demographics, computer literacy, acceptance, and perceptions of H5P interactive content. Quantitative analysis explored correlations, while qualitative analysis identified recurring themes from open-ended survey responses to determine students? perceptions. Results: In total, 184 MOOC participants agreed to participate in the study. Students demonstrated positive perceptions and a high level of acceptance of integrating H5P interactive content within the self-paced MOOC. Analysis of mean (SD) value across all responses consistently revealed favorable scores (greater than 5), ranging from 5.18 (SD 0.861) to 5.45 (SD 0.659) and 5.28 (SD 0.728) to 5.52 (SD 0.627), respectively. This finding underscores widespread satisfaction and robust acceptance of H5P interactive content. Students found the H5P interactive content more satisfying and fun, easier to understand, more effective, and more helpful in improving learning outcomes than material in the form of common documents and learning videos. There is a significant correlation between computer literacy, students? acceptance, and students? perceptions. Conclusions: Students from various backgrounds showed a high level of acceptance and positive perceptions of leveraging H5P interactive content in the self-paced MOOC. The findings suggest potential new uses of H5P interactive content in MOOCs, such as interactive videos with pop-up questions, to substitute for synchronous learning. The study underscores the significance of tailored educational strategies in supporting the professional development of health care professionals. UR - https://mededu.jmir.org/2024/1/e45468 UR - http://dx.doi.org/10.2196/45468 UR - http://www.ncbi.nlm.nih.gov/pubmed/39049507 ID - info:doi/10.2196/45468 ER - TY - JOUR AU - Thomae, V. Anita AU - Witt, M. Claudia AU - Barth, Jürgen PY - 2024/8/22 TI - Integration of ChatGPT Into a Course for Medical Students: Explorative Study on Teaching Scenarios, Students? Perception, and Applications JO - JMIR Med Educ SP - e50545 VL - 10 KW - medical education KW - ChatGPT KW - artificial intelligence KW - information for patients KW - critical appraisal KW - evaluation KW - blended learning KW - AI KW - digital skills KW - teaching N2 - Background: Text-generating artificial intelligence (AI) such as ChatGPT offers many opportunities and challenges in medical education. Acquiring practical skills necessary for using AI in a clinical context is crucial, especially for medical education. Objective: This explorative study aimed to investigate the feasibility of integrating ChatGPT into teaching units and to evaluate the course and the importance of AI-related competencies for medical students. Since a possible application of ChatGPT in the medical field could be the generation of information for patients, we further investigated how such information is perceived by students in terms of persuasiveness and quality. Methods: ChatGPT was integrated into 3 different teaching units of a blended learning course for medical students. Using a mixed methods approach, quantitative and qualitative data were collected. As baseline data, we assessed students? characteristics, including their openness to digital innovation. The students evaluated the integration of ChatGPT into the course and shared their thoughts regarding the future of text-generating AI in medical education. The course was evaluated based on the Kirkpatrick Model, with satisfaction, learning progress, and applicable knowledge considered as key assessment levels. In ChatGPT-integrating teaching units, students evaluated videos featuring information for patients regarding their persuasiveness on treatment expectations in a self-experience experiment and critically reviewed information for patients written using ChatGPT 3.5 based on different prompts. Results: A total of 52 medical students participated in the study. The comprehensive evaluation of the course revealed elevated levels of satisfaction, learning progress, and applicability specifically in relation to the ChatGPT-integrating teaching units. Furthermore, all evaluation levels demonstrated an association with each other. Higher openness to digital innovation was associated with higher satisfaction and, to a lesser extent, with higher applicability. AI-related competencies in other courses of the medical curriculum were perceived as highly important by medical students. Qualitative analysis highlighted potential use cases of ChatGPT in teaching and learning. In ChatGPT-integrating teaching units, students rated information for patients generated using a basic ChatGPT prompt as ?moderate? in terms of comprehensibility, patient safety, and the correct application of communication rules taught during the course. The students? ratings were considerably improved using an extended prompt. The same text, however, showed the smallest increase in treatment expectations when compared with information provided by humans (patient, clinician, and expert) via videos. Conclusions: This study offers valuable insights into integrating the development of AI competencies into a blended learning course. Integration of ChatGPT enhanced learning experiences for medical students. UR - https://mededu.jmir.org/2024/1/e50545 UR - http://dx.doi.org/10.2196/50545 ID - info:doi/10.2196/50545 ER - TY - JOUR AU - Sekiguchi, Kenji AU - Kawano, Seiji AU - Chihara, Norio AU - Satomi-Kobayashi, Seimi AU - Maeda, Eiichi AU - Matsumoto, Riki PY - 2024/8/22 TI - Live Streaming of the Professor?s Ward Rounds in Undergraduate Neurology Education: Usability Study JO - JMIR Form Res SP - e50128 VL - 8 KW - live streaming KW - ward round KW - web conferencing software KW - neurological examination KW - undergraduate education KW - medical student KW - medical education KW - rounds KW - remote education KW - video-conferencing KW - residents KW - live-stream KW - neurology KW - neuroscience KW - web conferencing KW - distance education KW - technology enhanced learning KW - mobile phone N2 - Background: Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. Objective: The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients? personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. Methods: We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. Results: The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73% response rate) showed that the mean score of participants? satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32% (26/82) preferred remote rounds. Conclusions: Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship. UR - https://formative.jmir.org/2024/1/e50128 UR - http://dx.doi.org/10.2196/50128 UR - http://www.ncbi.nlm.nih.gov/pubmed/39172503 ID - info:doi/10.2196/50128 ER - TY - JOUR AU - Holderried, Friederike AU - Stegemann-Philipps, Christian AU - Herrmann-Werner, Anne AU - Festl-Wietek, Teresa AU - Holderried, Martin AU - Eickhoff, Carsten AU - Mahling, Moritz PY - 2024/8/16 TI - A Language Model?Powered Simulated Patient With Automated Feedback for History Taking: Prospective Study JO - JMIR Med Educ SP - e59213 VL - 10 KW - virtual patients communication KW - communication skills KW - technology enhanced education KW - TEL KW - medical education KW - ChatGPT KW - GPT: LLM KW - LLMs KW - NLP KW - natural language processing KW - machine learning KW - artificial intelligence KW - language model KW - language models KW - communication KW - relationship KW - relationships KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - history KW - histories KW - simulated KW - student KW - students KW - interaction KW - interactions N2 - Background: Although history taking is fundamental for diagnosing medical conditions, teaching and providing feedback on the skill can be challenging due to resource constraints. Virtual simulated patients and web-based chatbots have thus emerged as educational tools, with recent advancements in artificial intelligence (AI) such as large language models (LLMs) enhancing their realism and potential to provide feedback. Objective: In our study, we aimed to evaluate the effectiveness of a Generative Pretrained Transformer (GPT) 4 model to provide structured feedback on medical students? performance in history taking with a simulated patient. Methods: We conducted a prospective study involving medical students performing history taking with a GPT-powered chatbot. To that end, we designed a chatbot to simulate patients? responses and provide immediate feedback on the comprehensiveness of the students? history taking. Students? interactions with the chatbot were analyzed, and feedback from the chatbot was compared with feedback from a human rater. We measured interrater reliability and performed a descriptive analysis to assess the quality of feedback. Results: Most of the study?s participants were in their third year of medical school. A total of 1894 question-answer pairs from 106 conversations were included in our analysis. GPT-4?s role-play and responses were medically plausible in more than 99% of cases. Interrater reliability between GPT-4 and the human rater showed ?almost perfect? agreement (Cohen ?=0.832). Less agreement (?<0.6) detected for 8 out of 45 feedback categories highlighted topics about which the model?s assessments were overly specific or diverged from human judgement. Conclusions: The GPT model was effective in providing structured feedback on history-taking dialogs provided by medical students. Although we unraveled some limitations regarding the specificity of feedback for certain feedback categories, the overall high agreement with human raters suggests that LLMs can be a valuable tool for medical education. Our findings, thus, advocate the careful integration of AI-driven feedback mechanisms in medical training and highlight important aspects when LLMs are used in that context. UR - https://mededu.jmir.org/2024/1/e59213 UR - http://dx.doi.org/10.2196/59213 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59213 ER - TY - JOUR AU - Ming, Shuai AU - Guo, Qingge AU - Cheng, Wenjun AU - Lei, Bo PY - 2024/8/13 TI - Influence of Model Evolution and System Roles on ChatGPT?s Performance in Chinese Medical Licensing Exams: Comparative Study JO - JMIR Med Educ SP - e52784 VL - 10 KW - ChatGPT KW - Chinese National Medical Licensing Examination KW - large language models KW - medical education KW - system role KW - LLM KW - LLMs KW - language model KW - language models KW - artificial intelligence KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - exam KW - exams KW - examination KW - examinations KW - OpenAI KW - answer KW - answers KW - response KW - responses KW - accuracy KW - performance KW - China KW - Chinese N2 - Background: With the increasing application of large language models like ChatGPT in various industries, its potential in the medical domain, especially in standardized examinations, has become a focal point of research. Objective: The aim of this study is to assess the clinical performance of ChatGPT, focusing on its accuracy and reliability in the Chinese National Medical Licensing Examination (CNMLE). Methods: The CNMLE 2022 question set, consisting of 500 single-answer multiple choices questions, were reclassified into 15 medical subspecialties. Each question was tested 8 to 12 times in Chinese on the OpenAI platform from April 24 to May 15, 2023. Three key factors were considered: the version of GPT-3.5 and 4.0, the prompt?s designation of system roles tailored to medical subspecialties, and repetition for coherence. A passing accuracy threshold was established as 60%. The ?2 tests and ? values were employed to evaluate the model?s accuracy and consistency. Results: GPT-4.0 achieved a passing accuracy of 72.7%, which was significantly higher than that of GPT-3.5 (54%; P<.001). The variability rate of repeated responses from GPT-4.0 was lower than that of GPT-3.5 (9% vs 19.5%; P<.001). However, both models showed relatively good response coherence, with ? values of 0.778 and 0.610, respectively. System roles numerically increased accuracy for both GPT-4.0 (0.3%?3.7%) and GPT-3.5 (1.3%?4.5%), and reduced variability by 1.7% and 1.8%, respectively (P>.05). In subgroup analysis, ChatGPT achieved comparable accuracy among different question types (P>.05). GPT-4.0 surpassed the accuracy threshold in 14 of 15 subspecialties, while GPT-3.5 did so in 7 of 15 on the first response. Conclusions: GPT-4.0 passed the CNMLE and outperformed GPT-3.5 in key areas such as accuracy, consistency, and medical subspecialty expertise. Adding a system role insignificantly enhanced the model?s reliability and answer coherence. GPT-4.0 showed promising potential in medical education and clinical practice, meriting further study. UR - https://mededu.jmir.org/2024/1/e52784 UR - http://dx.doi.org/10.2196/52784 ID - info:doi/10.2196/52784 ER - TY - JOUR AU - Takahashi, Hiromizu AU - Shikino, Kiyoshi AU - Kondo, Takeshi AU - Komori, Akira AU - Yamada, Yuji AU - Saita, Mizue AU - Naito, Toshio PY - 2024/8/13 TI - Educational Utility of Clinical Vignettes Generated in Japanese by ChatGPT-4: Mixed Methods Study JO - JMIR Med Educ SP - e59133 VL - 10 KW - generative AI KW - ChatGPT-4 KW - medical case generation KW - medical education KW - clinical vignettes KW - AI KW - artificial intelligence KW - Japanese KW - Japan N2 - Background: Evaluating the accuracy and educational utility of artificial intelligence?generated medical cases, especially those produced by large language models such as ChatGPT-4 (developed by OpenAI), is crucial yet underexplored. Objective: This study aimed to assess the educational utility of ChatGPT-4?generated clinical vignettes and their applicability in educational settings. Methods: Using a convergent mixed methods design, a web-based survey was conducted from January 8 to 28, 2024, to evaluate 18 medical cases generated by ChatGPT-4 in Japanese. In the survey, 6 main question items were used to evaluate the quality of the generated clinical vignettes and their educational utility, which are information quality, information accuracy, educational usefulness, clinical match, terminology accuracy (TA), and diagnosis difficulty. Feedback was solicited from physicians specializing in general internal medicine or general medicine and experienced in medical education. Chi-square and Mann-Whitney U tests were performed to identify differences among cases, and linear regression was used to examine trends associated with physicians? experience. Thematic analysis of qualitative feedback was performed to identify areas for improvement and confirm the educational utility of the cases. Results: Of the 73 invited participants, 71 (97%) responded. The respondents, primarily male (64/71, 90%), spanned a broad range of practice years (from 1976 to 2017) and represented diverse hospital sizes throughout Japan. The majority deemed the information quality (mean 0.77, 95% CI 0.75-0.79) and information accuracy (mean 0.68, 95% CI 0.65-0.71) to be satisfactory, with these responses being based on binary data. The average scores assigned were 3.55 (95% CI 3.49-3.60) for educational usefulness, 3.70 (95% CI 3.65-3.75) for clinical match, 3.49 (95% CI 3.44-3.55) for TA, and 2.34 (95% CI 2.28-2.40) for diagnosis difficulty, based on a 5-point Likert scale. Statistical analysis showed significant variability in content quality and relevance across the cases (P<.001 after Bonferroni correction). Participants suggested improvements in generating physical findings, using natural language, and enhancing medical TA. The thematic analysis highlighted the need for clearer documentation, clinical information consistency, content relevance, and patient-centered case presentations. Conclusions: ChatGPT-4?generated medical cases written in Japanese possess considerable potential as resources in medical education, with recognized adequacy in quality and accuracy. Nevertheless, there is a notable need for enhancements in the precision and realism of case details. This study emphasizes ChatGPT-4?s value as an adjunctive educational tool in the medical field, requiring expert oversight for optimal application. UR - https://mededu.jmir.org/2024/1/e59133 UR - http://dx.doi.org/10.2196/59133 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137031 ID - info:doi/10.2196/59133 ER - TY - JOUR AU - Zhu, Siyue AU - Li, Zenan AU - Sun, Ying AU - Kong, Linghui AU - Yin, Ming AU - Yong, Qinge AU - Gao, Yuan PY - 2024/8/12 TI - A Serious Game for Enhancing Rescue Reasoning Skills in Tactical Combat Casualty Care: Development and Deployment Study JO - JMIR Form Res SP - e50817 VL - 8 KW - combat casualty care KW - simulation training KW - medical service support KW - virtual reality KW - military exercise KW - medical education N2 - Background: Serious games (SGs) have emerged as engaging and instructional digital simulation tools that are increasingly being used for military medical training. SGs are often compared with traditional media in terms of learning outcomes, but it remains unclear which of the 2 options is more efficient and better accepted in the process of knowledge acquisition. Objective: This study aimed to create and test a scenario-based system suitable for enhancing rescue reasoning skills in tactical combat casualty care. Methods: To evaluate the effectiveness of the SGs, a randomized, observational, comparative trial was conducted. A total of 148 members from mobile medical logistics teams were recruited for training. Pre- and posttraining assessments were conducted using 2 different formats: a video-based online course (n=78) and a game simulation (n=70). We designed 3 evaluation instruments based on the first 2 levels of the Kirkpatrick model (reaction and learning) to measure trainees? satisfaction, knowledge proficiency, and self-confidence. Results: There were 4 elements that made up the learning path for the SGs: microcourses (video-based online courses), self-test, game simulation, and record query. The knowledge test scores in both groups were significantly higher after the intervention (t154=?6.010 and t138=?7.867, respectively; P<.001). For 5 simulation cases, the average operation time was 13.6 (SD 3.3) minutes, and the average case score was 279.0 (SD 57.6) points (from a possible total of 500 points), with a score rate of only 44% (222/500 points) to 67% (336/500 points). The results indicated no significant difference in trainees? satisfaction between the 2 training methods (P=.04). However, the game simulation method outperformed the video-based online course in terms of learning proficiency (t146=?2.324, P=.02) and self-perception (t146=?5.492, P<.001). Conclusions: Despite the high satisfaction reported by trainees for both training methods, the game simulation approach demonstrated superior efficiency and acceptance in terms of knowledge acquisition, self-perception, and overall performance. The developed SG holds significant potential as an essential assessment tool for evaluating frontline rescue skills and rescue reasoning in mobile medical logistics teams. UR - https://formative.jmir.org/2024/1/e50817 UR - http://dx.doi.org/10.2196/50817 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50817 ER - TY - JOUR AU - Srinivasa, Komal AU - Charlton, Amanda AU - Moir, Fiona AU - Goodyear-Smith, Felicity PY - 2024/8/7 TI - How to Develop an Online Video for Teaching Health Procedural Skills: Tutorial for Health Educators New to Video Production JO - JMIR Med Educ SP - e51740 VL - 10 KW - online video KW - developing video KW - procedural video KW - medical education KW - clinician educator KW - health education N2 - Background: Clinician educators are experts in procedural skills that students need to learn. Some clinician educators are interested in creating their own procedural videos but are typically not experts in video production, and there is limited information on this topic in the clinical education literature. Therefore, we present a tutorial for clinician educators to develop a procedural video. Objective: We describe the steps needed to develop a medical procedural video from the perspective of a clinician educator new to creating videos, informed by best practices as evidenced by the literature. We also produce a checklist of elements that ensure a quality video. Finally, we identify the barriers and facilitators to making such a video. Methods: We used the example of processing a piece of skeletal muscle in a pathology laboratory to make a video. We developed the video by dividing it into 3 phases: preproduction, production, and postproduction. After writing the learning outcomes, we created a storyboard and script, which were validated by subject matter and audiovisual experts. Photos and videos were captured on a digital camera mounted on a monopod. Video editing software was used to sequence the video clips and photos, insert text and audio narration, and generate closed captions. The finished video was uploaded to YouTube (Google) and then inserted into open-source authoring software to enable an interactive quiz. Results: The final video was 4 minutes and 4 seconds long and took 70 hours to create. The final video included audio narration, closed captioning, bookmarks, and an interactive quiz. We identified that an effective video has six key factors: (1) clear learning outcomes, (2) being engaging, (3) being learner-centric, (4) incorporating principles of multimedia learning, (5) incorporating adult learning theories, and (6) being of high audiovisual quality. To ensure educational quality, we developed a checklist of elements that educators can use to develop a video. One of the barriers to creating procedural videos for a clinician educator who is new to making videos is the significant time commitment to build videography and editing skills. The facilitators for developing an online video include creating a community of practice and repeated skill-building rehearsals using simulations. Conclusions: We outlined the steps in procedural video production and developed a checklist of quality elements. These steps and the checklist can guide a clinician educator in creating a quality video while recognizing the time, technical, and cognitive requirements. UR - https://mededu.jmir.org/2024/1/e51740 UR - http://dx.doi.org/10.2196/51740 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110488 ID - info:doi/10.2196/51740 ER - TY - JOUR AU - McBee, C. Joseph AU - Han, Y. Daniel AU - Liu, Li AU - Ma, Leah AU - Adjeroh, A. Donald AU - Xu, Dong AU - Hu, Gangqing PY - 2024/8/7 TI - Assessing ChatGPT?s Competency in Addressing Interdisciplinary Inquiries on Chatbot Uses in Sports Rehabilitation: Simulation Study JO - JMIR Med Educ SP - e51157 VL - 10 KW - ChatGPT KW - chatbots KW - multirole-playing KW - interdisciplinary inquiry KW - medical education KW - sports medicine N2 - Background: ChatGPT showcases exceptional conversational capabilities and extensive cross-disciplinary knowledge. In addition, it can perform multiple roles in a single chat session. This unique multirole-playing feature positions ChatGPT as a promising tool for exploring interdisciplinary subjects. Objective: The aim of this study was to evaluate ChatGPT?s competency in addressing interdisciplinary inquiries based on a case study exploring the opportunities and challenges of chatbot uses in sports rehabilitation. Methods: We developed a model termed PanelGPT to assess ChatGPT?s competency in addressing interdisciplinary topics through simulated panel discussions. Taking chatbot uses in sports rehabilitation as an example of an interdisciplinary topic, we prompted ChatGPT through PanelGPT to role-play a physiotherapist, psychologist, nutritionist, artificial intelligence expert, and athlete in a simulated panel discussion. During the simulation, we posed questions to the panel while ChatGPT acted as both the panelists for responses and the moderator for steering the discussion. We performed the simulation using ChatGPT-4 and evaluated the responses by referring to the literature and our human expertise. Results: By tackling questions related to chatbot uses in sports rehabilitation with respect to patient education, physiotherapy, physiology, nutrition, and ethical considerations, responses from the ChatGPT-simulated panel discussion reasonably pointed to various benefits such as 24/7 support, personalized advice, automated tracking, and reminders. ChatGPT also correctly emphasized the importance of patient education, and identified challenges such as limited interaction modes, inaccuracies in emotion-related advice, assurance of data privacy and security, transparency in data handling, and fairness in model training. It also stressed that chatbots are to assist as a copilot, not to replace human health care professionals in the rehabilitation process. Conclusions: ChatGPT exhibits strong competency in addressing interdisciplinary inquiry by simulating multiple experts from complementary backgrounds, with significant implications in assisting medical education. UR - https://mededu.jmir.org/2024/1/e51157 UR - http://dx.doi.org/10.2196/51157 UR - http://www.ncbi.nlm.nih.gov/pubmed/39042885 ID - info:doi/10.2196/51157 ER - TY - JOUR AU - Zhui, Li AU - Fenghe, Li AU - Xuehu, Wang AU - Qining, Fu AU - Wei, Ren PY - 2024/8/1 TI - Ethical Considerations and Fundamental Principles of Large Language Models in Medical Education: Viewpoint JO - J Med Internet Res SP - e60083 VL - 26 KW - medical education KW - artificial intelligence KW - large language models KW - medical ethics KW - AI KW - LLMs KW - ethics KW - academic integrity KW - privacy and data risks KW - data security KW - data protection KW - intellectual property rights KW - educational research UR - https://www.jmir.org/2024/1/e60083 UR - http://dx.doi.org/10.2196/60083 UR - http://www.ncbi.nlm.nih.gov/pubmed/38971715 ID - info:doi/10.2196/60083 ER - TY - JOUR AU - Mikkonen, Kasperi AU - Helminen, Eeva-Eerika AU - Saarni, I. Samuli AU - Saarni, E. Suoma PY - 2024/7/29 TI - Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review JO - J Med Internet Res SP - e54473 VL - 26 KW - mental health KW - psychotherapy KW - digital learning KW - Kirkpatrick model KW - e-learning KW - online health KW - psychotherapy training KW - learning outcome KW - learning outcomes KW - systematic review KW - training methods KW - mental disorders KW - mental disorder KW - accessibility KW - evidence-based KW - scalability KW - cost-effectiveness KW - internet KW - education N2 - Background: Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. Objective: This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. Results: The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. Conclusions: e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings. UR - https://www.jmir.org/2024/1/e54473 UR - http://dx.doi.org/10.2196/54473 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073862 ID - info:doi/10.2196/54473 ER - TY - JOUR AU - Yeo, Ji-Young AU - Nam, Hyeongil AU - Park, Jong-Il AU - Han, Soo-Yeon PY - 2024/7/26 TI - Multidisciplinary Design?Based Multimodal Virtual Reality Simulation in Nursing Education: Mixed Methods Study JO - JMIR Med Educ SP - e53106 VL - 10 KW - multidisciplinary KW - multimodal KW - nursing KW - simulation KW - virtual reality KW - VR KW - education KW - allied health KW - educational KW - simulations KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - feasibility KW - nurse KW - nurses KW - qualitative KW - interview KW - interviews KW - development KW - develop KW - teaching KW - educator KW - educators KW - user test KW - user testing KW - module KW - modules KW - usability KW - satisfaction N2 - Background: The COVID-19 pandemic underscored the necessity for innovative educational methods in nursing. Our study takes a unique approach using a multidisciplinary simulation design, which offers a systematic and comprehensive strategy for developing virtual reality (VR) simulations in nursing education. Objective: The aim of this study is to develop VR simulation content for a pediatric nursing module based on a multidisciplinary simulation design and to evaluate its feasibility for nursing education. Methods: This study used a 1-group, posttest-only design. VR content for pediatric nursing practice was developed by integrating the technological characteristics of a multimodal VR system with the learning elements of traditional nursing simulation, combining various disciplines, including education, engineering, and nursing. A user test was conducted with 12 nursing graduates (preservice nurses) followed by post hoc surveys (assessing presence, VR systems, VR sickness, and simulation satisfaction) and in-depth, one-on-one interviews. Results: User tests showed mean scores of 4.01 (SD 1.43) for presence, 4.91 (SD 0.81) for the VR system, 0.64 (SD 0.35) for VR sickness, and 5.00 (SD 1.00) for simulation satisfaction. In-depth interviews revealed that the main strengths of the immersive VR simulation for pediatric pneumonia nursing were effective visualization and direct experience through hands-on manipulation; the drawback was keyword-based voice interaction. To improve VR simulation quality, participants suggested increasing the number of nursing techniques and refining them in more detail. Conclusions: This VR simulation content for a pediatric nursing practice using a multidisciplinary educational design model was confirmed to have positive educational potential. Further research is needed to confirm the specific learning effects of immersive nursing content based on multidisciplinary design models. UR - https://mededu.jmir.org/2024/1/e53106 UR - http://dx.doi.org/10.2196/53106 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53106 ER - TY - JOUR AU - Zhui, Li AU - Yhap, Nina AU - Liping, Liu AU - Zhengjie, Wang AU - Zhonghao, Xiong AU - Xiaoshu, Yuan AU - Hong, Cui AU - Xuexiu, Liu AU - Wei, Ren PY - 2024/7/25 TI - Impact of Large Language Models on Medical Education and Teaching Adaptations JO - JMIR Med Inform SP - e55933 VL - 12 KW - large language models KW - medical education KW - opportunities KW - challenges KW - critical thinking KW - educator UR - https://medinform.jmir.org/2024/1/e55933 UR - http://dx.doi.org/10.2196/55933 ID - info:doi/10.2196/55933 ER - TY - JOUR AU - Cherif, Hela AU - Moussa, Chirine AU - Missaoui, Mouhaymen Abdel AU - Salouage, Issam AU - Mokaddem, Salma AU - Dhahri, Besma PY - 2024/7/23 TI - Appraisal of ChatGPT?s Aptitude for Medical Education: Comparative Analysis With Third-Year Medical Students in a Pulmonology Examination JO - JMIR Med Educ SP - e52818 VL - 10 KW - medical education KW - ChatGPT KW - GPT KW - artificial intelligence KW - natural language processing KW - NLP KW - pulmonary medicine KW - pulmonary KW - lung KW - lungs KW - respiratory KW - respiration KW - pneumology KW - comparative analysis KW - large language models KW - LLMs KW - LLM KW - language model KW - generative AI KW - generative artificial intelligence KW - generative KW - exams KW - exam KW - examinations KW - examination N2 - Background: The rapid evolution of ChatGPT has generated substantial interest and led to extensive discussions in both public and academic domains, particularly in the context of medical education. Objective: This study aimed to evaluate ChatGPT?s performance in a pulmonology examination through a comparative analysis with that of third-year medical students. Methods: In this cross-sectional study, we conducted a comparative analysis with 2 distinct groups. The first group comprised 244 third-year medical students who had previously taken our institution?s 2020 pulmonology examination, which was conducted in French. The second group involved ChatGPT-3.5 in 2 separate sets of conversations: without contextualization (V1) and with contextualization (V2). In both V1 and V2, ChatGPT received the same set of questions administered to the students. Results: V1 demonstrated exceptional proficiency in radiology, microbiology, and thoracic surgery, surpassing the majority of medical students in these domains. However, it faced challenges in pathology, pharmacology, and clinical pneumology. In contrast, V2 consistently delivered more accurate responses across various question categories, regardless of the specialization. ChatGPT exhibited suboptimal performance in multiple choice questions compared to medical students. V2 excelled in responding to structured open-ended questions. Both ChatGPT conversations, particularly V2, outperformed students in addressing questions of low and intermediate difficulty. Interestingly, students showcased enhanced proficiency when confronted with highly challenging questions. V1 fell short of passing the examination. Conversely, V2 successfully achieved examination success, outperforming 139 (62.1%) medical students. Conclusions: While ChatGPT has access to a comprehensive web-based data set, its performance closely mirrors that of an average medical student. Outcomes are influenced by question format, item complexity, and contextual nuances. The model faces challenges in medical contexts requiring information synthesis, advanced analytical aptitude, and clinical judgment, as well as in non-English language assessments and when confronted with data outside mainstream internet sources. UR - https://mededu.jmir.org/2024/1/e52818 UR - http://dx.doi.org/10.2196/52818 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52818 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 - Tolentino, Raymond AU - Baradaran, Ashkan AU - Gore, Genevieve AU - Pluye, Pierre AU - Abbasgholizadeh-Rahimi, Samira PY - 2024/7/18 TI - Curriculum Frameworks and Educational Programs in AI for Medical Students, Residents, and Practicing Physicians: Scoping Review JO - JMIR Med Educ SP - e54793 VL - 10 KW - artificial intelligence KW - machine learning KW - curriculum KW - framework KW - medical education KW - review N2 - Background: The successful integration of artificial intelligence (AI) into clinical practice is contingent upon physicians? comprehension of AI principles and its applications. Therefore, it is essential for medical education curricula to incorporate AI topics and concepts, providing future physicians with the foundational knowledge and skills needed. However, there is a knowledge gap in the current understanding and availability of structured AI curriculum frameworks tailored for medical education, which serve as vital guides for instructing and facilitating the learning process. Objective: The overall aim of this study is to synthesize knowledge from the literature on curriculum frameworks and current educational programs that focus on the teaching and learning of AI for medical students, residents, and practicing physicians. Methods: We followed a validated framework and the Joanna Briggs Institute methodological guidance for scoping reviews. An information specialist performed a comprehensive search from 2000 to May 2023 in the following bibliographic databases: MEDLINE (Ovid), Embase (Ovid), CENTRAL (Cochrane Library), CINAHL (EBSCOhost), and Scopus as well as the gray literature. Papers were limited to English and French languages. This review included papers that describe curriculum frameworks for teaching and learning AI in medicine, irrespective of country. All types of papers and study designs were included, except conference abstracts and protocols. Two reviewers independently screened the titles and abstracts, read the full texts, and extracted data using a validated data extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. We adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting the results. Results: Of the 5104 papers screened, 21 papers relevant to our eligibility criteria were identified. In total, 90% (19/21) of the papers altogether described 30 current or previously offered educational programs, and 10% (2/21) of the papers described elements of a curriculum framework. One framework describes a general approach to integrating AI curricula throughout the medical learning continuum and another describes a core curriculum for AI in ophthalmology. No papers described a theory, pedagogy, or framework that guided the educational programs. Conclusions: This review synthesizes recent advancements in AI curriculum frameworks and educational programs within the domain of medical education. To build on this foundation, future researchers are encouraged to engage in a multidisciplinary approach to curriculum redesign. In addition, it is encouraged to initiate dialogues on the integration of AI into medical curriculum planning and to investigate the development, deployment, and appraisal of these innovative educational programs. International Registered Report Identifier (IRRID): RR2-10.11124/JBIES-22-00374 UR - https://mededu.jmir.org/2024/1/e54793 UR - http://dx.doi.org/10.2196/54793 UR - http://www.ncbi.nlm.nih.gov/pubmed/39023999 ID - info:doi/10.2196/54793 ER - TY - JOUR AU - Hassanipour, Soheil AU - Nayak, Sandeep AU - Bozorgi, Ali AU - Keivanlou, Mohammad-Hossein AU - Dave, Tirth AU - Alotaibi, Abdulhadi AU - Joukar, Farahnaz AU - Mellatdoust, Parinaz AU - Bakhshi, Arash AU - Kuriyakose, Dona AU - Polisetty, D. Lakshmi AU - Chimpiri, Mallika AU - Amini-Salehi, Ehsan PY - 2024/7/8 TI - The Ability of ChatGPT in Paraphrasing Texts and Reducing Plagiarism: A Descriptive Analysis JO - JMIR Med Educ SP - e53308 VL - 10 KW - ChatGPT KW - paraphrasing KW - text generation KW - prompts KW - academic journals KW - plagiarize KW - plagiarism KW - paraphrase KW - wording KW - LLM KW - LLMs KW - language model KW - language models KW - prompt KW - generative KW - artificial intelligence KW - NLP KW - natural language processing KW - rephrase KW - plagiarizing KW - honesty KW - integrity KW - texts KW - text KW - textual KW - generation KW - large language model KW - large language models N2 - Background: The introduction of ChatGPT by OpenAI has garnered significant attention. Among its capabilities, paraphrasing stands out. Objective: This study aims to investigate the satisfactory levels of plagiarism in the paraphrased text produced by this chatbot. Methods: Three texts of varying lengths were presented to ChatGPT. ChatGPT was then instructed to paraphrase the provided texts using five different prompts. In the subsequent stage of the study, the texts were divided into separate paragraphs, and ChatGPT was requested to paraphrase each paragraph individually. Lastly, in the third stage, ChatGPT was asked to paraphrase the texts it had previously generated. Results: The average plagiarism rate in the texts generated by ChatGPT was 45% (SD 10%). ChatGPT exhibited a substantial reduction in plagiarism for the provided texts (mean difference ?0.51, 95% CI ?0.54 to ?0.48; P<.001). Furthermore, when comparing the second attempt with the initial attempt, a significant decrease in the plagiarism rate was observed (mean difference ?0.06, 95% CI ?0.08 to ?0.03; P<.001). The number of paragraphs in the texts demonstrated a noteworthy association with the percentage of plagiarism, with texts consisting of a single paragraph exhibiting the lowest plagiarism rate (P<.001). Conclusion: Although ChatGPT demonstrates a notable reduction of plagiarism within texts, the existing levels of plagiarism remain relatively high. This underscores a crucial caution for researchers when incorporating this chatbot into their work. UR - https://mededu.jmir.org/2024/1/e53308 UR - http://dx.doi.org/10.2196/53308 ID - info:doi/10.2196/53308 ER - TY - JOUR AU - McGrane Minton, Heather AU - Murray, Linda AU - Allan, J. Marjorie AU - Perry, Roslyn AU - Bettencourt, F. Amie AU - Gross, Deborah AU - Strano, Lauri AU - Breitenstein, M. Susan PY - 2024/7/3 TI - Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation JO - JMIR Pediatr Parent SP - e55280 VL - 7 KW - COVID-19 KW - implementation KW - internet-based intervention KW - parenting KW - community dissemination KW - hybrid delivery N2 - Background: Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. Objective: This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. Methods: This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. Results: In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child?s behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Conclusions: Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed. UR - https://pediatrics.jmir.org/2024/1/e55280 UR - http://dx.doi.org/10.2196/55280 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55280 ER - TY - JOUR AU - Rössler, Lena AU - Herrmann, Manfred AU - Wiegand, Annette AU - Kanzow, Philipp PY - 2024/6/27 TI - Use of Multiple-Choice Items in Summative Examinations: Questionnaire Survey Among German Undergraduate Dental Training Programs JO - JMIR Med Educ SP - e58126 VL - 10 KW - alternate-choice KW - assessment KW - best-answer KW - dental KW - dental schools KW - dental training KW - education KW - educational assessment KW - educational measurement KW - examination KW - German KW - Germany KW - k of n KW - Kprim KW - K? KW - medical education KW - medical student KW - MTF KW - Multiple-True-False KW - multiple choice KW - multiple-select KW - Pick-N KW - scoring KW - scoring system KW - single choice KW - single response KW - test KW - testing KW - true/false KW - true-false KW - Type A KW - Type K KW - Type K? KW - Type R KW - Type X KW - undergraduate KW - undergraduate curriculum KW - undergraduate education N2 - Background: Multiple-choice examinations are frequently used in German dental schools. However, details regarding the used item types and applied scoring methods are lacking. Objective: This study aims to gain insight into the current use of multiple-choice items (ie, questions) in summative examinations in German undergraduate dental training programs. Methods: A paper-based 10-item questionnaire regarding the used assessment methods, multiple-choice item types, and applied scoring methods was designed. The pilot-tested questionnaire was mailed to the deans of studies and to the heads of the Department of Operative/Restorative Dentistry at all 30 dental schools in Germany in February 2023. Statistical analysis was performed using the Fisher exact test (P<.05). Results: The response rate amounted to 90% (27/30 dental schools). All respondent dental schools used multiple-choice examinations for summative assessments. Examinations were delivered electronically by 70% (19/27) of the dental schools. Almost all dental schools used single-choice Type A items (24/27, 89%), which accounted for the largest number of items in approximately half of the dental schools (13/27, 48%). Further item types (eg, conventional multiple-select items, Multiple-True-False, and Pick-N) were only used by fewer dental schools (?67%, up to 18 out of 27 dental schools). For the multiple-select item types, the applied scoring methods varied considerably (ie, awarding [intermediate] partial credit and requirements for partial credit). Dental schools with the possibility of electronic examinations used multiple-select items slightly more often (14/19, 74% vs 4/8, 50%). However, this difference was statistically not significant (P=.38). Dental schools used items either individually or as key feature problems consisting of a clinical case scenario followed by a number of items focusing on critical treatment steps (15/27, 56%). Not a single school used alternative testing methods (eg, answer-until-correct). A formal item review process was established at about half of the dental schools (15/27, 56%). Conclusions: Summative assessment methods among German dental schools vary widely. Especially, a large variability regarding the use and scoring of multiple-select multiple-choice items was found. UR - https://mededu.jmir.org/2024/1/e58126 UR - http://dx.doi.org/10.2196/58126 ID - info:doi/10.2196/58126 ER - TY - JOUR AU - He, Zonglin AU - Zhou, Botao AU - Feng, Haixiao AU - Bai, Jian AU - Wang, Yuechun PY - 2024/6/25 TI - Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis JO - JMIR Med Educ SP - e52224 VL - 10 KW - flipped classroom KW - flipped classroom teaching KW - physiology KW - scientific knowledge map KW - hot topics KW - frontier progress KW - evolution trend KW - classroom-based KW - bibliometric visual analysis KW - bibliometric KW - visual analysis KW - medical education KW - teaching method KW - bibliometric analysis KW - visualization tool KW - academic KW - academic community KW - inverted classroom N2 - Background: Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students? and teachers? responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively. Objective: This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature. Methods: A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends. Results: A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013?2014), extensive practice stage (2015?2019), and modification and growth stage (2020?2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others. Conclusions: This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents. UR - https://mededu.jmir.org/2024/1/e52224 UR - http://dx.doi.org/10.2196/52224 ID - info:doi/10.2196/52224 ER - TY - JOUR AU - Jones, Jennifer AU - Johnston, Sewan Jamie AU - Ndiaye, Yabsa Ngouille AU - Tokar, Anna AU - Singla, Saumya AU - Skinner, Ann Nadine AU - Strehlow, Matthew AU - Utunen, Heini PY - 2024/6/19 TI - Health Care Workers? Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis JO - JMIR Med Educ SP - e51915 VL - 10 KW - massive open online course KW - MOOC KW - online learning KW - online courses KW - online course KW - health care education KW - medical education KW - education KW - training KW - professional development KW - continuing education KW - COVID-19 training KW - infectious disease outbreak response KW - emergency KW - public health KW - crisis KW - crises KW - outbreak KW - pandemic KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - humanitarian emergency response KW - health care workers KW - nurse KW - nurses KW - practitioner KW - practitioners KW - clinician KW - clinicians KW - health care worker KW - medic KW - low-income KW - lower-middle income KW - LIC KW - LMIC KW - developing country KW - developing countries KW - developing nation KW - developing nations KW - case study KW - survey KW - surveys KW - descriptive analysis KW - descriptive analyses KW - motivation KW - motivations KW - lower-middle?income country KW - low-income country N2 - Background: Massive open online courses (MOOCs) are increasingly used to educate health care workers during public health emergencies. In early 2020, the World Health Organization (WHO) developed a series of MOOCs for COVID-19, introducing the disease and strategies to control its outbreak, with 6 courses specifically targeting health care workers as learners. In 2020, Stanford University also launched a MOOC designed to deliver accurate and timely education on COVID-19, equipping health care workers across the globe to provide health care safely and effectively to patients with the novel infectious disease. Although the use of MOOCs for just-in-time training has expanded during the pandemic, evidence is limited regarding the factors motivating health care workers to enroll in and complete courses, particularly in low-income countries (LICs) and lower-middle?income countries (LMICs). Objective: This study seeks to gain insights on the characteristics and motivations of learners turning to MOOCs for just-in-time training, to provide evidence that can better inform MOOC design to meet the needs of health care workers. We examine data from learners in 1 Stanford University and 6 WHO COVID-19 courses to identify (1) the characteristics of health care workers completing the courses and (2) the factors motivating them to enroll. Methods: We analyze (1) course registration data of the 49,098 health care workers who completed the 7 focal courses and (2) survey responses from 6272 course completers. The survey asked respondents to rank their motivations for enrollment and share feedback about their learning experience. We use descriptive statistics to compare responses by health care profession and by World Bank country income classification. Results: Health care workers completed the focal courses from all regions of the world, with nearly one-third (14,159/49,098, 28.84%) practicing in LICs and LMICs. Survey data revealed a diverse range of professional roles among the learners, including physicians (2171/6272, 34.61%); nurses (1599/6272, 25.49%); and other health care professionals such as allied health professionals, community health workers, paramedics, and pharmacists (2502/6272, 39.89%). Across all health care professions, the primary motivation to enroll was for personal learning to improve clinical practice. Continuing education credit was also an important motivator, particularly for nonphysicians and learners in LICs and LMICs. Course cost (3423/6272, 54.58%) and certification (4238/6272, 67.57%) were also important to a majority of learners. Conclusions: Our results demonstrate that a diverse range of health care professionals accessed MOOCs for just-in-time training during a public health emergency. Although all health care workers were motivated to improve their clinical practice, different factors were influential across professions and locations. These factors should be considered in MOOC design to meet the needs of health care workers, particularly those in lower-resource settings where alternative avenues for training may be limited. UR - https://mededu.jmir.org/2024/1/e51915 UR - http://dx.doi.org/10.2196/51915 ID - info:doi/10.2196/51915 ER - TY - JOUR AU - Moldt, Julia-Astrid AU - Festl-Wietek, Teresa AU - Fuhl, Wolfgang AU - Zabel, Susanne AU - Claassen, Manfred AU - Wagner, Samuel AU - Nieselt, Kay AU - Herrmann-Werner, Anne PY - 2024/6/12 TI - Assessing AI Awareness and Identifying Essential Competencies: Insights From Key Stakeholders in Integrating AI Into Medical Education JO - JMIR Med Educ SP - e58355 VL - 10 KW - AI in medicine KW - artificial intelligence KW - medical education KW - medical students KW - qualitative approach KW - qualitative analysis KW - needs assessment N2 - Background: The increasing importance of artificial intelligence (AI) in health care has generated a growing need for health care professionals to possess a comprehensive understanding of AI technologies, requiring an adaptation in medical education. Objective: This paper explores stakeholder perceptions and expectations regarding AI in medicine and examines their potential impact on the medical curriculum. This study project aims to assess the AI experiences and awareness of different stakeholders and identify essential AI-related topics in medical education to define necessary competencies for students. Methods: The empirical data were collected as part of the TüKITZMed project between August 2022 and March 2023, using a semistructured qualitative interview. These interviews were administered to a diverse group of stakeholders to explore their experiences and perspectives of AI in medicine. A qualitative content analysis of the collected data was conducted using MAXQDA software. Results: Semistructured interviews were conducted with 38 participants (6 lecturers, 9 clinicians, 10 students, 6 AI experts, and 7 institutional stakeholders). The qualitative content analysis revealed 6 primary categories with a total of 24 subcategories to answer the research questions. The evaluation of the stakeholders? statements revealed several commonalities and differences regarding their understanding of AI. Crucial identified AI themes based on the main categories were as follows: possible curriculum contents, skills, and competencies; programming skills; curriculum scope; and curriculum structure. Conclusions: The analysis emphasizes integrating AI into medical curricula to ensure students? proficiency in clinical applications. Standardized AI comprehension is crucial for defining and teaching relevant content. Considering diverse perspectives in implementation is essential to comprehensively define AI in the medical context, addressing gaps and facilitating effective solutions for future AI use in medical studies. The results provide insights into potential curriculum content and structure, including aspects of AI in medicine. UR - https://mededu.jmir.org/2024/1/e58355 UR - http://dx.doi.org/10.2196/58355 ID - info:doi/10.2196/58355 ER - TY - JOUR AU - Sekhar, C. Tejas AU - Nayak, R. Yash AU - Abdoler, A. Emily PY - 2024/6/7 TI - A Use Case for Generative AI in Medical Education JO - JMIR Med Educ SP - e56117 VL - 10 KW - medical education KW - med ed KW - generative artificial intelligence KW - artificial intelligence KW - GAI KW - AI KW - Anki KW - flashcard KW - undergraduate medical education KW - UME UR - https://mededu.jmir.org/2024/1/e56117 UR - http://dx.doi.org/10.2196/56117 ID - info:doi/10.2196/56117 ER - TY - JOUR AU - Pendergrast, Tricia AU - Chalmers, Zachary PY - 2024/6/7 TI - Authors? Reply: A Use Case for Generative AI in Medical Education JO - JMIR Med Educ SP - e58370 VL - 10 KW - ChatGPT KW - undergraduate medical education KW - large language models UR - https://mededu.jmir.org/2024/1/e58370 UR - http://dx.doi.org/10.2196/58370 ID - info:doi/10.2196/58370 ER - TY - JOUR AU - Kataoka, Koshi AU - Nishizaki, Yuji AU - Shimizu, Taro AU - Yamamoto, Yu AU - Shikino, Kiyoshi AU - Nojima, Masanori AU - Nagasaki, Kazuya AU - Fukui, Sho AU - Nishiguchi, Sho AU - Katayama, Kohta AU - Kurihara, Masaru AU - Ueda, Rieko AU - Kobayashi, Hiroyuki AU - Tokuda, Yasuharu PY - 2024/5/30 TI - Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study JO - JMIR Med Educ SP - e52207 VL - 10 KW - clinical knowledge support system KW - GM-ITE KW - postgraduate clinical resident KW - in-training examination performance KW - exam KW - exams KW - examination KW - examinations KW - resident KW - residents KW - cross-sectional KW - national KW - nationwide KW - postgraduate KW - decision support KW - point-of-care KW - UpToDate KW - DynaMed KW - knowledge support KW - medical education KW - performance KW - information behavior KW - information behaviour KW - information seeking KW - teaching KW - pedagogy KW - pedagogical KW - log KW - logs KW - usage KW - evidence-based medicine KW - EBM KW - educational KW - decision support system KW - clinical decision support KW - Japan KW - General Medicine In-Training Examination N2 - Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents? General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year?1 and ?2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents? GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents? clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes. UR - https://mededu.jmir.org/2024/1/e52207 UR - http://dx.doi.org/10.2196/52207 ID - info:doi/10.2196/52207 ER - TY - JOUR AU - Arango-Ibanez, Pablo Juan AU - Posso-Nuñez, Alejandro Jose AU - Díaz-Solórzano, Pablo Juan AU - Cruz-Suárez, Gustavo PY - 2024/5/24 TI - Evidence-Based Learning Strategies in Medicine Using AI JO - JMIR Med Educ SP - e54507 VL - 10 KW - artificial intelligence KW - large language models KW - ChatGPT KW - active recall KW - memory cues KW - LLMs KW - evidence-based KW - learning strategy KW - medicine KW - AI KW - medical education KW - knowledge KW - relevance UR - https://mededu.jmir.org/2024/1/e54507 UR - http://dx.doi.org/10.2196/54507 ID - info:doi/10.2196/54507 ER - TY - JOUR AU - Takagi, Soshi AU - Koda, Masahide AU - Watari, Takashi PY - 2024/5/23 TI - The Performance of ChatGPT-4V in Interpreting Images and Tables in the Japanese Medical Licensing Exam JO - JMIR Med Educ SP - e54283 VL - 10 KW - ChatGPT KW - medical licensing examination KW - generative artificial intelligence KW - medical education KW - large language model KW - images KW - tables KW - artificial intelligence KW - AI KW - Japanese KW - reliability KW - medical application KW - medical applications KW - diagnostic KW - diagnostics KW - online data KW - web-based data UR - https://mededu.jmir.org/2024/1/e54283 UR - http://dx.doi.org/10.2196/54283 ID - info:doi/10.2196/54283 ER - TY - JOUR AU - Chelli, Mikaël AU - Descamps, Jules AU - Lavoué, Vincent AU - Trojani, Christophe AU - Azar, Michel AU - Deckert, Marcel AU - Raynier, Jean-Luc AU - Clowez, Gilles AU - Boileau, Pascal AU - Ruetsch-Chelli, Caroline PY - 2024/5/22 TI - Hallucination Rates and Reference Accuracy of ChatGPT and Bard for Systematic Reviews: Comparative Analysis JO - J Med Internet Res SP - e53164 VL - 26 KW - artificial intelligence KW - large language models KW - ChatGPT KW - Bard KW - rotator cuff KW - systematic reviews KW - literature search KW - hallucinated KW - human conducted N2 - Background: Large language models (LLMs) have raised both interest and concern in the academic community. They offer the potential for automating literature search and synthesis for systematic reviews but raise concerns regarding their reliability, as the tendency to generate unsupported (hallucinated) content persist. Objective: The aim of the study is to assess the performance of LLMs such as ChatGPT and Bard (subsequently rebranded Gemini) to produce references in the context of scientific writing. Methods: The performance of ChatGPT and Bard in replicating the results of human-conducted systematic reviews was assessed. Using systematic reviews pertaining to shoulder rotator cuff pathology, these LLMs were tested by providing the same inclusion criteria and comparing the results with original systematic review references, serving as gold standards. The study used 3 key performance metrics: recall, precision, and F1-score, alongside the hallucination rate. Papers were considered ?hallucinated? if any 2 of the following information were wrong: title, first author, or year of publication. Results: In total, 11 systematic reviews across 4 fields yielded 33 prompts to LLMs (3 LLMs×11 reviews), with 471 references analyzed. Precision rates for GPT-3.5, GPT-4, and Bard were 9.4% (13/139), 13.4% (16/119), and 0% (0/104) respectively (P<.001). Recall rates were 11.9% (13/109) for GPT-3.5 and 13.7% (15/109) for GPT-4, with Bard failing to retrieve any relevant papers (P<.001). Hallucination rates stood at 39.6% (55/139) for GPT-3.5, 28.6% (34/119) for GPT-4, and 91.4% (95/104) for Bard (P<.001). Further analysis of nonhallucinated papers retrieved by GPT models revealed significant differences in identifying various criteria, such as randomized studies, participant criteria, and intervention criteria. The study also noted the geographical and open-access biases in the papers retrieved by the LLMs. Conclusions: Given their current performance, it is not recommended for LLMs to be deployed as the primary or exclusive tool for conducting systematic reviews. Any references generated by such models warrant thorough validation by researchers. The high occurrence of hallucinations in LLMs highlights the necessity for refining their training and functionality before confidently using them for rigorous academic purposes. UR - https://www.jmir.org/2024/1/e53164 UR - http://dx.doi.org/10.2196/53164 UR - http://www.ncbi.nlm.nih.gov/pubmed/38776130 ID - info:doi/10.2196/53164 ER - TY - JOUR AU - Lambert, Raphaella AU - Choo, Zi-Yi AU - Gradwohl, Kelsey AU - Schroedl, Liesl AU - Ruiz De Luzuriaga, Arlene PY - 2024/5/16 TI - Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study JO - JMIR Dermatol SP - e55898 VL - 7 KW - artificial intelligence KW - large language models KW - large language model KW - LLM KW - LLMs KW - machine learning KW - natural language processing KW - deep learning KW - ChatGPT KW - health literacy KW - health knowledge KW - health information KW - patient education KW - dermatology KW - dermatologist KW - dermatologists KW - derm KW - dermatology resident KW - dermatology residents KW - dermatologic patient education material KW - dermatologic patient education materials KW - patient education material KW - patient education materials KW - education material KW - education materials N2 - Background: Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels. Objective: This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees. Methods: The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to ?Create a patient education handout about [condition] at a [FKRL]? to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees. Results: The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%). Conclusions: GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology. UR - https://derma.jmir.org/2024/1/e55898 UR - http://dx.doi.org/10.2196/55898 UR - http://www.ncbi.nlm.nih.gov/pubmed/38754096 ID - info:doi/10.2196/55898 ER - TY - JOUR AU - Friche, Pauline AU - Moulis, Lionel AU - Du Thanh, Aurélie AU - Dereure, Olivier AU - Duflos, Claire AU - Carbonnel, Francois PY - 2024/5/13 TI - Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study JO - JMIR Form Res SP - e56005 VL - 8 KW - dermoscopy KW - dermatoscope KW - dermatoscopes KW - dermatological KW - skin KW - training KW - GP KW - family practitioner KW - family practitioners KW - family physician KW - family physicians KW - general practice KW - family medicine KW - primary health care KW - internship and residency KW - education KW - e-learning KW - eLearning KW - dermatology KW - resident KW - residency KW - intern KW - interns KW - internship KW - internships N2 - Background: Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60% to 90%, but its use is limited due to lack of training. The characteristics of ?ideal? dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy. Objective: This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training. Methods: We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-Nîmes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question. Results: In total, 134 residents were included, and 66.4% (n=89) and 47% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1% (n=82) of participants for module 1 and 87.3% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6%) with the training course, and 96.3% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident?s initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001). Conclusions: The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors. UR - https://formative.jmir.org/2024/1/e56005 UR - http://dx.doi.org/10.2196/56005 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739910 ID - info:doi/10.2196/56005 ER - TY - JOUR AU - Shetty, Shishir AU - Bhat, Supriya AU - Al Bayatti, Saad AU - Al Kawas, Sausan AU - Talaat, Wael AU - El-Kishawi, Mohamed AU - Al Rawi, Natheer AU - Narasimhan, Sangeetha AU - Al-Daghestani, Hiba AU - Madi, Medhini AU - Shetty, Raghavendra PY - 2024/5/8 TI - The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review JO - JMIR Med Educ SP - e52953 VL - 10 KW - virtual reality KW - simulators KW - radiology education KW - medical imaging KW - radiology KW - education KW - systematic review KW - literature review KW - imaging KW - meta analysis KW - student KW - students KW - VR KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. Objective: This systematic literature review aims to explore the scope of VR use in radiology education. Methods: A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)?defined study selection process. Results: The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored ?good? in the overall quality and the remaining 5 (71%) scored ?fair.? VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students? skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. Conclusions: The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education. UR - https://mededu.jmir.org/2024/1/e52953 UR - http://dx.doi.org/10.2196/52953 ID - info:doi/10.2196/52953 ER - TY - JOUR AU - Skryd, Anthony AU - Lawrence, Katharine PY - 2024/5/8 TI - ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study JO - JMIR Form Res SP - e51346 VL - 8 KW - ChatGPT KW - medical education KW - large language models KW - LLMs KW - clinical decision-making N2 - Background: Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments. Objective: The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts. Methods: A brief, single-site exploratory evaluation of the publicly available ChatGPT-3.5 (OpenAI) was conducted by implementing the tool into the daily attending rounds of a general internal medicine inpatient service at a large urban academic medical center. ChatGPT was integrated into rounds via both structured and organic use, using the web-based ?chatbot? style interface to interact with the LLM through conversational free-text and discrete queries. A qualitative approach using phenomenological inquiry was used to identify key insights related to the use of ChatGPT through analysis of ChatGPT conversation logs and associated shorthand notes from the clinical sessions. Results: Identified use cases for ChatGPT integration included addressing medical knowledge gaps through discrete medical knowledge inquiries, building differential diagnoses and engaging dual-process thinking, challenging medical axioms, using cognitive aids to support acute care decision-making, and improving complex care management by facilitating conversations with subspecialties. Potential additional uses included engaging in difficult conversations with patients, exploring ethical challenges and general medical ethics teaching, personal continuing medical education resources, developing ward-based teaching tools, supporting and automating clinical documentation, and supporting productivity and task management. LLM biases, misinformation, ethics, and health equity were identified as areas of concern and potential limitations to clinical and training use. A code of conduct on ethical and appropriate use was also developed to guide team usage on the wards. Conclusions: Overall, ChatGPT offers a novel tool to enhance ward-based learning through rapid information querying, second-order content exploration, and engaged team discussion regarding generated responses. More research is needed to fully understand contexts for educational use, particularly regarding the risks and limitations of the tool in clinical settings and its impacts on trainee development. UR - https://formative.jmir.org/2024/1/e51346 UR - http://dx.doi.org/10.2196/51346 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717811 ID - info:doi/10.2196/51346 ER - TY - JOUR AU - Grosjean, Julien AU - Dufour, Frank AU - Benis, Arriel AU - Januel, Jean-Marie AU - Staccini, Pascal AU - Darmoni, Jacques Stéfan PY - 2024/4/30 TI - Digital Health Education for the Future: The SaNuRN (Santé Numérique Rouen-Nice) Consortium?s Journey JO - JMIR Med Educ SP - e53997 VL - 10 KW - digital health KW - medical informatics KW - education KW - health education KW - curriculum KW - students KW - teaching materials KW - hybrid learning KW - program development KW - capacity building KW - access to information KW - e-learning KW - open access KW - open data KW - skills framework KW - competency-based learning KW - telemedicine training KW - medical simulation KW - objective structured clinical examination KW - OSCE KW - script concordance test KW - SCT KW - virtual patient UR - https://mededu.jmir.org/2024/1/e53997 UR - http://dx.doi.org/10.2196/53997 ID - info:doi/10.2196/53997 ER - TY - JOUR AU - Chien, Cheng-Yu AU - Tsai, Shang-Li AU - Huang, Chien-Hsiung AU - Wang, Ming-Fang AU - Lin, Chi-Chun AU - Chen, Chen-Bin AU - Tsai, Li-Heng AU - Tseng, Hsiao-Jung AU - Huang, Yan-Bo AU - Ng, Chip-Jin PY - 2024/4/29 TI - Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study JO - JMIR Med Educ SP - e52230 VL - 10 KW - cardiopulmonary resuscitation KW - blended method KW - blended KW - hybrid KW - refresher KW - refreshers KW - teaching KW - instruction KW - observational KW - training KW - professional development KW - continuing education KW - retraining KW - traditional method KW - self-directed learning KW - resuscitation KW - CPR KW - emergency KW - rescue KW - life support KW - cardiac KW - cardiopulmonary N2 - Background: Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method. Objective: This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators. Methods: This study recruited participants aged ?18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators. Results: This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3% female), with 332 (28.5%), 270 (23.2%), 258 (22.2%), and 303 (26.1%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80%); however, a higher proportion (98/303, 32.3%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training. Conclusions: Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach. Trial Registration: IGOGO NCT05659108; https://www.cgmh-igogo.tw UR - https://mededu.jmir.org/2024/1/e52230 UR - http://dx.doi.org/10.2196/52230 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683663 ID - info:doi/10.2196/52230 ER - TY - JOUR AU - Wang, Shangqiguo AU - Mo, Changgeng AU - Chen, Yuan AU - Dai, Xiaolu AU - Wang, Huiyi AU - Shen, Xiaoli PY - 2024/4/26 TI - Exploring the Performance of ChatGPT-4 in the Taiwan Audiologist Qualification Examination: Preliminary Observational Study Highlighting the Potential of AI Chatbots in Hearing Care JO - JMIR Med Educ SP - e55595 VL - 10 KW - ChatGPT KW - medical education KW - artificial intelligence KW - AI KW - audiology KW - hearing care KW - natural language processing KW - large language model KW - Taiwan KW - hearing KW - hearing specialist KW - audiologist KW - examination KW - information accuracy KW - educational technology KW - healthcare services KW - chatbot KW - health care services N2 - Background: Artificial intelligence (AI) chatbots, such as ChatGPT-4, have shown immense potential for application across various aspects of medicine, including medical education, clinical practice, and research. Objective: This study aimed to evaluate the performance of ChatGPT-4 in the 2023 Taiwan Audiologist Qualification Examination, thereby preliminarily exploring the potential utility of AI chatbots in the fields of audiology and hearing care services. Methods: ChatGPT-4 was tasked to provide answers and reasoning for the 2023 Taiwan Audiologist Qualification Examination. The examination encompassed six subjects: (1) basic auditory science, (2) behavioral audiology, (3) electrophysiological audiology, (4) principles and practice of hearing devices, (5) health and rehabilitation of the auditory and balance systems, and (6) auditory and speech communication disorders (including professional ethics). Each subject included 50 multiple-choice questions, with the exception of behavioral audiology, which had 49 questions, amounting to a total of 299 questions. Results: The correct answer rates across the 6 subjects were as follows: 88% for basic auditory science, 63% for behavioral audiology, 58% for electrophysiological audiology, 72% for principles and practice of hearing devices, 80% for health and rehabilitation of the auditory and balance systems, and 86% for auditory and speech communication disorders (including professional ethics). The overall accuracy rate for the 299 questions was 75%, which surpasses the examination?s passing criteria of an average 60% accuracy rate across all subjects. A comprehensive review of ChatGPT-4?s responses indicated that incorrect answers were predominantly due to information errors. Conclusions: ChatGPT-4 demonstrated a robust performance in the Taiwan Audiologist Qualification Examination, showcasing effective logical reasoning skills. Our results suggest that with enhanced information accuracy, ChatGPT-4?s performance could be further improved. This study indicates significant potential for the application of AI chatbots in audiology and hearing care services. UR - https://mededu.jmir.org/2024/1/e55595 UR - http://dx.doi.org/10.2196/55595 ID - info:doi/10.2196/55595 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 - Dsouza, Maria Jeanne PY - 2024/4/15 TI - A Student?s Viewpoint on ChatGPT Use and Automation Bias in Medical Education JO - JMIR Med Educ SP - e57696 VL - 10 KW - AI KW - artificial intelligence KW - ChatGPT KW - medical education UR - https://mededu.jmir.org/2024/1/e57696 UR - http://dx.doi.org/10.2196/57696 ID - info:doi/10.2196/57696 ER - TY - JOUR AU - Kröplin, Juliane AU - Maier, Leonie AU - Lenz, Jan-Hendrik AU - Romeike, Bernd PY - 2024/4/15 TI - Knowledge Transfer and Networking Upon Implementation of a Transdisciplinary Digital Health Curriculum in a Unique Digital Health Training Culture: Prospective Analysis JO - JMIR Med Educ SP - e51389 VL - 10 KW - big data KW - digital didactics KW - digital health applications KW - digital leadership KW - digital literacy KW - generative artificial intelligence KW - mobile working KW - robotics KW - telemedicine KW - wearables N2 - Background: Digital health has been taught at medical faculties for a few years. However, in general, the teaching of digital competencies in medical education and training is still underrepresented. Objective: This study aims to analyze the objective acquisition of digital competencies through the implementation of a transdisciplinary digital health curriculum as a compulsory elective subject at a German university. The main subject areas of digital leadership and management, digital learning and didactics, digital communication, robotics, and generative artificial intelligence were developed and taught in a transdisciplinary manner over a period of 1 semester. Methods: The participants evaluated the relevant content of the curriculum regarding the competencies already taught in advance during the study, using a Likert scale. The participants? increase in digital competencies were examined with a pre-post test consisting of 12 questions. Statistical analysis was performed using an unpaired 2-tailed Student t test. A P value of <.05 was considered statistically significant. Furthermore, an analysis of the acceptance of the transdisciplinary approach as well as the application of an alternative examination method (term paper instead of a test with closed and open questions) was carried out. Results: In the first year after the introduction of the compulsory elective subject, students of human medicine (n=15), dentistry (n=3), and medical biotechnology (n=2) participated in the curriculum. In total, 13 participants were women (7 men), and 61.1% (n=11) of the participants in human medicine and dentistry were in the preclinical study stage (clinical: n=7, 38.9%). All the aforementioned learning objectives were largely absent in all study sections (preclinical: mean 4.2; clinical: mean 4.4; P=.02). The pre-post test comparison revealed a significant increase of 106% in knowledge (P<.001) among the participants. Conclusions: The transdisciplinary teaching of a digital health curriculum, including digital teaching methods, considers perspectives and skills from different disciplines. Our new curriculum facilitates an objective increase in knowledge regarding the complex challenges of the digital transformation of our health care system. Of the 16 student term papers arising from the course, robotics and artificial intelligence attracted the most interest, accounting for 9 of the submissions. UR - https://mededu.jmir.org/2024/1/e51389 UR - http://dx.doi.org/10.2196/51389 ID - info:doi/10.2196/51389 ER - TY - JOUR AU - Wu, Yijun AU - Zheng, Yue AU - Feng, Baijie AU - Yang, Yuqi AU - Kang, Kai AU - Zhao, Ailin PY - 2024/4/10 TI - Embracing ChatGPT for Medical Education: Exploring Its Impact on Doctors and Medical Students JO - JMIR Med Educ SP - e52483 VL - 10 KW - artificial intelligence KW - AI KW - ChatGPT KW - medical education KW - doctors KW - medical students UR - https://mededu.jmir.org/2024/1/e52483 UR - http://dx.doi.org/10.2196/52483 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598263 ID - info:doi/10.2196/52483 ER - TY - JOUR AU - Fija?ko, Nino AU - Masterson Creber, Ruth AU - Metli?ar, ?pela AU - Strnad, Matej AU - Greif, Robert AU - ?tiglic, Gregor AU - Skok, Pavel PY - 2024/4/5 TI - Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List?Controlled Trial JO - JMIR Serious Games SP - e56037 VL - 12 KW - serious smartphone game KW - adult basic life support KW - teaching KW - game KW - games KW - gaming KW - education KW - nurse KW - nursing KW - nurses KW - educational KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - smartphone KW - smartphones KW - RCT KW - randomized controlled trial KW - controlled trial KW - technology-enhanced learning KW - TEL KW - life support KW - knowledge retention KW - theoretical knowledge KW - practice KW - practical KW - resuscitation N2 - Background: Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education. Objective: The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students? theoretical knowledge of and practical skills in adult BLS. Methods: This study used a randomized wait list?controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants? theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist. Results: In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants? theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator. Conclusions: Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training. Trial Registration: ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675 UR - https://games.jmir.org/2024/1/e56037 UR - http://dx.doi.org/10.2196/56037 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578690 ID - info:doi/10.2196/56037 ER - TY - JOUR AU - Gerbutavicius, Rokas AU - Merle, A. David AU - Wolf, Armin AU - Dimopoulos, Spyridon AU - Kortuem, Ulrich Karsten AU - Kortuem, Charlotte Friederike PY - 2024/3/29 TI - User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial JO - JMIR Form Res SP - e55742 VL - 8 KW - mHealth KW - mobile health KW - workflow optimization KW - patient satisfaction KW - health education KW - educational background KW - phacoemulsification N2 - Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the ?Patient Journey? app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. UR - https://formative.jmir.org/2024/1/e55742 UR - http://dx.doi.org/10.2196/55742 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551619 ID - info:doi/10.2196/55742 ER - TY - JOUR AU - Noda, Masao AU - Ueno, Takayoshi AU - Koshu, Ryota AU - Takaso, Yuji AU - Shimada, Dias Mari AU - Saito, Chizu AU - Sugimoto, Hisashi AU - Fushiki, Hiroaki AU - Ito, Makoto AU - Nomura, Akihiro AU - Yoshizaki, Tomokazu PY - 2024/3/28 TI - Performance of GPT-4V in Answering the Japanese Otolaryngology Board Certification Examination Questions: Evaluation Study JO - JMIR Med Educ SP - e57054 VL - 10 KW - artificial intelligence KW - GPT-4v KW - large language model KW - otolaryngology KW - GPT KW - ChatGPT KW - LLM KW - LLMs KW - language model KW - language models KW - head KW - respiratory KW - ENT: ear KW - nose KW - throat KW - neck KW - NLP KW - natural language processing KW - image KW - images KW - exam KW - exams KW - examination KW - examinations KW - answer KW - answers KW - answering KW - response KW - responses N2 - Background: Artificial intelligence models can learn from medical literature and clinical cases and generate answers that rival human experts. However, challenges remain in the analysis of complex data containing images and diagrams. Objective: This study aims to assess the answering capabilities and accuracy of ChatGPT-4 Vision (GPT-4V) for a set of 100 questions, including image-based questions, from the 2023 otolaryngology board certification examination. Methods: Answers to 100 questions from the 2023 otolaryngology board certification examination, including image-based questions, were generated using GPT-4V. The accuracy rate was evaluated using different prompts, and the presence of images, clinical area of the questions, and variations in the answer content were examined. Results: The accuracy rate for text-only input was, on average, 24.7% but improved to 47.3% with the addition of English translation and prompts (P<.001). The average nonresponse rate for text-only input was 46.3%; this decreased to 2.7% with the addition of English translation and prompts (P<.001). The accuracy rate was lower for image-based questions than for text-only questions across all types of input, with a relatively high nonresponse rate. General questions and questions from the fields of head and neck allergies and nasal allergies had relatively high accuracy rates, which increased with the addition of translation and prompts. In terms of content, questions related to anatomy had the highest accuracy rate. For all content types, the addition of translation and prompts increased the accuracy rate. As for the performance based on image-based questions, the average of correct answer rate with text-only input was 30.4%, and that with text-plus-image input was 41.3% (P=.02). Conclusions: Examination of artificial intelligence?s answering capabilities for the otolaryngology board certification examination improves our understanding of its potential and limitations in this field. Although the improvement was noted with the addition of translation and prompts, the accuracy rate for image-based questions was lower than that for text-based questions, suggesting room for improvement in GPT-4V at this stage. Furthermore, text-plus-image input answers a higher rate in image-based questions. Our findings imply the usefulness and potential of GPT-4V in medicine; however, future consideration of safe use methods is needed. UR - https://mededu.jmir.org/2024/1/e57054 UR - http://dx.doi.org/10.2196/57054 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546736 ID - info:doi/10.2196/57054 ER - TY - JOUR AU - Burch, Vanessa AU - McGuire, Jessica AU - Buch, Eric AU - Sathekge, Mike AU - M'bouaffou, Francis AU - Senkubuge, Flavia AU - Fagan, Johannes PY - 2024/3/6 TI - Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation JO - JMIR Form Res SP - e40868 VL - 8 KW - web-based certification examinations KW - web-based structured oral examinations KW - medical education KW - specialist and subspecialist examinations KW - structured oral examinations KW - Colleges of Medicine of South Africa N2 - Background: The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. Objective: This formative evaluation explored candidates? acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates? overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. Methods: This mixed methods, single-arm evaluation anonymously gathered candidates? perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Results: Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; ?21=667; P<.001; 2021: N=7988; ?21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). Conclusions: Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method. UR - https://formative.jmir.org/2024/1/e40868 UR - http://dx.doi.org/10.2196/40868 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064633 ID - info:doi/10.2196/40868 ER - TY - JOUR AU - Willms, Amanda AU - Liu, Sam PY - 2024/2/29 TI - Exploring the Feasibility of Using ChatGPT to Create Just-in-Time Adaptive Physical Activity mHealth Intervention Content: Case Study JO - JMIR Med Educ SP - e51426 VL - 10 KW - ChatGPT KW - digital health KW - mobile health KW - mHealth KW - physical activity KW - application KW - mobile app KW - mobile apps KW - content creation KW - behavior change KW - app design N2 - Background: Achieving physical activity (PA) guidelines? recommendation of 150 minutes of moderate-to-vigorous PA per week has been shown to reduce the risk of many chronic conditions. Despite the overwhelming evidence in this field, PA levels remain low globally. By creating engaging mobile health (mHealth) interventions through strategies such as just-in-time adaptive interventions (JITAIs) that are tailored to an individual?s dynamic state, there is potential to increase PA levels. However, generating personalized content can take a long time due to various versions of content required for the personalization algorithms. ChatGPT presents an incredible opportunity to rapidly produce tailored content; however, there is a lack of studies exploring its feasibility. Objective: This study aimed to (1) explore the feasibility of using ChatGPT to create content for a PA JITAI mobile app and (2) describe lessons learned and future recommendations for using ChatGPT in the development of mHealth JITAI content. Methods: During phase 1, we used Pathverse, a no-code app builder, and ChatGPT to develop a JITAI app to help parents support their child?s PA levels. The intervention was developed based on the Multi-Process Action Control (M-PAC) framework, and the necessary behavior change techniques targeting the M-PAC constructs were implemented in the app design to help parents support their child?s PA. The acceptability of using ChatGPT for this purpose was discussed to determine its feasibility. In phase 2, we summarized the lessons we learned during the JITAI content development process using ChatGPT and generated recommendations to inform future similar use cases. Results: In phase 1, by using specific prompts, we efficiently generated content for 13 lessons relating to increasing parental support for their child?s PA following the M-PAC framework. It was determined that using ChatGPT for this case study to develop PA content for a JITAI was acceptable. In phase 2, we summarized our recommendations into the following six steps when using ChatGPT to create content for mHealth behavior interventions: (1) determine target behavior, (2) ground the intervention in behavior change theory, (3) design the intervention structure, (4) input intervention structure and behavior change constructs into ChatGPT, (5) revise the ChatGPT response, and (6) customize the response to be used in the intervention. Conclusions: ChatGPT offers a remarkable opportunity for rapid content creation in the context of an mHealth JITAI. Although our case study demonstrated that ChatGPT was acceptable, it is essential to approach its use, along with other language models, with caution. Before delivering content to population groups, expert review is crucial to ensure accuracy and relevancy. Future research and application of these guidelines are imperative as we deepen our understanding of ChatGPT and its interactions with human input. UR - https://mededu.jmir.org/2024/1/e51426 UR - http://dx.doi.org/10.2196/51426 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421689 ID - info:doi/10.2196/51426 ER - TY - JOUR AU - Mareli?, Marko AU - Klasni?, Ksenija AU - Vuku?i? Rukavina, Tea PY - 2024/2/27 TI - Measuring e-Professional Behavior of Doctors of Medicine and Dental Medicine on Social Networking Sites: Indexes Construction With Formative Indicators JO - JMIR Med Educ SP - e50156 VL - 10 KW - e-professionalism KW - social media KW - formative index KW - social networking KW - doctors KW - medical KW - dental medicine N2 - Background: Previous studies have predominantly measured e-professionalism through perceptions or attitudes, yet there exists no validated measure specifically targeting the actual behaviors of health care professionals (HCPs) in this realm. This study addresses this gap by constructing a normative framework, drawing from 3 primary sources to define e-professional behavior across 6 domains. Four domains pertain to the dangers of social networking sites (SNSs), encompassing confidentiality, privacy, patient interaction, and equitable resource allocation. Meanwhile, 2 domains focus on the opportunities of SNSs, namely, the proactive dissemination of public health information and maintaining scientific integrity. Objective: This study aims to develop and validate 2 new measures assessing the e-professional behavior of doctors of medicine (MDs) and doctors of dental medicine (DMDs), focusing on both the dangers and opportunities associated with SNSs. Methods: The study used a purposive sample of MDs and DMDs in Croatia who were users of at least one SNS. Data collection took place in 2021 through an online survey. Validation of both indexes used a formative approach, which involved a 5-step methodology: content specification, indicators definition with instructions for item coding and index construction, indicators collinearity check using the variance inflation factor (VIF), external validity test using multiple indicators multiple causes (MIMIC) model, and external validity test by checking the relationships of the indexes with the scale of attitude toward SNSs using Pearson correlation coefficients. Results: A total of 753 responses were included in the analysis. The first e-professionalism index, assessing the dangers associated with SNSs, comprises 14 items. During the indicators collinearity check, all indicators displayed acceptable VIF values below 2.5. The MIMIC model showed good fit (?213=9.4, P=.742; ?2/df=0.723; root-mean-square error of approximation<.001; goodness-of-fit index=0.998; comparative fit index=1.000). The external validity of the index is supported by a statistically significant negative correlation with the scale measuring attitudes toward SNSs (r=?0.225, P<.001). Following the removal of 1 item, the second e-professionalism index, focusing on the opportunities associated with SNSs, comprises 5 items. During the indicators collinearity check, all indicators exhibited acceptable VIF values below 2.5. Additionally, the MIMIC model demonstrated a good fit (?24=2.5, P=.718; ?2/df=0.637; root-mean-square error of approximation<0.001; goodness-of-fit index=0.999; comparative fit index=1.000). The external validity of the index is supported by a statistically significant positive correlation with the scale of attitude toward SNSs (r=0.338; P<.001). Conclusions: Following the validation process, the instrument designed for gauging the e-professional behavior of MDs and DMDs consists of 19 items, which contribute to the formation of 2 distinct indexes: the e-professionalism index, focusing on the dangers associated with SNSs, comprising 14 items, and the e-professionalism index, highlighting the opportunities offered by SNSs, consisting of 5 items. These indexes serve as valid measures of the e-professional behavior of MDs and DMDs, with the potential for further refinement to encompass emerging forms of unprofessional behavior that may arise over time. UR - https://mededu.jmir.org/2024/1/e50156 UR - http://dx.doi.org/10.2196/50156 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412021 ID - info:doi/10.2196/50156 ER - TY - JOUR AU - Kumar, Ajay AU - Burr, Pierce AU - Young, Michael Tim PY - 2024/2/22 TI - Using AI Text-to-Image Generation to Create Novel Illustrations for Medical Education: Current Limitations as Illustrated by Hypothyroidism and Horner Syndrome JO - JMIR Med Educ SP - e52155 VL - 10 KW - artificial intelligence KW - AI KW - medical illustration KW - medical images KW - medical education KW - image KW - images KW - illustration KW - illustrations KW - photo KW - photos KW - photographs KW - face KW - facial KW - paralysis KW - photograph KW - photography KW - Horner's syndrome KW - Horner syndrome KW - Bernard syndrome KW - Bernard's syndrome KW - miosis KW - oculosympathetic KW - ptosis KW - ophthalmoplegia KW - nervous system KW - autonomic KW - eye KW - eyes KW - pupil KW - pupils KW - neurologic KW - neurological UR - https://mededu.jmir.org/2024/1/e52155 UR - http://dx.doi.org/10.2196/52155 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386400 ID - info:doi/10.2196/52155 ER - TY - JOUR AU - Johnson, G. Susanne AU - Espehaug, Birgitte AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2024/2/21 TI - Occupational Therapy Students? Evidence-Based Practice Skills as Reported in a Mobile App: Cross-Sectional Study JO - JMIR Med Educ SP - e48507 VL - 10 KW - active learning strategies KW - application KW - cross-sectional study KW - development KW - education KW - higher education KW - interactive KW - mobile application KW - mobile app KW - occupational therapy students KW - occupational therapy KW - students KW - usability KW - use N2 - Background: Evidence-based practice (EBP) is an important aspect of the health care education curriculum. EBP involves following the 5 EBP steps: ask, assess, appraise, apply, and audit. These 5 steps reflect the suggested core competencies covered in teaching and learning programs to support future health care professionals applying EBP. When implementing EBP teaching, assessing outcomes by documenting the student?s performance and skills is relevant. This can be done using mobile devices. Objective: The aim of this study was to assess occupational therapy students? EBP skills as reported in a mobile app. Methods: We applied a cross-sectional design. Descriptive statistics were used to present frequencies, percentages, means, and ranges of data regarding EBP skills found in the EBPsteps app. Associations between students? ability to formulate the Population, Intervention, Comparison, and Outcome/Population, Interest, and Context (PICO/PICo) elements and identifying relevant research evidence were analyzed with the chi-square test. Results: Of 4 cohorts with 150 students, 119 (79.3%) students used the app and produced 240 critically appraised topics (CATs) in the app. The EBP steps ?ask,? ?assess,? and ?appraise? were often correctly performed. The clinical question was formulated correctly in 53.3% (128/240) of the CATs, and students identified research evidence in 81.2% (195/240) of the CATs. Critical appraisal checklists were used in 81.2% (195/240) of the CATs, and most of these checklists were assessed as relevant for the type of research evidence identified (165/195, 84.6%). The least frequently correctly reported steps were ?apply? and ?audit.? In 39.6% (95/240) of the CATs, it was reported that research evidence was applied. Only 61% (58/95) of these CATs described how the research was applied to clinical practice. Evaluation of practice changes was reported in 38.8% (93/240) of the CATs. However, details about practice changes were lacking in all these CATs. A positive association was found between correctly reporting the "population" and "interventions/interest" elements of the PICO/PICo and identifying research evidence (P<.001). Conclusions: We assessed the students? EBP skills based on how they documented following the EBP steps in the EBPsteps app, and our results showed variations in how well the students mastered the steps. ?Apply? and ?audit? were the most difficult EBP steps for the students to perform, and this finding has implications and gives directions for further development of the app and educational instruction in EBP. The EBPsteps app is a new and relevant app for students to learn and practice EBP, and it can be used to assess students? EBP skills objectively. UR - https://mededu.jmir.org/2024/1/e48507 UR - http://dx.doi.org/10.2196/48507 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381475 ID - info:doi/10.2196/48507 ER - TY - JOUR AU - Abid, Areeba AU - Murugan, Avinash AU - Banerjee, Imon AU - Purkayastha, Saptarshi AU - Trivedi, Hari AU - Gichoya, Judy PY - 2024/2/20 TI - AI Education for Fourth-Year Medical Students: Two-Year Experience of a Web-Based, Self-Guided Curriculum and Mixed Methods Study JO - JMIR Med Educ SP - e46500 VL - 10 KW - medical education KW - machine learning KW - artificial intelligence KW - elective curriculum KW - medical student KW - student KW - students KW - elective KW - electives KW - curricula KW - curriculum KW - lesson plan KW - lesson plans KW - educators KW - educator KW - teacher KW - teachers KW - teaching KW - computer programming KW - programming KW - coding KW - programmer KW - programmers KW - self guided KW - self directed N2 - Background: Artificial intelligence (AI) and machine learning (ML) are poised to have a substantial impact in the health care space. While a plethora of web-based resources exist to teach programming skills and ML model development, there are few introductory curricula specifically tailored to medical students without a background in data science or programming. Programs that do exist are often restricted to a specific specialty. Objective: We hypothesized that a 1-month elective for fourth-year medical students, composed of high-quality existing web-based resources and a project-based structure, would empower students to learn about the impact of AI and ML in their chosen specialty and begin contributing to innovation in their field of interest. This study aims to evaluate the success of this elective in improving self-reported confidence scores in AI and ML. The authors also share our curriculum with other educators who may be interested in its adoption. Methods: This elective was offered in 2 tracks: technical (for students who were already competent programmers) and nontechnical (with no technical prerequisites, focusing on building a conceptual understanding of AI and ML). Students established a conceptual foundation of knowledge using curated web-based resources and relevant research papers, and were then tasked with completing 3 projects in their chosen specialty: a data set analysis, a literature review, and an AI project proposal. The project-based nature of the elective was designed to be self-guided and flexible to each student?s interest area and career goals. Students? success was measured by self-reported confidence in AI and ML skills in pre and postsurveys. Qualitative feedback on students? experiences was also collected. Results: This web-based, self-directed elective was offered on a pass-or-fail basis each month to fourth-year students at Emory University School of Medicine beginning in May 2021. As of June 2022, a total of 19 students had successfully completed the elective, representing a wide range of chosen specialties: diagnostic radiology (n=3), general surgery (n=1), internal medicine (n=5), neurology (n=2), obstetrics and gynecology (n=1), ophthalmology (n=1), orthopedic surgery (n=1), otolaryngology (n=2), pathology (n=2), and pediatrics (n=1). Students? self-reported confidence scores for AI and ML rose by 66% after this 1-month elective. In qualitative surveys, students overwhelmingly reported enthusiasm and satisfaction with the course and commented that the self-direction and flexibility and the project-based design of the course were essential. Conclusions: Course participants were successful in diving deep into applications of AI in their widely-ranging specialties, produced substantial project deliverables, and generally reported satisfaction with their elective experience. The authors are hopeful that a brief, 1-month investment in AI and ML education during medical school will empower this next generation of physicians to pave the way for AI and ML innovation in health care. UR - https://mededu.jmir.org/2024/1/e46500 UR - http://dx.doi.org/10.2196/46500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38376896 ID - info:doi/10.2196/46500 ER - TY - JOUR AU - Liu, Wa Justina Yat AU - Mak, Ying Pui AU - Chan, Kitty AU - Cheung, Ki Daphne Sze AU - Cheung, Kin AU - Fong, K. Kenneth N. AU - Kor, Kin Patrick Pui AU - Lai, Hung Timothy Kam AU - Maximo, Tulio PY - 2024/2/15 TI - The Effects of Immersive Virtual Reality?Assisted Experiential Learning on Enhancing Empathy in Undergraduate Health Care Students Toward Older Adults With Cognitive Impairment: Multiple-Methods Study JO - JMIR Med Educ SP - e48566 VL - 10 KW - immersive virtual reality KW - undergraduate health care education KW - empathy KW - cognitive impairment N2 - Background: Immersive virtual reality (IVR)?assisted experiential learning has the potential to foster empathy among undergraduate health care students toward older adults with cognitive impairment by facilitating a sense of embodiment. However, the extent of its effectiveness, including enhancing students? learning experiences and achieving intended learning outcomes, remains underexplored. Objective: This study aims to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment as the primary outcome (objective 1) and on their learning experience (objective 2) and their attainment of learning outcomes as the secondary outcomes (objective 3). Methods: A multiple-methods design was used, which included surveys, focus groups, and a review of the students? group assignments. Survey data were summarized using descriptive statistics, whereas paired 2-tailed t tests were used to evaluate differences in empathy scores before and after the 2-hour IVR tutorial (objective 1). Focus groups were conducted to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment (objective 1). Descriptive statistics obtained from surveys and thematic analyses of focus groups were used to explore the students? learning experiences (objective 2). Thematic analysis of group assignments was conducted to identify learning outcomes (objective 3). Results: A total of 367 undergraduate nursing and occupational therapy students were recruited via convenience sampling. There was a significant increase in the students? empathy scores, measured using the Kiersma-Chen Empathy Scale, from 78.06 (SD 7.72) before to 81.17 (SD 8.93) after (P<.001). Students expressed high satisfaction with the IVR learning innovation, with a high satisfaction mean score of 20.68 (SD 2.55) and a high self-confidence mean score of 32.04 (SD 3.52) on the Student Satisfaction and Self-Confidence scale. Students exhibited a good sense of presence in the IVR learning environment, as reflected in the scores for adaptation (41.30, SD 6.03), interface quality (11.36, SD 3.70), involvement (62.00, SD 9.47), and sensory fidelity (31.47, SD 5.23) on the Presence Questionnaire version 2.0. In total, 3 major themes were identified from the focus groups, which involved 23 nursing students: enhanced sympathy toward older adults with cognitive impairment, improved engagement in IVR learning, and confidence in understanding the key concepts through the learning process. These themes supplement and align with the survey results. The analysis of the written assignments revealed that students attained the learning outcomes of understanding the challenges faced by older adults with cognitive impairment, the importance of providing person-centered care, and the need for an age-friendly society. Conclusions: IVR-assisted experiential learning enhances students? knowledge and empathy in caring for older adults with cognitive impairment. These findings suggest that IVR can be a valuable tool in professional health care education. UR - https://mededu.jmir.org/2024/1/e48566 UR - http://dx.doi.org/10.2196/48566 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358800 ID - info:doi/10.2196/48566 ER - TY - JOUR AU - Cheng, Pengfei AU - Huang, Yangxi AU - Yang, Pengyu AU - Wang, Haizhen AU - Xu, Baichao AU - Qu, Chaoran AU - Zhang, Hua PY - 2024/2/6 TI - The Effects of Serious Games on Cardiopulmonary Resuscitation Training and Education: Systematic Review With Meta-Analysis of Randomized Controlled Trials JO - JMIR Serious Games SP - e52990 VL - 12 KW - CPR KW - education KW - meta-analysis KW - serious game KW - training N2 - Background: Serious games have emerged as an innovative educational strategy with the potential to significantly enhance the quality and effectiveness of cardiopulmonary resuscitation (CPR) training. Despite their promise, there remains a degree of controversy when comparing the advantages of serious games with traditional CPR training methods. This study seeks to provide a comprehensive assessment of the impact of serious games on CPR training and education by systematically analyzing the results of previous research. Objective: This study aimed to assess the effect of serious games on CPR training and education by summarizing and pooling the results of previous studies. Methods: We conducted a thorough and systematic search across 9 prominent web-based databases, encompassing the period from the inception of these databases until April 1, 2023. The databases included in our search were PubMed, Cochrane Library, Wiley Online Library, EBSCO (PsycInfo), SpringerLink, Chinese Biology Medicine Disc, Vip Journal Integration Platform, Wanfang Database, and Chinese National Knowledge Infrastructure. The studies selected adhered to the following criteria: (1) being a randomized controlled trial comparing serious games and traditional methods for CPR training; (2) having participants aged 12 years or older in CPR; (3) having an experimental group using serious games and a control group using nongame methods for CPR instruction; and (4) having outcomes including theoretical and skill assessments, compression depth, and rate. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. Data analysis was performed using RevMan (version 5.3; Cochrane Training), and mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. Results: A total of 9 articles were included, involving 791 study participants, of whom 395 in the experimental group taught CPR training using serious games and 396 in the control group taught CPR training using traditional methods. The results of our meta-analysis indicate that the use of serious games in CPR training yields outcomes that are comparable in effectiveness to traditional training methods across several key areas. Specifically, serious games demonstrated equivalence to traditional formats in theory assessment (SMD ?0.22, 95% CI ? 0.96 to 0.51; P=.55), skill assessment (SMD ?0.49, 95% CI ?1.52 to 0.55; P=.36), compression depth (MD ?3.17, 95% CI ?0.18 to 6.53; P=.06), and compression rate (MD ?0.20, 95% CI ?7.29 to 6.89; P=.96). Conclusions: In summary, serious games offer a viable and effective CPR education approach, yielding results comparable to traditional formats. This modality is a valuable addition to CPR training methodologies. However, caution is warranted in interpreting these findings due to limited controlled trials, small sample sizes, and low-quality meta-analyzed evidence. UR - https://games.jmir.org/2024/1/e52990 UR - http://dx.doi.org/10.2196/52990 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319697 ID - info:doi/10.2196/52990 ER - TY - JOUR AU - Gray, Megan AU - Baird, Austin AU - Sawyer, Taylor AU - James, Jasmine AU - DeBroux, Thea AU - Bartlett, Michelle AU - Krick, Jeanne AU - Umoren, Rachel PY - 2024/2/1 TI - Increasing Realism and Variety of Virtual Patient Dialogues for Prenatal Counseling Education Through a Novel Application of ChatGPT: Exploratory Observational Study JO - JMIR Med Educ SP - e50705 VL - 10 KW - prenatal counseling KW - virtual health KW - virtual patient KW - simulation KW - neonatology KW - ChatGPT KW - AI KW - artificial intelligence N2 - Background: Using virtual patients, facilitated by natural language processing, provides a valuable educational experience for learners. Generating a large, varied sample of realistic and appropriate responses for virtual patients is challenging. Artificial intelligence (AI) programs can be a viable source for these responses, but their utility for this purpose has not been explored. Objective: In this study, we explored the effectiveness of generative AI (ChatGPT) in developing realistic virtual standardized patient dialogues to teach prenatal counseling skills. Methods: ChatGPT was prompted to generate a list of common areas of concern and questions that families expecting preterm delivery at 24 weeks gestation might ask during prenatal counseling. ChatGPT was then prompted to generate 2 role-plays with dialogues between a parent expecting a potential preterm delivery at 24 weeks and their counseling physician using each of the example questions. The prompt was repeated for 2 unique role-plays: one parent was characterized as anxious and the other as having low trust in the medical system. Role-play scripts were exported verbatim and independently reviewed by 2 neonatologists with experience in prenatal counseling, using a scale of 1-5 on realism, appropriateness, and utility for virtual standardized patient responses. Results: ChatGPT generated 7 areas of concern, with 35 example questions used to generate role-plays. The 35 role-play transcripts generated 176 unique parent responses (median 5, IQR 4-6, per role-play) with 268 unique sentences. Expert review identified 117 (65%) of the 176 responses as indicating an emotion, either directly or indirectly. Approximately half (98/176, 56%) of the responses had 2 or more sentences, and half (88/176, 50%) included at least 1 question. More than half (104/176, 58%) of the responses from role-played parent characters described a feeling, such as being scared, worried, or concerned. The role-plays of parents with low trust in the medical system generated many unique sentences (n=50). Most of the sentences in the responses were found to be reasonably realistic (214/268, 80%), appropriate for variable prenatal counseling conversation paths (233/268, 87%), and usable without more than a minimal modification in a virtual patient program (169/268, 63%). Conclusions: Generative AI programs, such as ChatGPT, may provide a viable source of training materials to expand virtual patient programs, with careful attention to the concerns and questions of patients and families. Given the potential for unrealistic or inappropriate statements and questions, an expert should review AI chat outputs before deploying them in an educational program. UR - https://mededu.jmir.org/2024/1/e50705 UR - http://dx.doi.org/10.2196/50705 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300696 ID - info:doi/10.2196/50705 ER - TY - JOUR AU - Khodabakhshian, Nairy AU - Gaeul Lee, Kyla AU - Marawi, Tulip AU - Sorkhou, Maryam AU - Vyravanathan, Sobiga AU - Harnett, Nicole PY - 2024/2/1 TI - Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53901 VL - 13 KW - communication KW - medical education KW - patient-facing KW - scoping review KW - technology KW - virtual reality N2 - Background: Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education. Objective: The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education. Methods: A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non?communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. Results: As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods. Conclusions: The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care?specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry. International Registered Report Identifier (IRRID): DERR1-10.2196/53901 UR - https://www.researchprotocols.org/2024/1/e53901 UR - http://dx.doi.org/10.2196/53901 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300671 ID - info:doi/10.2196/53901 ER - TY - JOUR AU - Guinez-Molinos, Sergio AU - Espinoza, Sonia AU - Andrade, Jose AU - Medina, Alejandro PY - 2024/1/29 TI - Design and Development of Learning Management System Huemul for Teaching Fast Healthcare Interoperability Resource: Algorithm Development and Validation Study JO - JMIR Med Educ SP - e45413 VL - 10 KW - interoperability KW - health information system KW - Health Level Seven International KW - HL7 KW - Fast Healthcare Interoperability Resource KW - FHIR KW - certification KW - training KW - interoperable KW - e-learning KW - application programming interface KW - API N2 - Background: Interoperability between health information systems is a fundamental requirement to guarantee the continuity of health care for the population. The Fast Healthcare Interoperability Resource (FHIR) is the standard that enables the design and development of interoperable systems with broad adoption worldwide. However, FHIR training curriculums need an easily administered web-based self-learning platform with modules to create scenarios and questions that the learner answers. This paper proposes a system for teaching FHIR that automatically evaluates the answers, providing the learner with continuous feedback and progress. Objective: We are designing and developing a learning management system for creating, applying, deploying, and automatically assessing FHIR web-based courses. Methods: The system requirements for teaching FHIR were collected through interviews with experts involved in academic and professional FHIR activities (universities and health institutions). The interviews were semistructured, recording and documenting each meeting. In addition, we used an ad hoc instrument to register and analyze all the needs to elicit the requirements. Finally, the information obtained was triangulated with the available evidence. This analysis was carried out with Atlas-ti software. For design purposes, the requirements were divided into functional and nonfunctional. The functional requirements were (1) a test and question manager, (2) an application programming interface (API) to orchestrate components, (3) a test evaluator that automatically evaluates the responses, and (4) a client application for students. Security and usability are essential nonfunctional requirements to design functional and secure interfaces. The software development methodology was based on the traditional spiral model. The end users of the proposed system are (1) the system administrator for all technical aspects of the server, (2) the teacher designing the courses, and (3) the students interested in learning FHIR. Results: The main result described in this work is Huemul, a learning management system for training on FHIR, which includes the following components: (1) Huemul Admin: a web application to create users, tests, and questions and define scores; (2) Huemul API: module for communication between different software components (FHIR server, client, and engine); (3) Huemul Engine: component for answers evaluation to identify differences and validate the content; and (4) Huemul Client: the web application for users to show the test and questions. Huemul was successfully implemented with 416 students associated with the 10 active courses on the platform. In addition, the teachers have created 60 tests and 695 questions. Overall, the 416 students who completed their courses rated Huemul highly. Conclusions: Huemul is the first platform that allows the creation of courses, tests, and questions that enable the automatic evaluation and feedback of FHIR operations. Huemul has been implemented in multiple FHIR teaching scenarios for health care professionals. Professionals trained on FHIR with Huemul are leading successful national and international initiatives. UR - https://mededu.jmir.org/2024/1/e45413 UR - http://dx.doi.org/10.2196/45413 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285492 ID - info:doi/10.2196/45413 ER - TY - JOUR AU - Al-Worafi, Mohammed Yaser AU - Goh, Wen Khang AU - Hermansyah, Andi AU - Tan, Siang Ching AU - Ming, Chiau Long PY - 2024/1/12 TI - The Use of ChatGPT for Education Modules on Integrated Pharmacotherapy of Infectious Disease: Educators' Perspectives JO - JMIR Med Educ SP - e47339 VL - 10 KW - innovation and technology KW - quality education KW - sustainable communities KW - innovation and infrastructure KW - partnerships for the goals KW - sustainable education KW - social justice KW - ChatGPT KW - artificial intelligence KW - feasibility N2 - Background: Artificial Intelligence (AI) plays an important role in many fields, including medical education, practice, and research. Many medical educators started using ChatGPT at the end of 2022 for many purposes. Objective: The aim of this study was to explore the potential uses, benefits, and risks of using ChatGPT in education modules on integrated pharmacotherapy of infectious disease. Methods: A content analysis was conducted to investigate the applications of ChatGPT in education modules on integrated pharmacotherapy of infectious disease. Questions pertaining to curriculum development, syllabus design, lecture note preparation, and examination construction were posed during data collection. Three experienced professors rated the appropriateness and precision of the answers provided by ChatGPT. The consensus rating was considered. The professors also discussed the prospective applications, benefits, and risks of ChatGPT in this educational setting. Results: ChatGPT demonstrated the ability to contribute to various aspects of curriculum design, with ratings ranging from 50% to 92% for appropriateness and accuracy. However, there were limitations and risks associated with its use, including incomplete syllabi, the absence of essential learning objectives, and the inability to design valid questionnaires and qualitative studies. It was suggested that educators use ChatGPT as a resource rather than relying primarily on its output. There are recommendations for effectively incorporating ChatGPT into the curriculum of the education modules on integrated pharmacotherapy of infectious disease. Conclusions: Medical and health sciences educators can use ChatGPT as a guide in many aspects related to the development of the curriculum of the education modules on integrated pharmacotherapy of infectious disease, syllabus design, lecture notes preparation, and examination preparation with caution. UR - https://mededu.jmir.org/2024/1/e47339 UR - http://dx.doi.org/10.2196/47339 UR - http://www.ncbi.nlm.nih.gov/pubmed/38214967 ID - info:doi/10.2196/47339 ER - TY - JOUR AU - Sun, Ting AU - Xu, Xuejie AU - Zhu, Ningning AU - Zhang, Jing AU - Ma, Zuchang AU - Xie, Hui PY - 2023/12/15 TI - A Service-Learning Project Based on a Community-Oriented Intelligent Health Promotion System for Postgraduate Nursing Students: Mixed Methods Study JO - JMIR Med Educ SP - e52279 VL - 9 KW - service learning KW - intelligent health promotion system KW - scientific awareness KW - research innovation ability N2 - Background: Service learning (SL) is a pedagogical approach that combines community service with cognitive learning for professionals. Its efficacy in promoting community health has gained broad recognition in nursing education. The application of postgraduate nursing SL programs in community-based intelligent health remains underexplored. Thus, additional investigation is necessary to assess the influence of the SL project based on a community-oriented intelligent health promotion system (SLP-COIHPS) on postgraduate nursing students and health service recipients. Objective: This study aims to assess how SLP-COIHPS influences the scientific awareness and research innovation abilities of postgraduate nursing students. In addition, the study sought to examine the experiences of both participating students and health service recipients. Methods: We conducted a mixed methods investigation by using web-based surveys and conducting interviews. The web-based surveys aimed to explore the differences in scientific awareness and research innovation capabilities between 2 distinct groups: an experimental group of 23 postgraduate nursing students actively participated in SLP-COIHPS, while 23 postgraduate students (matched one-to-one with the experimental group in terms of grade, sex, and research methods) served as control participants. Semistructured interviews were conducted with 65% (15/23) of postgraduate students and 3% (12/405) of community residents who received health services, aiming to assess the project?s impact on them. The community-based intelligent health promotion system installed in intelligent health cabins can be conceptualized as an expert system providing valuable references for student health education. It has the capability to generate comprehensive assessments and personalized health guidance plans. Following training, students were involved in offering health assessments, health education, and related services. Subsequently, after the web-based surveys and semistructured interviews, quantitative data were analyzed using the SPSS (IBM Corp) software package, using 2-tailed t tests and Mann-Whitney U tests; qualitative data underwent analysis using the constructivist grounded theory approach. Results: Postgraduate nursing students participating in this program scored 12.83 (Cohen d>0.8; P<.001) and 10.56 (Cohen d>0.8; P=.004) points higher than postgraduate students in the control group in research awareness and research innovation capability, respectively. On the basis of the qualitative results, postgraduate students reported improvement in this program. Analysis of the interviews revealed a total of 12 subcategories across three primary domains: (1) specialized skills, (2) scientific research ability, and (3) comprehensive qualities. Community residents reported high satisfaction and positive experiences. Analysis of the interviews with community residents identified two primary categories: (1) satisfaction and (2) perceived benefits. Conclusions: SLP-COIHPS had a positive impact on students? development of scientific awareness and research innovation ability. Qualitative study findings also support the further development of practical programs that integrate intelligent health and SL theories in the field of medical education. This includes exploring the potential factors influencing postgraduate nursing students? research capabilities or investigating the long-term effects of the project. UR - https://mededu.jmir.org/2023/1/e52279 UR - http://dx.doi.org/10.2196/52279 UR - http://www.ncbi.nlm.nih.gov/pubmed/38100207 ID - info:doi/10.2196/52279 ER - TY - JOUR AU - Watari, Takashi AU - Takagi, Soshi AU - Sakaguchi, Kota AU - Nishizaki, Yuji AU - Shimizu, Taro AU - Yamamoto, Yu AU - Tokuda, Yasuharu PY - 2023/12/6 TI - Performance Comparison of ChatGPT-4 and Japanese Medical Residents in the General Medicine In-Training Examination: Comparison Study JO - JMIR Med Educ SP - e52202 VL - 9 KW - ChatGPT KW - artificial intelligence KW - medical education KW - clinical training KW - non-English language KW - ChatGPT-4 KW - Japan KW - Japanese KW - Asia KW - Asian KW - exam KW - examination KW - exams KW - examinations KW - NLP KW - natural language processing KW - LLM KW - language model KW - language models KW - performance KW - response KW - responses KW - answer KW - answers KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - reasoning KW - clinical KW - GM-ITE KW - self-assessment KW - residency programs N2 - Background: The reliability of GPT-4, a state-of-the-art expansive language model specializing in clinical reasoning and medical knowledge, remains largely unverified across non-English languages. Objective: This study aims to compare fundamental clinical competencies between Japanese residents and GPT-4 by using the General Medicine In-Training Examination (GM-ITE). Methods: We used the GPT-4 model provided by OpenAI and the GM-ITE examination questions for the years 2020, 2021, and 2022 to conduct a comparative analysis. This analysis focused on evaluating the performance of individuals who were concluding their second year of residency in comparison to that of GPT-4. Given the current abilities of GPT-4, our study included only single-choice exam questions, excluding those involving audio, video, or image data. The assessment included 4 categories: general theory (professionalism and medical interviewing), symptomatology and clinical reasoning, physical examinations and clinical procedures, and specific diseases. Additionally, we categorized the questions into 7 specialty fields and 3 levels of difficulty, which were determined based on residents? correct response rates. Results: Upon examination of 137 GM-ITE questions in Japanese, GPT-4 scores were significantly higher than the mean scores of residents (residents: 55.8%, GPT-4: 70.1%; P<.001). In terms of specific disciplines, GPT-4 scored 23.5 points higher in the ?specific diseases,? 30.9 points higher in ?obstetrics and gynecology,? and 26.1 points higher in ?internal medicine.? In contrast, GPT-4 scores in ?medical interviewing and professionalism,? ?general practice,? and ?psychiatry? were lower than those of the residents, although this discrepancy was not statistically significant. Upon analyzing scores based on question difficulty, GPT-4 scores were 17.2 points lower for easy problems (P=.007) but were 25.4 and 24.4 points higher for normal and difficult problems, respectively (P<.001). In year-on-year comparisons, GPT-4 scores were 21.7 and 21.5 points higher in the 2020 (P=.01) and 2022 (P=.003) examinations, respectively, but only 3.5 points higher in the 2021 examinations (no significant difference). Conclusions: In the Japanese language, GPT-4 also outperformed the average medical residents in the GM-ITE test, originally designed for them. Specifically, GPT-4 demonstrated a tendency to score higher on difficult questions with low resident correct response rates and those demanding a more comprehensive understanding of diseases. However, GPT-4 scored comparatively lower on questions that residents could readily answer, such as those testing attitudes toward patients and professionalism, as well as those necessitating an understanding of context and communication. These findings highlight the strengths and limitations of artificial intelligence applications in medical education and practice. UR - https://mededu.jmir.org/2023/1/e52202 UR - http://dx.doi.org/10.2196/52202 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055323 ID - info:doi/10.2196/52202 ER - TY - JOUR AU - Hu, Yanjie AU - Yuan, Xingzhu AU - Ye, Peiling AU - Chang, Chengting AU - Hu, Han Yue AU - Zhang, Weihua AU - Li, Ka PY - 2023/11/23 TI - Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses JO - JMIR Serious Games SP - e52022 VL - 11 KW - virtual reality KW - clinical nursing KW - artificial intelligence KW - AI-assisted medical rehabilitation KW - health promotion KW - umbrella review N2 - Background: Virtual reality (VR) has shown promising levels of effectiveness in nursing education, pain management, and rehabilitation. However, meta-analyses have discussed the effects of VR usage in nursing unilaterally and inconsistently, and the evidence base is diffuse and varied. Objective: We aimed to synthesize the combined evidence from meta-analyses that assessed the effects of nurses using VR technology on nursing education or patient health outcomes. Methods: We conducted an umbrella review by searching for meta-analyses about VR intervention in clinical nursing practice on Web of Science, Embase, Cochrane, and PubMed, and in reference lists. Eligible studies were published in English between December 1, 2012, and September 20, 2023. Meta-analyses of ?2 intervention studies and meta-analyses without 95% CI or heterogeneity data were excluded. Characteristic indicators, population information, VR intervention information, and 95% CIs were extracted. A descriptive analysis of research results was conducted to discern relationships between VR interventions and outcomes. I2 and P values were used to evaluate publication bias. AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) checklist were used to appraise literature quality. Results: In total, 768 records were identified; 74 meta-analyses were included for review. The most reported VR study conditions were neuronursing (25/74, 34%), pediatric nursing (13/74, 18%), surgical and wound care (11/74, 15%), oncological nursing (11/74, 15%), and older adult nursing (10/74, 14%). Further, 30% (22/74) of meta-analyses reported publication bias, and 15% (11/74) and 8% (6/74) were rated as ?high? based on AMSTAR 2 and the GRADE checklist, respectively. The main outcome indicators among all included meta-analyses were pain (37/214, 17.3%), anxiety (36/214, 16.8%), cognitive function (17/214, 7.9%), balance (16/214, 7.5%), depression (16/214, 7.5%), motor function (12/214, 5.6%), and participation in life (12/214, 5.6%). VR treatment for cognition, pain, anxiety, and depression was effective (all P values were <.05), while the utility of VR for improving motor function, balance, memory, and attention was controversial. Adverse effects included nausea, vomiting, and dizziness (incidence: range 4.76%-50%). The most common VR platforms were Pico VR glasses, head-mounted displays, the Nintendo Wii, and the Xbox Kinect. VR intervention duration ranged from 2 weeks to 12 months (typically ?4 wk). VR session length and frequency ranged from 5 to 100 minutes and from 1 to 10 times per week, respectively. Conclusions: VR in nursing has positive effects?relieving patients? pain, anxiety, and depression and improving cognitive function?despite the included studies? limited quality. However, applying VR in nursing to improve patients? motor function, balance, memory, and attention remains controversial. Nursing researchers need to further explore the effects and standard operation protocols of VR in clinical practice, and more high-quality research on VR in nursing is needed. Trial Registration: PROSPERO CRD42022381382; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=381382 UR - https://games.jmir.org/2023/1/e52022 UR - http://dx.doi.org/10.2196/52022 ID - info:doi/10.2196/52022 ER - TY - JOUR AU - Abuyaman, Omar PY - 2023/11/10 TI - Strengths and Weaknesses of ChatGPT Models for Scientific Writing About Medical Vitamin B12: Mixed Methods Study JO - JMIR Form Res SP - e49459 VL - 7 KW - AI KW - ChatGPT KW - GPT-4 KW - GPT-3.5 KW - vitamin B12 KW - artificial intelligence KW - language editing KW - wide range information KW - AI solutions KW - scientific content N2 - Background: ChatGPT is a large language model developed by OpenAI designed to generate human-like responses to prompts. Objective: This study aims to evaluate the ability of GPT-4 to generate scientific content and assist in scientific writing using medical vitamin B12 as the topic. Furthermore, the study will compare the performance of GPT-4 to its predecessor, GPT-3.5. Methods: The study examined responses from GPT-4 and GPT-3.5 to vitamin B12?related prompts, focusing on their quality and characteristics and comparing them to established scientific literature. Results: The results indicated that GPT-4 can potentially streamline scientific writing through its ability to edit language and write abstracts, keywords, and abbreviation lists. However, significant limitations of ChatGPT were revealed, including its inability to identify and address bias, inability to include recent information, lack of transparency, and inclusion of inaccurate information. Additionally, it cannot check for plagiarism or provide proper references. The accuracy of GPT-4?s answers was found to be superior to GPT-3.5. Conclusions: ChatGPT can be considered a helpful assistant in the writing process but not a replacement for a scientist?s expertise. Researchers must remain aware of its limitations and use it appropriately. The improvements in consecutive ChatGPT versions suggest the possibility of overcoming some present limitations in the near future. UR - https://formative.jmir.org/2023/1/e49459 UR - http://dx.doi.org/10.2196/49459 UR - http://www.ncbi.nlm.nih.gov/pubmed/37948100 ID - info:doi/10.2196/49459 ER - TY - JOUR AU - Schwarzkopf, Sophie-Caroline AU - Distler, Marius AU - Welsch, Thilo AU - Krause-Jüttler, Grit AU - Weitz, Jürgen AU - Kolbinger, R. Fiona PY - 2023/11/9 TI - Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study JO - JMIR Serious Games SP - e44708 VL - 11 KW - Serious game KW - surgical education KW - clinical reasoning KW - medical education KW - postoperative complications KW - educational games KW - computer-based learning KW - colorectal surgery KW - decision-making KW - pancreatic surgery N2 - Background: The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education. Objective: This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis. Methods: In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants? proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out. Results: A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%). Conclusions: Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care. UR - https://games.jmir.org/2023/1/e44708 UR - http://dx.doi.org/10.2196/44708 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943588 ID - info:doi/10.2196/44708 ER - TY - JOUR AU - Akhras, Aya AU - ElSaban, Mariam AU - Tamil?Selvan, Varshini AU - Alzaabi, Zain Shaika AU - Senok, Abiola? AU - Zary, Nabil AU - Ho, B. Samuel PY - 2023/11/6 TI - An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (?COVID-19 Rounds?): Cross-Sectional Study JO - JMIR Med Educ SP - e40264 VL - 9 KW - medical education KW - COVID-19 KW - technology-enhanced learning KW - distance learning KW - student engagement KW - 5E instructional model N2 - Background: The COVID-19 pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called ?COVID-19 Rounds? to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called ?COVID-19 Rounds? and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19?related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based ?COVID-19 Rounds? course. This program included web-based clinical experiences with physicians on actual rounds in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81%) out of 47 fourth-year medical students participated in this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale. Most students were satisfied with the course format (27/38, 71%), organization (31/38, 82%), and the learning experience (28/38, 74%) that the course offered. The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90%), providing weekly updates regarding emerging evidence (32/38, 84%), and enhancing understanding of the challenges of the pandemic (34/38, 90%). Satisfaction with distance learning was moderate (23/37, 62%), and a minority of students would have preferred an in-person version of the course (10/37, 27%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were also highlighted. UR - https://mededu.jmir.org/2023/1/e40264 UR - http://dx.doi.org/10.2196/40264 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856734 ID - info:doi/10.2196/40264 ER - TY - JOUR AU - Baglivo, Francesco AU - De Angelis, Luigi AU - Casigliani, Virginia AU - Arzilli, Guglielmo AU - Privitera, Pierpaolo Gaetano AU - Rizzo, Caterina PY - 2023/11/1 TI - Exploring the Possible Use of AI Chatbots in Public Health Education: Feasibility Study JO - JMIR Med Educ SP - e51421 VL - 9 KW - artificial intelligence KW - chatbots KW - medical education KW - vaccination KW - public health KW - medical students KW - large language model KW - generative AI KW - ChatGPT KW - Google Bard KW - AI chatbot KW - health education KW - health care KW - medical training KW - educational support tool KW - chatbot model N2 - Background: Artificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of health care and public health, including medical training. During the ?Hygiene and Public Health? course for fifth-year medical students, a practical training session was conducted on vaccination using AI chatbots as an educational supportive tool. Before receiving specific training on vaccination, the students were given a web-based test extracted from the Italian National Medical Residency Test. After completing the test, a critical correction of each question was performed assisted by AI chatbots. Objective: The main aim of this study was to identify whether AI chatbots can be considered educational support tools for training in public health. The secondary objective was to assess the performance of different AI chatbots on complex multiple-choice medical questions in the Italian language. Methods: A test composed of 15 multiple-choice questions on vaccination was extracted from the Italian National Medical Residency Test using targeted keywords and administered to medical students via Google Forms and to different AI chatbot models (Bing Chat, ChatGPT, Chatsonic, Google Bard, and YouChat). The correction of the test was conducted in the classroom, focusing on the critical evaluation of the explanations provided by the chatbot. A Mann-Whitney U test was conducted to compare the performances of medical students and AI chatbots. Student feedback was collected anonymously at the end of the training experience. Results: In total, 36 medical students and 5 AI chatbot models completed the test. The students achieved an average score of 8.22 (SD 2.65) out of 15, while the AI chatbots scored an average of 12.22 (SD 2.77). The results indicated a statistically significant difference in performance between the 2 groups (U=49.5, P<.001), with a large effect size (r=0.69). When divided by question type (direct, scenario-based, and negative), significant differences were observed in direct (P<.001) and scenario-based (P<.001) questions, but not in negative questions (P=.48). The students reported a high level of satisfaction (7.9/10) with the educational experience, expressing a strong desire to repeat the experience (7.6/10). Conclusions: This study demonstrated the efficacy of AI chatbots in answering complex medical questions related to vaccination and providing valuable educational support. Their performance significantly surpassed that of medical students in direct and scenario-based questions. The responsible and critical use of AI chatbots can enhance medical education, making it an essential aspect to integrate into the educational system. UR - https://mededu.jmir.org/2023/1/e51421 UR - http://dx.doi.org/10.2196/51421 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910155 ID - info:doi/10.2196/51421 ER - TY - JOUR AU - Lindner, R. Jacek AU - Ebrahimi, Ashkan AU - Kochanowicz, F. Julian AU - Szczupak, Justyna AU - Paris, Timothy AU - Abdelsamie, Ahmed AU - Parikh, V. Sagar AU - McShane, Rupert AU - Costi, Sara PY - 2023/11/1 TI - Preliminary Evaluation of a Web-Based International Journal Club for Ketamine in Psychiatric Disorders: Cross-Sectional Survey Study JO - JMIR Med Educ SP - e46158 VL - 9 KW - web-based journal club KW - journal club KW - remote learning KW - ketamine KW - medical education KW - web-based KW - survey KW - COVID-19 KW - psychiatry KW - evaluation KW - YouTube KW - networking KW - internet KW - format N2 - Background: The use of novel rapid-acting antidepressants for psychiatric disorders is expanding. The web-based Ketamine and Related Compounds International Journal Club (KIJC) was created during the COVID-19 pandemic by UK academic psychiatrists and trainees for interested global professionals to discuss papers related to the topic of ketamine for the treatment of psychiatric disorders. The KIJC aimed to facilitate bidirectional discussions, sharing of ideas, and networking among participants. Objective: The aim of this study is a preliminary evaluation of the journal club?s format for satisfaction and impact after the first year of running. Methods: A website, email, and word of mouth were used for recruitment. The journal club was held twice per month using videoconferencing software in 3 parts: a 20-minute presentation, a 15-minute chaired question and answer session, and a 25-minute informal discussion with participants? cameras on. The first 2 parts were recorded and uploaded to the website alongside links to the corresponding papers. In total, 24 speakers presented from 8 countries, typically within 2 (SD 2) months of publication. The average attendance was 51 (SD 20) audience members, and there were 63 (SD 50) views of each subsequent recording. Two anonymous web-based cross-sectional surveys were conducted from November 2021 to February 2022, one for speakers and another for audience members, separately. Various survey statements, 14 for speakers and 12 for the audience, were categorized according to satisfaction and impact, alongside obtaining participants? primary career roles and requesting optional written feedback. Responses were compared between both groups and analyzed, including an inductive thematic analysis and a summary of lessons learned. Results: A total of 30 survey responses were obtained, demonstrating overall agreement with the statements. In total, 12 (50%) out of 24 speakers and 18 (35%) out of an average of 51 (SD 20) audience members regarded the journal club?s format as satisfying and impactful. The majority (26/30, 87%) of respondents identified as clinicians (9/30, 30%), researchers (9/30, 30%), and clinician-researchers (8/30, 27%). Additionally, 11 (37%) of the 30 respondents also provided optional written feedback: 3 (10%) speakers and 8 (27%) audience members. From the written feedback, 5 main themes were derived: engagement with the journal club, desire for active participation, improving the platform, positive learning experiences, and suggestions for future sessions. Conclusions: The journal club successfully reached its intended audience and developed into a web-based community. The majority of the participants were satisfied with the format and found it impactful. Overall, the journal club appears to be a valuable tool for knowledge sharing and community building in the field of ketamine use for the treatment of psychiatric disorders. A larger sample size and additional testing methods are required to support the generalizability of the journal club?s format. UR - https://mededu.jmir.org/2023/1/e46158 UR - http://dx.doi.org/10.2196/46158 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910164 ID - info:doi/10.2196/46158 ER - TY - JOUR AU - Kunitsu, Yuki PY - 2023/10/30 TI - The Potential of GPT-4 as a Support Tool for Pharmacists: Analytical Study Using the Japanese National Examination for Pharmacists JO - JMIR Med Educ SP - e48452 VL - 9 KW - natural language processing KW - generative pretrained transformer KW - GPT-4 KW - ChatGPT KW - artificial intelligence KW - AI KW - chatbot KW - pharmacy KW - pharmacist N2 - Background: The advancement of artificial intelligence (AI), as well as machine learning, has led to its application in various industries, including health care. AI chatbots, such as GPT-4, developed by OpenAI, have demonstrated potential in supporting health care professionals by providing medical information, answering examination questions, and assisting in medical education. However, the applicability of GPT-4 in the field of pharmacy remains unexplored. Objective: This study aimed to evaluate GPT-4?s ability to answer questions from the Japanese National Examination for Pharmacists (JNEP) and assess its potential as a support tool for pharmacists in their daily practice. Methods: The question texts and answer choices from the 107th and 108th JNEP, held in February 2022 and February 2023, were input into GPT-4. As GPT-4 cannot process diagrams, questions that included diagram interpretation were not analyzed and were initially given a score of 0. The correct answer rates were calculated and compared with the passing criteria of each examination to evaluate GPT-4?s performance. Results: For the 107th and 108th JNEP, GPT-4 achieved an accuracy rate of 64.5% (222/344) and 62.9% (217/345), respectively, for all questions. When considering only the questions that GPT-4 could answer, the accuracy rates increased to 78.2% (222/284) and 75.3% (217/287), respectively. The accuracy rates tended to be lower for physics, chemistry, and calculation questions. Conclusions: Although GPT-4 demonstrated the potential to answer questions from the JNEP and support pharmacists? capabilities, it also showed limitations in handling highly specialized questions, calculation questions, and questions requiring diagram recognition. Further evaluation is necessary to explore its applicability in real-world clinical settings, considering the complexities of patient scenarios and collaboration with health care professionals. By addressing these limitations, GPT-4 could become a more reliable tool for pharmacists in their daily practice. UR - https://mededu.jmir.org/2023/1/e48452 UR - http://dx.doi.org/10.2196/48452 UR - http://www.ncbi.nlm.nih.gov/pubmed/37837968 ID - info:doi/10.2196/48452 ER - TY - JOUR AU - Preiksaitis, Carl AU - Rose, Christian PY - 2023/10/20 TI - Opportunities, Challenges, and Future Directions of Generative Artificial Intelligence in Medical Education: Scoping Review JO - JMIR Med Educ SP - e48785 VL - 9 KW - medical education KW - artificial intelligence KW - ChatGPT KW - Bard KW - AI KW - educator KW - scoping KW - review KW - learner KW - generative N2 - Background: Generative artificial intelligence (AI) technologies are increasingly being utilized across various fields, with considerable interest and concern regarding their potential application in medical education. These technologies, such as Chat GPT and Bard, can generate new content and have a wide range of possible applications. Objective: This study aimed to synthesize the potential opportunities and limitations of generative AI in medical education. It sought to identify prevalent themes within recent literature regarding potential applications and challenges of generative AI in medical education and use these to guide future areas for exploration. Methods: We conducted a scoping review, following the framework by Arksey and O'Malley, of English language articles published from 2022 onward that discussed generative AI in the context of medical education. A literature search was performed using PubMed, Web of Science, and Google Scholar databases. We screened articles for inclusion, extracted data from relevant studies, and completed a quantitative and qualitative synthesis of the data. Results: Thematic analysis revealed diverse potential applications for generative AI in medical education, including self-directed learning, simulation scenarios, and writing assistance. However, the literature also highlighted significant challenges, such as issues with academic integrity, data accuracy, and potential detriments to learning. Based on these themes and the current state of the literature, we propose the following 3 key areas for investigation: developing learners? skills to evaluate AI critically, rethinking assessment methodology, and studying human-AI interactions. Conclusions: The integration of generative AI in medical education presents exciting opportunities, alongside considerable challenges. There is a need to develop new skills and competencies related to AI as well as thoughtful, nuanced approaches to examine the growing use of generative AI in medical education. UR - https://mededu.jmir.org/2023/1/e48785/ UR - http://dx.doi.org/10.2196/48785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48785 ER - TY - JOUR AU - Hu, Je-Ming AU - Liu, Feng-Cheng AU - Chu, Chi-Ming AU - Chang, Yu-Tien PY - 2023/10/18 TI - Health Care Trainees? and Professionals? Perceptions of ChatGPT in Improving Medical Knowledge Training: Rapid Survey Study JO - J Med Internet Res SP - e49385 VL - 25 KW - ChatGPT KW - large language model KW - medicine KW - perception evaluation KW - internet survey KW - structural equation modeling KW - SEM N2 - Background: ChatGPT is a powerful pretrained large language model. It has both demonstrated potential and raised concerns related to knowledge translation and knowledge transfer. To apply and improve knowledge transfer in the real world, it is essential to assess the perceptions and acceptance of the users of ChatGPT-assisted training. Objective: We aimed to investigate the perceptions of health care trainees and professionals on ChatGPT-assisted training, using biomedical informatics as an example. Methods: We used purposeful sampling to include all health care undergraduate trainees and graduate professionals (n=195) from January to May 2023 in the School of Public Health at the National Defense Medical Center in Taiwan. Subjects were asked to watch a 2-minute video introducing 5 scenarios about ChatGPT-assisted training in biomedical informatics and then answer a self-designed online (web- and mobile-based) questionnaire according to the Kirkpatrick model. The survey responses were used to develop 4 constructs: ?perceived knowledge acquisition,? ?perceived training motivation,? ?perceived training satisfaction,? and ?perceived training effectiveness.? The study used structural equation modeling (SEM) to evaluate and test the structural model and hypotheses. Results: The online questionnaire response rate was 152 of 195 (78%); 88 of 152 participants (58%) were undergraduate trainees and 90 of 152 participants (59%) were women. The ages ranged from 18 to 53 years (mean 23.3, SD 6.0 years). There was no statistical difference in perceptions of training evaluation between men and women. Most participants were enthusiastic about the ChatGPT-assisted training, while the graduate professionals were more enthusiastic than undergraduate trainees. Nevertheless, some concerns were raised about potential cheating on training assessment. The average scores for knowledge acquisition, training motivation, training satisfaction, and training effectiveness were 3.84 (SD 0.80), 3.76 (SD 0.93), 3.75 (SD 0.87), and 3.72 (SD 0.91), respectively (Likert scale 1-5: strongly disagree to strongly agree). Knowledge acquisition had the highest score and training effectiveness the lowest. In the SEM results, training effectiveness was influenced predominantly by knowledge acquisition and partially met the hypotheses in the research framework. Knowledge acquisition had a direct effect on training effectiveness, training satisfaction, and training motivation, with ? coefficients of .80, .87, and .97, respectively (all P<.001). Conclusions: Most health care trainees and professionals perceived ChatGPT-assisted training as an aid in knowledge transfer. However, to improve training effectiveness, it should be combined with empirical experts for proper guidance and dual interaction. In a future study, we recommend using a larger sample size for evaluation of internet-connected large language models in medical knowledge transfer. UR - https://www.jmir.org/2023/1/e49385 UR - http://dx.doi.org/10.2196/49385 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851495 ID - info:doi/10.2196/49385 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 - Yang, Han AU - Xiao, Xiang AU - Wu, Xuanyu AU - Fu, Xiaoxu AU - Du, Quanyu AU - Luo, Yan AU - Li, Bin AU - Zeng, Jinhao AU - Zhang, Yi PY - 2023/9/20 TI - Virtual Standardized Patients Versus Traditional Academic Training for Improving Clinical Competence Among Traditional Chinese Medicine Students: Prospective Randomized Controlled Trial JO - J Med Internet Res SP - e43763 VL - 25 KW - virtual standardized patients KW - clinical competence KW - traditional Chinese medicine KW - medical education N2 - Background: The practical training course of internal medicine of traditional Chinese medicine (PTC-IMTCM) is primarily based on traditional case teaching, which can be stressful for teachers. The use of virtual standardized patient (VSP) applications could be an alternative; however, there is limited evidence regarding their feasibility and effectiveness. Objective: This study aimed to build a VSP-TCM application according to the characteristics of PTC-IMTCM and the needs of students and to compare its efficacy with that of traditional teaching in improving TCM clinical competence among students. Methods: A prequestionnaire investigation was conducted before the course, and a VSP-TCM system was developed based on the results of the questionnaire. A randomized controlled trial was then conducted between February 26, 2020, and August 20, 2021. A total of 84 medical students were included and were divided into 2 groups: an observation group, trained with VSP-TCM (n=42, 50%), and a control group, trained with traditional academic training (n=42, 50%). Formative and summative assessments were conducted to evaluate teaching effectiveness. After completing the course, the students were administered a questionnaire to self-assess their satisfaction with the course. A questionnaire was also administered to 15 teachers to uncover their perspectives on VSP-TCM. Results: All participants completed the study. In the formative assessment, the VSP-TCM group performed better in medical interviewing ability (mean 7.19, SD 0.63, vs mean 6.83, SD 0.81; P=.04), clinical judgment (mean 6.48, SD 0.98, vs mean 5.86, SD 1.04; P=.006), and comprehensive ability (mean 6.71, SD 0.59, vs mean 6.40, SD 0.58; P=.02) than the control group. Similarly, in the summative evaluation, the VSP-TCM group performed better in the online systematic knowledge test (OSKT; mean 86.62, SD 2.71, vs mean 85.38, SD 2.62; P=.046), application of TCM technology (mean 87.86, SD 3.04, vs mean 86.19, SD 3.08; P=.02), TCM syndrome differentiation and therapeutic regimen (mean 90.93, SD 2.42, vs mean 89.60, SD 2.86; P=.03), and communication skills (mean 90.67, SD 4.52, vs mean 88.24, SD 4.56; P=.02) than the control group. There was no significant difference in medical writing between both groups (mean 75.07, SD 3.61, vs mean 75.71, SD 2.86; P=.37). The postcourse feedback questionnaire indicated that VSP-TCM can better enhance students? TCM thinking ability (n=39, 93%, vs n=37, 88%; P=.002), medical history collection (n=38, 90%, vs n=30, 72; P=.001), syndrome differentiation and treatment and critical thinking (n=38, 90%, vs n=37, 88%; P=.046), comprehensive clinical application ability (n=40, 95%, vs n=36, 86%; P=.009), interpersonal communication skills (n=36, 86%, vs n=28, 67%; P=.01), and autonomous learning ability (n=37, 88%, vs n=28, 67%; P=.01) than traditional academic training. Similarly, the teachers held a positive perspective on VSP-TCM. Conclusions: VSP-TCM enhances students? TCM clinical competence and dialectical thinking and improves their ability to work autonomously. Moreover, the VSP-TCM system is feasible, practical, and cost-effective and thus merits further promotion in TCM education. UR - https://www.jmir.org/2023/1/e43763 UR - http://dx.doi.org/10.2196/43763 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728989 ID - info:doi/10.2196/43763 ER - TY - JOUR AU - Huang, ST Ryan AU - Lu, Qi Kevin Jia AU - Meaney, Christopher AU - Kemppainen, Joel AU - Punnett, Angela AU - Leung, Fok-Han PY - 2023/9/19 TI - Assessment of Resident and AI Chatbot Performance on the University of Toronto Family Medicine Residency Progress Test: Comparative Study JO - JMIR Med Educ SP - e50514 VL - 9 KW - medical education KW - medical knowledge exam KW - artificial intelligence KW - AI KW - natural language processing KW - NLP KW - large language model KW - LLM KW - machine learning, ChatGPT KW - GPT-3.5 KW - GPT-4 KW - education KW - language model KW - education examination KW - testing KW - utility KW - family medicine KW - medical residents KW - test KW - community N2 - Background: Large language model (LLM)?based chatbots are evolving at an unprecedented pace with the release of ChatGPT, specifically GPT-3.5, and its successor, GPT-4. Their capabilities in general-purpose tasks and language generation have advanced to the point of performing excellently on various educational examination benchmarks, including medical knowledge tests. Comparing the performance of these 2 LLM models to that of Family Medicine residents on a multiple-choice medical knowledge test can provide insights into their potential as medical education tools. Objective: This study aimed to quantitatively and qualitatively compare the performance of GPT-3.5, GPT-4, and Family Medicine residents in a multiple-choice medical knowledge test appropriate for the level of a Family Medicine resident. Methods: An official University of Toronto Department of Family and Community Medicine Progress Test consisting of multiple-choice questions was inputted into GPT-3.5 and GPT-4. The artificial intelligence chatbot?s responses were manually reviewed to determine the selected answer, response length, response time, provision of a rationale for the outputted response, and the root cause of all incorrect responses (classified into arithmetic, logical, and information errors). The performance of the artificial intelligence chatbots were compared against a cohort of Family Medicine residents who concurrently attempted the test. Results: GPT-4 performed significantly better compared to GPT-3.5 (difference 25.0%, 95% CI 16.3%-32.8%; McNemar test: P<.001); it correctly answered 89/108 (82.4%) questions, while GPT-3.5 answered 62/108 (57.4%) questions correctly. Further, GPT-4 scored higher across all 11 categories of Family Medicine knowledge. In 86.1% (n=93) of the responses, GPT-4 provided a rationale for why other multiple-choice options were not chosen compared to the 16.7% (n=18) achieved by GPT-3.5. Qualitatively, for both GPT-3.5 and GPT-4 responses, logical errors were the most common, while arithmetic errors were the least common. The average performance of Family Medicine residents was 56.9% (95% CI 56.2%-57.6%). The performance of GPT-3.5 was similar to that of the average Family Medicine resident (P=.16), while the performance of GPT-4 exceeded that of the top-performing Family Medicine resident (P<.001). Conclusions: GPT-4 significantly outperforms both GPT-3.5 and Family Medicine residents on a multiple-choice medical knowledge test designed for Family Medicine residents. GPT-4 provides a logical rationale for its response choice, ruling out other answer choices efficiently and with concise justification. Its high degree of accuracy and advanced reasoning capabilities facilitate its potential applications in medical education, including the creation of exam questions and scenarios as well as serving as a resource for medical knowledge or information on community services. UR - https://mededu.jmir.org/2023/1/e50514 UR - http://dx.doi.org/10.2196/50514 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725411 ID - info:doi/10.2196/50514 ER - TY - JOUR AU - Fulton-Ward, Taylor AU - Bain, Robert AU - Khoury, G. Emma AU - Keshwara, M. Sumirat AU - Joseph, S. Prince Josiah AU - Selby, Peter AU - Millward, P. Christopher PY - 2023/9/11 TI - Benefits of Mentoring in Oncology Education for Mentors and Mentees: Pre-Post Interventional Study of the British Oncology Network for Undergraduate Societies' National Oncology Mentorship Scheme JO - JMIR Med Educ SP - e48263 VL - 9 KW - mentoring KW - medical education KW - oncology KW - medical student KW - teaching KW - undergraduate KW - graduate KW - student KW - cancer KW - mentor KW - mentee KW - mentors KW - mentees N2 - Background: Formal education of oncology is lacking in many undergraduate medical curricula. Mentoring schemes can expose participants to specific areas of medicine and may address the shortfalls in oncology education. Few mentoring schemes have been designed within the United Kingdom, especially within oncology. There is a need to understand reasons for mentor and mentee participation in such schemes and to identify ways to minimize barriers to engagement. Objective: This study identifies motivations for participation in an oncology mentoring scheme and its benefits and limitations to both the mentee and the mentor. Methods: The British Oncology Network for Undergraduate Societies launched a National Oncology Mentorship Scheme (NOMS) on September 1, 2021. Mentees (medical student or foundation doctor) were paired with mentors (specialty registrar or consultant), for 6 months of mentoring. In total, 86 mentors and 112 mentees were recruited to the scheme. The mentees and mentors were asked to meet at least 3 times during this period and suggestions were provided on the content of mentoring. Mentees and mentors were invited to complete a prescheme questionnaire, exploring motivations for involvement in the scheme, current experiences within oncology, and knowledge and interests in the field. At the end of the scheme, mentors and mentees were asked to complete a postscheme questionnaire exploring experiences and benefits or limitations of participation. Paired analysis was performed using the Wilcoxon signed-rank test. For free text data, content analysis was applied to summarize the main themes in the data. Results: Of the 66 (59%) mentees who completed the prescheme questionnaire, 41 (62%) were clinical, 21 (32%) preclinical medical students, and the remainder were junior doctors. For mentees, networking was the primary reason for joining the scheme (n=25, 38%). Mentees ranked experience of oncology at medical school at 3 on 10 (IQR 2-5). In this, 46 (53%) mentors completed the prescheme questionnaire, 35 (76%) were registrar level, and the remainder were consultant level (n=11). The most common reason for mentor participation was to increase awareness and interest in the field (n=29, 63%). Of those who completed the prescheme questionnaire, 23 (35%) mentees and 25 (54%) mentors completed the postscheme questionnaire. Knowledge in all areas of oncology assessed significantly increased during the scheme (P<.001). Most mentees (n=21, 91%) and mentors (n=18, 72%) felt they had benefited from the scheme. Mentees cited gaining insights into oncology as most beneficial; and mentors, opportunities to develop professionally. Whilst mentees did not report any barriers to participating in the scheme, mentors stated lack of time as the greatest barrier to mentoring. Conclusions: British Oncology Network for Undergraduate Societies? NOMS is expanding and is beneficial for mentees through increasing knowledge, providing exposure, and career advice in oncology. Mentors benefit from improving their mentoring skills and personal satisfaction. UR - https://mededu.jmir.org/2023/1/e48263 UR - http://dx.doi.org/10.2196/48263 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695662 ID - info:doi/10.2196/48263 ER - TY - JOUR AU - Martindale, M. Jaclyn AU - Carrasquillo, A. Rachel AU - Otallah, Ireland Scott AU - Brooks, K. Amber AU - Denizard-Thompson, Nancy AU - Pharr, Emily AU - Choate, Nakiea AU - Sokolosky, Mitchell AU - Strauss, Doyle Lauren PY - 2023/9/11 TI - Local Culture and Community Through a Digital Lens: Viewpoint on Designing and Implementing a Virtual Second Look Event for Residency Applicants JO - JMIR Med Educ SP - e44240 VL - 9 KW - medical education KW - graduate medical education KW - residency application KW - virtual interviews KW - match KW - recruitment N2 - Background: The COVID-19 pandemic altered how residency interviews occur. Despite 2 years of web-based interviews, these are still perceived as inferior to in-person experiences. Showcasing a program and location is critical for recruitment; however, it is difficult to highlight the program?s location and community digitally. This article presents the authors? viewpoints on designing and implementing a virtual second look for residency applicants. Objective: Our objective was to host a web-based event to feature the benefits of living in Winston-Salem, North Carolina, for residency applicants, enhance recruitment efforts, and ensure a successful residency match. The goal was to cover topics that interested all applicants, highlight how Winston-Salem is a special place to live, involve current residents, and engage community members. Methods: Three programs?child neurology, neurology, and family medicine were chosen for a pilot virtual second look. All residency program directors? were asked to recommend community contacts and help identify residents and faculty who may serve as content experts on one of the topics in the panel discussions. A total of 24 community leaders from restaurants, venues, schools, and businesses were contacted, and 18 agreed to participate. The panel discussions included living in and raising a family in Winston-Salem, experiencing Winston-Salem arts and music, where to eat and drink like a local, and enjoying sports and outdoors in the area. The 2-hour event was hosted on Zoom. Postevent feedback assessments were automatically sent to each registrant through Research Electronic Data Capture (REDCap). This study was deemed exempt from Wake Forest University Health Sciences institutional review board review (IRB00088703). Results: There were 51 registrants for the event, and 28 of 48 registrants provided postevent feedback, which was positive. The authors found in the MATCH residency results that 2 of 2 child neurology positions, 4 of 6 adult neurology positions, and 1 of 10 family medicine positions attended our second look event. One adult neurology resident who did not participate was an internal candidate. All respondents agreed or strongly agreed that the session was valuable, well organized, and met their expectations or goals. Furthermore, all respondents gained new information during this web-based event not obtained during their interview day. Conclusions: The virtual second look event for residency attendees featured the benefits of living in Winston-Salem, and the perspectives of current residents. Feedback from the session was overall positive; however, a top desire would be devoting more time for the applicants to ask questions directly to the community leaders and our resident trainees. This program could be reproducible by other institutions. It could be broadened to a graduate medical education?wide virtual second look event where all medical and surgical programs could opt to participate, facilitating an equitable opportunity for prospective applicants. UR - https://mededu.jmir.org/2023/1/e44240 UR - http://dx.doi.org/10.2196/44240 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695665 ID - info:doi/10.2196/44240 ER - TY - JOUR AU - Lau, Tiang Siew AU - Siah, Jiat Rosalind Chiew AU - Dzakirin Bin Rusli, Khairul AU - Loh, Liang Wen AU - Yap, Gwee John Yin AU - Ang, Emily AU - Lim, Ping Fui AU - Liaw, Ying Sok PY - 2023/8/30 TI - Design and Evaluation of Using Head-Mounted Virtual Reality for Learning Clinical Procedures: Mixed Methods Study JO - JMIR Serious Games SP - e46398 VL - 11 KW - user experience KW - acceptability KW - usability KW - virtual patient KW - clinical procedure KW - immersive KW - nursing student KW - virtual reality KW - education KW - performance N2 - Background: The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients? outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited. Objective: The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system. Methods: This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions. Results: Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort. Conclusions: The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses? knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes. UR - https://games.jmir.org/2023/1/e46398 UR - http://dx.doi.org/10.2196/46398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647108 ID - info:doi/10.2196/46398 ER - TY - JOUR AU - Manuel, K. Jennifer AU - Purcell, Natalie AU - Abadjian, Linda AU - Cardoos, Stephanie AU - Yalch, Matthew AU - Hill, Coleen AU - McCarthy, Brittan AU - Bertenthal, Daniel AU - McGrath, Sarah AU - Seal, Karen PY - 2023/8/28 TI - Virtual Worlds Technology to Enhance Training for Primary Care Providers in Assessment and Management of Posttraumatic Stress Disorder Using Motivational Interviewing: Pilot Randomized Controlled Trial JO - JMIR Med Educ SP - e42862 VL - 9 KW - primary care KW - posttraumatic stress disorder KW - PTSD KW - motivational interviewing KW - virtual training KW - training KW - virtual KW - stress KW - disorder KW - treatment KW - patient KW - assessment KW - communication KW - feasibility KW - acceptability KW - efficacy N2 - Background: Many individuals with posttraumatic stress disorder (PTSD) first present to primary care rather than specialty mental health care. Primary care providers often lack the training required to assess and treat patients with PTSD. Virtual trainings have emerged as a convenient and effective way of training primary care providers in PTSD assessment and communication methods (ie, motivational interviewing [MI]). Objective: The aim of this study was to conduct a pilot randomized controlled trial of a synchronous Virtual Worlds (VW; a virtual world where learners were immersed as avatars) training versus an asynchronous web-based training on PTSD and MI, comparing the feasibility, acceptability, usability, and preliminary efficacy of 2 different training platforms among primary care providers. Methods: Participating primary care providers were randomized to a VW and a web-based PTSD training. Outcomes were collected at baseline, posttraining, and 90-days follow-up. Standardized patient interviews measured participants? communication skills in assessing and managing patients with PTSD symptoms. Results: Compared to the web-based training, the VW training platform achieved larger learning gains in MI (ie, partnership and empathy) and in discussing pharmacotherapy and psychotherapy for PTSD. Both VW and web-based trainings led to increases in PTSD knowledge and primary care providers? self-confidence. Conclusions: The asynchronous web-based PTSD training improved PTSD-related knowledge and self-confidence but was not as effective as the VW immersive experience in teaching MI or clinical management. Because VW training is synchronous and new for many learners, it required more time, facilitation, and technical support. As computer technology improves, VW educational interventions may become more feasible, particularly in teaching clinical skills. Trial Registration: ClinicalTrials.gov NCT03898271; https://tinyurl.com/mu479es5 UR - https://mededu.jmir.org/2023/1/e42862 UR - http://dx.doi.org/10.2196/42862 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639299 ID - info:doi/10.2196/42862 ER - TY - JOUR AU - Hsu, Hsing-Yu AU - Hsu, Kai-Cheng AU - Hou, Shih-Yen AU - Wu, Ching-Lung AU - Hsieh, Yow-Wen AU - Cheng, Yih-Dih PY - 2023/8/21 TI - Examining Real-World Medication Consultations and Drug-Herb Interactions: ChatGPT Performance Evaluation JO - JMIR Med Educ SP - e48433 VL - 9 KW - ChatGPT KW - large language model KW - natural language processing KW - real-world medication consultation questions KW - NLP KW - drug-herb interactions KW - pharmacist KW - LLM KW - language models KW - chat generative pre-trained transformer N2 - Background: Since OpenAI released ChatGPT, with its strong capability in handling natural tasks and its user-friendly interface, it has garnered significant attention. Objective: A prospective analysis is required to evaluate the accuracy and appropriateness of medication consultation responses generated by ChatGPT. Methods: A prospective cross-sectional study was conducted by the pharmacy department of a medical center in Taiwan. The test data set comprised retrospective medication consultation questions collected from February 1, 2023, to February 28, 2023, along with common questions about drug-herb interactions. Two distinct sets of questions were tested: real-world medication consultation questions and common questions about interactions between traditional Chinese and Western medicines. We used the conventional double-review mechanism. The appropriateness of each response from ChatGPT was assessed by 2 experienced pharmacists. In the event of a discrepancy between the assessments, a third pharmacist stepped in to make the final decision. Results: Of 293 real-world medication consultation questions, a random selection of 80 was used to evaluate ChatGPT?s performance. ChatGPT exhibited a higher appropriateness rate in responding to public medication consultation questions compared to those asked by health care providers in a hospital setting (31/51, 61% vs 20/51, 39%; P=.01). Conclusions: The findings from this study suggest that ChatGPT could potentially be used for answering basic medication consultation questions. Our analysis of the erroneous information allowed us to identify potential medical risks associated with certain questions; this problem deserves our close attention. UR - https://mededu.jmir.org/2023/1/e48433 UR - http://dx.doi.org/10.2196/48433 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561097 ID - info:doi/10.2196/48433 ER - TY - JOUR AU - Toohey, Shannon AU - Wray, Alisa AU - Hunter, John AU - Saadat, Soheil AU - Boysen-Osborn, Megan AU - Smart, Jonathan AU - Wiechmann, Warren AU - Pressman, D. Sarah PY - 2023/8/18 TI - Authors? Response to the Validity of Cortisol and Galvanic Skin Responses for Measuring Student Stress During Training JO - JMIR Med Educ SP - e50902 VL - 9 KW - augmented reality KW - AR KW - salivary cortisol KW - galvanic skin conductance KW - medical simulation KW - medical education UR - https://mededu.jmir.org/2023/1/e50902 UR - http://dx.doi.org/10.2196/50902 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594800 ID - info:doi/10.2196/50902 ER - TY - JOUR AU - Sonawane, Urvi AU - Kasetti, Pragna PY - 2023/8/18 TI - How Valid Are Cortisol and Galvanic Skin Responses in Measuring Student Stress During Training? Comment on the Psychological Effects of Simulation Training JO - JMIR Med Educ SP - e45340 VL - 9 KW - augmented reality KW - AR KW - salivary cortisol KW - galvanic skin conductance KW - medical simulation KW - medical education UR - https://mededu.jmir.org/2023/1/e45340 UR - http://dx.doi.org/10.2196/45340 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594784 ID - info:doi/10.2196/45340 ER - TY - JOUR AU - Lee, Hyeonhoon PY - 2023/8/17 TI - Using ChatGPT as a Learning Tool in Acupuncture Education: Comparative Study JO - JMIR Med Educ SP - e47427 VL - 9 KW - ChatGPT KW - educational tool KW - artificial intelligence KW - acupuncture KW - AI KW - personalized education KW - students N2 - Background: ChatGPT (Open AI) is a state-of-the-art artificial intelligence model with potential applications in the medical fields of clinical practice, research, and education. Objective: This study aimed to evaluate the potential of ChatGPT as an educational tool in college acupuncture programs, focusing on its ability to support students in learning acupuncture point selection, treatment planning, and decision-making. Methods: We collected case studies published in Acupuncture in Medicine between June 2022 and May 2023. Both ChatGPT-3.5 and ChatGPT-4 were used to generate suggestions for acupuncture points based on case presentations. A Wilcoxon signed-rank test was conducted to compare the number of acupuncture points generated by ChatGPT-3.5 and ChatGPT-4, and the overlapping ratio of acupuncture points was calculated. Results: Among the 21 case studies, 14 studies were included for analysis. ChatGPT-4 generated significantly more acupuncture points (9.0, SD 1.1) compared to ChatGPT-3.5 (5.6, SD 0.6; P<.001). The overlapping ratios of acupuncture points for ChatGPT-3.5 (0.40, SD 0.28) and ChatGPT-4 (0.34, SD 0.27; P=.67) were not significantly different. Conclusions: ChatGPT may be a useful educational tool for acupuncture students, providing valuable insights into personalized treatment plans. However, it cannot fully replace traditional diagnostic methods, and further studies are needed to ensure its safe and effective implementation in acupuncture education. UR - https://mededu.jmir.org/2023/1/e47427 UR - http://dx.doi.org/10.2196/47427 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590034 ID - info:doi/10.2196/47427 ER - TY - JOUR AU - Dalavaye, Nishaanth AU - Baskaran, Ravanth AU - Mukhopadhyay, Srinjay AU - Gamage, Peramuna Movin AU - Ng, Vincent AU - Sharif, Hama AU - Rutherford, Stephen PY - 2023/8/17 TI - Exploring the Educational Value of Popular Culture in Web-Based Medical Education: Pre-Post Study on Teaching Jaundice Using ?The Simpsons? JO - JMIR Med Educ SP - e44789 VL - 9 KW - educational innovation KW - jaundice KW - medical education KW - popular culture KW - web-based teaching N2 - Background: The potential of popular culture as a tool for knowledge delivery and enhancing engagement in education is promising but not extensively studied. Furthermore, concerns exist regarding learning fatigue due to increased reliance on videoconferencing platforms following the COVID-19 pandemic. To ensure effective web-based teaching sessions that maintain attention spans and enhance understanding, innovative solutions are necessary. Objective: This study aims to evaluate the use of specific popular culture case studies to enhance student engagement in a web-based near-peer teaching session. Methods: We delivered a web-based teaching session to undergraduate medical students in the United Kingdom. The session included clinical vignettes and single-best-answer questions using characters from ?The Simpsons? television show as patient analogies for various causes of jaundice. A pre-post survey, employing a 7-point Likert scale, was distributed to gather data from participants. Results: A total of 53 survey responses were collected. Participants reported significantly improved understanding of jaundice after the session compared to before the session (median 6, IQR 5-6 vs median 4, IQR 3-4.5; P<.001). The majority of participants agreed that the inclusion of ?The Simpsons? characters enhanced their knowledge and made the teaching session more memorable and engaging (memorability: median 6, IQR 5-7; engagement: median 6, IQR 5-7). Conclusions: When appropriately integrated, popular culture can effectively engage students and improve self-perceived knowledge retention. ?The Simpsons? characters can be used pedagogically and professionally as patient analogies to deliver teaching on the topic of jaundice. UR - https://mededu.jmir.org/2023/1/e44789 UR - http://dx.doi.org/10.2196/44789 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590059 ID - info:doi/10.2196/44789 ER - TY - JOUR AU - Stanich, Jessica AU - Sunga, Kharmene AU - Loprinzi-Brauer, Caitlin AU - Ginsburg, Alexander AU - Ingram, Cory AU - Bellolio, Fernanda AU - Cabrera, Daniel PY - 2023/8/16 TI - Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study JO - JMIR Med Educ SP - e43710 VL - 9 KW - palliative care KW - emergency medicine KW - gaming simulation KW - resident education KW - medical education KW - residency KW - end of life KW - palliative KW - dying KW - death KW - interpersonal skill N2 - Background: Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. Objective: We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. Methods: This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool?Modified survey to evaluate perceived effectiveness in teaching end-of-life management. Results: Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool?Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient?s condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. Conclusions: This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management. UR - https://mededu.jmir.org/2023/1/e43710 UR - http://dx.doi.org/10.2196/43710 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585258 ID - info:doi/10.2196/43710 ER - TY - JOUR AU - Safranek, W. Conrad AU - Sidamon-Eristoff, Elizabeth Anne AU - Gilson, Aidan AU - Chartash, David PY - 2023/8/14 TI - The Role of Large Language Models in Medical Education: Applications and Implications JO - JMIR Med Educ SP - e50945 VL - 9 KW - large language models KW - ChatGPT KW - medical education KW - LLM KW - artificial intelligence in health care KW - AI KW - autoethnography UR - https://mededu.jmir.org/2023/1/e50945 UR - http://dx.doi.org/10.2196/50945 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578830 ID - info:doi/10.2196/50945 ER - TY - JOUR AU - Deutsch, E. Judith AU - Palmieri, L. John AU - Gorin, Holly AU - Wendell, Augustus AU - Wohn, Yvette Donghee AU - Damodaran, Harish PY - 2023/8/10 TI - Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study JO - JMIR Med Educ SP - e44361 VL - 9 KW - physical therapy KW - education KW - teaching tool KW - simulation-based learning KW - computer-aided instruction KW - standardized assessment KW - clinical reasoning KW - sensors N2 - Background: The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale. Objective: This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability. Methods: A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education. Results: The faculty members? and students? positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability. Conclusions: The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption. UR - https://mededu.jmir.org/2023/1/e44361 UR - http://dx.doi.org/10.2196/44361 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561552 ID - info:doi/10.2196/44361 ER - TY - JOUR AU - McQuade, N. Casey AU - Simonson, G. Michael AU - Ehrenberger, A. Kristen AU - Kohli, Amar PY - 2023/8/9 TI - Developing a Web-Based Asynchronous Case Discussion Format on Social Media to Teach Clinical Reasoning: Mixed Methods Study JO - JMIR Med Educ SP - e45277 VL - 9 KW - case discussion KW - case report KW - clinical reasoning KW - clinical vignette KW - junior doctor KW - junior physician KW - medical education KW - medical student KW - morning report KW - report style KW - resident KW - social media KW - trainee KW - Twitter N2 - Background: Case-based learning conferences are valuable to trainees, but growing clinical demands hinder consistent attendance. Social media increasingly acts as a venue for trainees to supplement their education asynchronously. We designed and implemented a web-based asynchronous clinical case discussion series on the Twitter social media platform to fill this educational gap. Objective: The aim of this mixed methods study is to examine the nature of interactions among web-based case discussion participants and assess local attitudes regarding the educational intervention. Methods: Starting in February 2018, we posted clinical vignettes to a dedicated Twitter account with the prompt ?What else do you want to know?? to stimulate discussion. The authors replied in real time when case discussion participants requested additional details. Additional data about the case were posted at regular intervals to the discussion thread to advance the overall case discussion. Participants were asked to explain their reasoning and support their conclusions when appropriate. Web-based engagement was assessed using Twitter Analytics. Participants? posts were qualitatively analyzed for themes, with special attention to examples of using clinical reasoning skills. A codebook of types of participant posts and interactions was refined iteratively. Local engagement and attitudes at our institution were assessed by surveying internal medicine trainees (n=182) and faculty (n=165) after 6 months. Results: Over a 6-month period, 11 live case discussions were engaged with by users 1773 times. A total of 86 Twitter profiles spanning 22 US states and 6 countries contributed to discussions among participants and the authors. Participants from all training levels were present, ranging from students to faculty. Interactions among participants and the case moderators were most commonly driven by clinical reasoning, including hypothesis-driven information gathering, discussing the differential diagnosis, and data interpretation or organization. Of 71 respondents to the local survey, 29 (41%) reported having a Twitter account. Of the 29 respondents with Twitter accounts, 17 (59%) reported participating in the case discussions. Respondents agreed that case participation increased both their clinical reasoning skills (15/17, 88%) and clinical knowledge (13/17, 76%). Conclusions: A social media?based serialized case discussion was a feasible asynchronous teaching method for engaging web-based learners of all levels in a clinical reasoning discussion. Further study should examine what factors drive trainee participation in web-based case discussions and under what circumstances asynchronous discussion might be preferred over in-person teaching activities. UR - https://mededu.jmir.org/2023/1/e45277 UR - http://dx.doi.org/10.2196/45277 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556191 ID - info:doi/10.2196/45277 ER - TY - JOUR AU - Borchert, J. Robin AU - Hickman, R. Charlotte AU - Pepys, Jack AU - Sadler, J. Timothy PY - 2023/8/7 TI - Performance of ChatGPT on the Situational Judgement Test?A Professional Dilemmas?Based Examination for Doctors in the United Kingdom JO - JMIR Med Educ SP - e48978 VL - 9 KW - ChatGPT KW - language models KW - Situational Judgement Test KW - medical education KW - artificial intelligence KW - language model KW - exam KW - examination KW - SJT KW - judgement KW - reasoning KW - communication KW - chatbot N2 - Background: ChatGPT is a large language model that has performed well on professional examinations in the fields of medicine, law, and business. However, it is unclear how ChatGPT would perform on an examination assessing professionalism and situational judgement for doctors. Objective: We evaluated the performance of ChatGPT on the Situational Judgement Test (SJT): a national examination taken by all final-year medical students in the United Kingdom. This examination is designed to assess attributes such as communication, teamwork, patient safety, prioritization skills, professionalism, and ethics. Methods: All questions from the UK Foundation Programme Office?s (UKFPO?s) 2023 SJT practice examination were inputted into ChatGPT. For each question, ChatGPT?s answers and rationales were recorded and assessed on the basis of the official UK Foundation Programme Office scoring template. Questions were categorized into domains of Good Medical Practice on the basis of the domains referenced in the rationales provided in the scoring sheet. Questions without clear domain links were screened by reviewers and assigned one or multiple domains. ChatGPT's overall performance, as well as its performance across the domains of Good Medical Practice, was evaluated. Results: Overall, ChatGPT performed well, scoring 76% on the SJT but scoring full marks on only a few questions (9%), which may reflect possible flaws in ChatGPT?s situational judgement or inconsistencies in the reasoning across questions (or both) in the examination itself. ChatGPT demonstrated consistent performance across the 4 outlined domains in Good Medical Practice for doctors. Conclusions: Further research is needed to understand the potential applications of large language models, such as ChatGPT, in medical education for standardizing questions and providing consistent rationales for examinations assessing professionalism and ethics. UR - https://mededu.jmir.org/2023/1/e48978 UR - http://dx.doi.org/10.2196/48978 UR - http://www.ncbi.nlm.nih.gov/pubmed/37548997 ID - info:doi/10.2196/48978 ER - TY - JOUR AU - Lu, Qi Kevin Jia AU - Meaney, Christopher AU - Guo, Elaine AU - Leung, Fok-Han PY - 2023/7/27 TI - Evaluating the Applicability of Existing Lexicon-Based Sentiment Analysis Techniques on Family Medicine Resident Feedback Field Notes: Retrospective Cohort Study JO - JMIR Med Educ SP - e41953 VL - 9 KW - medical education KW - medical resident KW - feedback KW - field note KW - text mining KW - data mining KW - sentiment analysis KW - lexicon KW - lexical KW - dictionary KW - dictionaries KW - vocabulary KW - resident KW - medical student KW - medical trainee KW - residency KW - utility KW - feasibility N2 - Background: Field notes, a form for resident-preceptor clinical encounter feedback, are widely adopted across Canadian medical residency training programs for documenting residents? performance. This process generates a sizeable cumulative collection of feedback text, which is difficult for medical education faculty to navigate. As sentiment analysis is a subfield of text mining that can efficiently synthesize the polarity of a text collection, sentiment analysis may serve as an innovative solution. Objective: This study aimed to examine the feasibility and utility of sentiment analysis using 3 popular sentiment lexicons on medical resident field notes. Methods: We used a retrospective cohort design, curating text data from University of Toronto medical resident field notes gathered over 2 years (from July 2019 to June 2021). Lexicon-based sentiment analysis was applied using 3 standardized dictionaries, modified by removing ambiguous words as determined by a medical subject matter expert. Our modified lexicons assigned words from the text data a sentiment score, and we aggregated the word-level scores to a document-level polarity score. Agreement between dictionaries was assessed, and the document-level polarity was correlated with the overall preceptor rating of the clinical encounter under assessment. Results: Across the 3 original dictionaries, approximately a third of labeled words in our field note corpus were deemed ambiguous and were removed to create modified dictionaries. Across the 3 modified dictionaries, the mean sentiment for the ?Strengths? section of the field notes was mildly positive, while it was slightly less positive in the ?Areas of Improvement? section. We observed reasonable agreement between dictionaries for sentiment scores in both field note sections. Overall, the proportion of positively labeled documents increased with the overall preceptor rating, and the proportion of negatively labeled documents decreased with the overall preceptor rating. Conclusions: Applying sentiment analysis to systematically analyze field notes is feasible. However, the applicability of existing lexicons is limited in the medical setting, even after the removal of ambiguous words. Limited applicability warrants the need to generate new dictionaries specific to the medical education context. Additionally, aspect-based sentiment analysis may be applied to navigate the more nuanced structure of texts when identifying sentiments. Ultimately, this will allow for more robust inferences to discover opportunities for improving resident teaching curriculums. UR - https://mededu.jmir.org/2023/1/e41953 UR - http://dx.doi.org/10.2196/41953 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498660 ID - info:doi/10.2196/41953 ER - TY - JOUR AU - Liaw, Ying Sok AU - Tan, Zhi Jian AU - Bin Rusli, Dzakirin Khairul AU - Ratan, Rabindra AU - Zhou, Wentao AU - Lim, Siriwan AU - Lau, Ching Tang AU - Seah, Betsy AU - Chua, Ling Wei PY - 2023/7/26 TI - Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training: Randomized Controlled Study JO - J Med Internet Res SP - e47748 VL - 25 KW - artificial intelligence KW - interprofessional education KW - interprofessional communication KW - sepsis care KW - team training KW - virtual reality KW - simulation KW - AI KW - health care education KW - nursing student KW - nursing education KW - medical education N2 - Background: Interprofessional communication is needed to enhance the early recognition and management of patients with sepsis. Preparing medical and nursing students using virtual reality simulation has been shown to be an effective learning approach for sepsis team training. However, its scalability is constrained by unequal cohort sizes between medical and nursing students. An artificial intelligence (AI) medical team member can be implemented in a virtual reality simulation to engage nursing students in sepsis team training. Objective: This study aimed to evaluate the effectiveness of an AI-powered doctor versus a human-controlled doctor in training nursing students for sepsis care and interprofessional communication. Methods: A randomized controlled trial study was conducted with 64 nursing students who were randomly assigned to undertake sepsis team training with an AI-powered doctor (AI-powered group) or with medical students using virtual reality simulation (human-controlled group). Participants from both groups were tested on their sepsis and communication performance through simulation-based assessments (posttest). Participants? sepsis knowledge and self-efficacy in interprofessional communication were also evaluated before and after the study interventions. Results: A total of 32 nursing students from each group completed the simulation-based assessment, sepsis and communication knowledge test, and self-efficacy questionnaire. Compared with the baseline scores, both the AI-powered and human-controlled groups demonstrated significant improvements in communication knowledge (P=.001) and self-efficacy in interprofessional communication (P<.001) in posttest scores. For sepsis care knowledge, a significant improvement in sepsis care knowledge from the baseline was observed in the AI-powered group (P<.001) but not in the human-controlled group (P=.16). Although no significant differences were found in sepsis care performance between the groups (AI-powered group: mean 13.63, SD 4.23, vs human-controlled group: mean 12.75, SD 3.85, P=.39), the AI-powered group (mean 9.06, SD 1.78) had statistically significantly higher sepsis posttest knowledge scores (P=.009) than the human-controlled group (mean 7.75, SD 2.08). No significant differences were found in interprofessional communication performance between the 2 groups (AI-powered group: mean 29.34, SD 8.37, vs human-controlled group: mean 27.06, SD 5.69, P=.21). However, the human-controlled group (mean 69.6, SD 14.4) reported a significantly higher level of self-efficacy in interprofessional communication (P=.008) than the AI-powered group (mean 60.1, SD 13.3). Conclusions: Our study suggested that AI-powered doctors are not inferior to human-controlled virtual reality simulations with respect to sepsis care and interprofessional communication performance, which supports the viability of implementing AI-powered doctors to achieve scalability in sepsis team training. Our findings also suggested that future innovations should focus on the sociability of AI-powered doctors to enhance users? interprofessional communication training. Perhaps in the nearer term, future studies should examine how to best blend AI-powered training with human-controlled virtual reality simulation to optimize clinical performance in sepsis care and interprofessional communication. Trial Registration: ClinicalTrials.gov NCT05953441; https://clinicaltrials.gov/study/NCT05953441 UR - https://www.jmir.org/2023/1/e47748 UR - http://dx.doi.org/10.2196/47748 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494112 ID - info:doi/10.2196/47748 ER - TY - JOUR AU - Darnell, C. Julia AU - Lou, Mimi AU - Goldstone, W. Lisa PY - 2023/7/10 TI - Evaluating Change in Student Pharmacists? Familiarity, Attitudes, Comfort, and Knowledge as a Result of Integrating Digital Health Topics Into a Case Conference Series: Cohort Study JO - JMIR Med Educ SP - e43313 VL - 9 KW - digital health KW - telehealth KW - digital therapeutics KW - mobile health applications KW - wearable health technologies KW - pharmacy education KW - medical education KW - patient cases KW - technology KW - education KW - digital KW - survey KW - intervention N2 - Background: The use of technology in health care, often referred to as digital health, has expanded rapidly because of the need to provide remote care during the COVID-19 pandemic. In light of this rapid boom, it is clear that health care professionals need to be trained in these technologies in order to provide high-level care. Despite the growing number of technologies used across health care, digital health is not a commonly taught topic in health care curricula. Several pharmacy organizations have called attention to the need to teach digital health to student pharmacists; however, there is currently no consensus on best methods to do so. Objective: The objective of this study was to determine if there was a significant change in student pharmacist scores on the Digital Health Familiarity, Attitudes, Comfort, and Knowledge Scale (DH-FACKS) after exposure to digital health topics in a yearlong discussion?based case conference series. Methods: Student pharmacists? initial comfort, attitudes, and knowledge were gathered by a baseline DH-FACKS score at the beginning of the fall semester. Digital health concepts were integrated into a number of cases in the case conference course series throughout the academic year. The DH-FACKS was administered again to students after completion of the spring semester. Results were matched, scored, and analyzed to assess any difference in DH-FACKS scores. Results: A total of 91 of 373 students completed both the pre- and postsurvey (response rate of 24%). Using a scale from 1 to 10, the mean student-reported knowledge of digital health increased from 4.5 (SD 2.5) before intervention to 6.6 (SD 1.6) after intervention (P<.001) and the mean self-reported comfort increased from 4.7 (SD 2.5) before intervention to 6.7 (SD 1.8) after intervention (P<.001). There was a significant increase in scores for all 4 elements of the DH-FACKS. The mean familiarity scores increased from 11.6 (SD 3.7) to 15.8 (SD 2.2), out of a maximum of 20 (P<.001). The mean attitudes scores increased from 15.6 (SD 2.1) to 16.5 (SD 1.9), out of a maximum of 20 (P=.001). The mean comfort scores increased from 10.1 (SD 3.9) to 14.8 (SD 3.1), out of a maximum of 20 (P<.001). The mean knowledge scores increased from 9.9 (SD 3.4) to 12.8 (SD 3.9), out of a maximum of 20 (P<.001). Conclusions: Including digital health topics in a case conference series is an effective and approachable way of providing education on important digital health concepts to students. Students experienced an increase in familiarity, attitudes, comfort, and knowledge after the yearlong intervention. As case-based discussions are an important component of most pharmacy and other medical curricula, this method can be easily applied by other programs that wish to give their students practice applying their knowledge of digital health to complex case-based scenarios. UR - https://mededu.jmir.org/2023/1/e43313 UR - http://dx.doi.org/10.2196/43313 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428523 ID - info:doi/10.2196/43313 ER - TY - JOUR AU - Allen, Jay-Sheree AU - Oxentenko, Amy PY - 2023/6/13 TI - Four Lessons Learned From Career Pivots in Academic Medicine JO - J Med Internet Res SP - e47641 VL - 25 KW - women KW - academic medicine KW - career KW - pivot KW - transition KW - women in medicine UR - https://www.jmir.org/2023/1/e47641 UR - http://dx.doi.org/10.2196/47641 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310784 ID - info:doi/10.2196/47641 ER - TY - JOUR AU - Zhong, Lydia AU - Lee, Koeun AU - Baggstrom, Q. Maria AU - Bhayani, K. Rakhee PY - 2023/5/31 TI - Investing in Women Trainees: Building a Women in Medicine Group at an Academic Institution JO - J Med Internet Res SP - e47783 VL - 25 KW - gender equity KW - graduate medical education KW - women in medicine KW - trainee wellness KW - women KW - gender gap KW - inequity KW - medical training KW - medicine UR - https://www.jmir.org/2023/1/e47783 UR - http://dx.doi.org/10.2196/47783 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256684 ID - info:doi/10.2196/47783 ER - TY - JOUR AU - Silver, K. Julie AU - Gavini, Nara PY - 2023/5/25 TI - The Push-Pull Mentoring Model: Ensuring the Success of Mentors and Mentees JO - J Med Internet Res SP - e48037 VL - 25 KW - mentorship KW - mentor KW - medical education KW - diversity KW - equity KW - Push-Pull Mentoring Model UR - https://www.jmir.org/2023/1/e48037 UR - http://dx.doi.org/10.2196/48037 UR - http://www.ncbi.nlm.nih.gov/pubmed/37227764 ID - info:doi/10.2196/48037 ER - TY - JOUR AU - Elvsaas, Orjasaeter Ida-Kristin AU - Garnweidner-Holme, Lisa AU - Habib, Laurence AU - Molin, Marianne PY - 2023/5/11 TI - Development and Evaluation of a Serious Game Application to Engage University Students in Critical Thinking About Health Claims: Mixed Methods Study JO - JMIR Form Res SP - e44831 VL - 7 KW - game application KW - critical thinking KW - critical health literacy KW - Informed Health Choices KW - evaluation KW - mixed methods study KW - serious games KW - behind the headlines KW - mobile phone N2 - Background: Misleading health claims are widespread in the media, and making choices based on such claims can negatively affect health. Thus, developing effective learning resources to enable people to think critically about health claims is of great value. Serious games can become an effective learning resource in this respect, as they can affect motivation and learning. Objective: This study aims to document how user insights and input can inform the concept and development of a serious game application in critical thinking about health claims in addition to gathering user experiences with the game application. Methods: This was a mixed methods study in 4 successive phases with both qualitative and quantitative data collected in the period from 2020-2022. Qualitative data on design and development were obtained from 4 unrecorded discussions, and qualitative evaluation data were obtained from 1 recorded focus group interview and 3 open-ended questions in the game application. The quantitative data originate from user statistics. The qualitative data were analyzed thematically, and user data were analyzed using nonparametric tests. Results: The first unrecorded discussion revealed that the students? (3 participants?) assessment of whether a claim was reliable or not was limited to performing Google searches when faced with an ad for a health intervention. On the basis of the acquired knowledge of the target group, the game?s prerequisites, and the technical possibilities, a pilot of the game was created and reviewed question by question in 3 unrecorded discussions (6 participants). After adjustments, the game was advertised at the Oslo Metropolitan University, and 193 students tested the game. A correlation (r=0.77; P<.001) was found between the number of replays and total points achieved in the game. There was no demonstrable difference (P=.07) between the total scores of students from different faculties. Overall, 36.3% (70/193) of the students answered the evaluation questions in the game. They used words such as ?fun? and ?educational? about the experiences with the game, and words such as ?motivating? and ?engaging? related to the learning experience. The design was described as ?varied? and ?user-friendly.? Suggested improvements include adding references, more games and modules, more difficult questions, and an introductory text explaining the game. The results from the focus group interview (4 participants) corresponded to a large extent with the results of the open-ended questions in the game. Conclusions: We found that user insights and inputs can be successfully used in the concept and development of a serious game that aims to engage students to think critically about health claims. The mixed methods evaluation revealed that the users experienced the game as educational and fun. Future research may focus on assessing the effect of the serious game on learning outcomes and health choices in randomized trials. UR - https://formative.jmir.org/2023/1/e44831 UR - http://dx.doi.org/10.2196/44831 UR - http://www.ncbi.nlm.nih.gov/pubmed/37166972 ID - info:doi/10.2196/44831 ER - TY - JOUR AU - Alami, Jawad AU - Hammonds, Clare AU - Hensien, Erin AU - Khraibani, Jenan AU - Borowitz, Stephen AU - Hellems, Martha AU - Riggs, Sara PY - 2023/5/10 TI - Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study JO - JMIR Med Educ SP - e38079 VL - 9 KW - EHR KW - pediatric KW - usability KW - prerounding KW - training KW - electronic health record KW - eHealth N2 - Background: Electronic health records (EHRs) play a substantial role in modern health care, especially during prerounding, when residents gather patient information to inform daily care decisions of the care team. The effective use of the EHR system is crucial for efficient and frustration-free prerounding. Ideally, the system should be designed to support efficient user interactions by presenting data effectively and providing easy navigation between different pages. Additionally, training on the system should aim to make user interactions more efficient by familiarizing the users with best practices that minimize interaction time while using the full potential of the system?s capabilities. However, formal training on EHR systems often falls short of providing residents with all the necessary EHR-related skills, leading to the adoption of inefficient practices and the underuse of the system?s full range of capabilities. Objective: This study aims to examine the efficiency of EHR use during prerounding among pediatric residents, assess the effect of experience level on EHR use, and identify areas for improvement in EHR design and training. Methods: A mixed methods approach was used, involving a self-reported survey and video analysis of prerounding practices of the entire population of pediatric residents from a large teaching hospital in the South Atlantic Region. The residents were stratified by experience level by postgraduate year. Data were collected on the number of pages accessed, duration of prerounding, task completion rates, and effective use of data sources. Observational and qualitative data complemented the quantitative analysis. Our study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines, ensuring completeness and transparency of reporting. Results: Of the 30 pediatric residents, 20 were included in the analyses; of these, 16 (80%) missed at least 1 step during prerounding. Although more experienced residents on average omitted fewer steps, 4 (57%) of the 7 most experienced residents still omitted at least 1 step. On average, residents took 6.5 minutes to round each patient and accessed 21 pages within the EHR during prerounding; no statistically significant differences were observed between experience levels for prerounding times (P=.48) or number of pages accessed (P=.92). The use of aggregated data pages within the EHR system neither seem to improve prerounding times nor decrease the number of pages accessed. Conclusions: The findings suggest that EHR design should be improved to better support user needs, and hospitals should adopt more effective training programs to familiarize residents with the system?s capabilities. We recommend implementing prerounding checklists and providing ongoing EHR training programs for health care practitioners. Despite the generalizability of limitations of our study in terms of sample size and specialization, it offers valuable insights for future research to investigate the impact of EHR use on patient outcomes and satisfaction, as well as identify factors that contribute to efficient and effective EHR usage. UR - https://mededu.jmir.org/2023/1/e38079 UR - http://dx.doi.org/10.2196/38079 UR - http://www.ncbi.nlm.nih.gov/pubmed/37163346 ID - info:doi/10.2196/38079 ER - TY - JOUR AU - Bogarin, Roberto AU - Elizondo, Luis AU - Kalaitzoglou, Evangelia AU - Popovic, Jadranka AU - Rogol, Alan AU - Richmond, Erick AU - Chanoine, Jean-Pierre AU - Lopez-Pedrosa, M. Jose AU - Ruiz Salazar, Francis AU - Vuguin, Patricia PY - 2023/5/8 TI - Bringing the Pediatric Endocrine Spanish Speaking Community Together: First Virtual Pediatric Endocrine Meeting in Low- and Middle-Income Countries in Central and South America JO - Interact J Med Res SP - e41353 VL - 12 KW - continuing medical education KW - continuing education KW - medical education KW - professional development KW - pediatric KW - child KW - endocrinology KW - endocrine KW - pediatric endocrinology KW - diabetes KW - low- and middle-income countries KW - Latin America KW - Spanish KW - virtual KW - resources KW - digital N2 - Background: Pediatric endocrinology is a specialty that is struggling worldwide to maintain adequately trained professionals. Pediatric endocrine care in Central America and Caribbean countries is often performed by pediatricians or adult endocrinologists due to the limited number of pediatric endocrinologists. These health care providers are seldom members of endocrine societies and frequently lack formal training in the field. Objective: In this study, we describe the scope of a virtual conference in pediatric endocrinology and diabetes targeted to low- and middle-income countries to provide equal opportunities for access to medical education for health care professionals. Methods: The virtual conference was sponsored by the Pediatric Endocrine Society (North America), Asociación Costarricense de Endocrinología (previously, Asociación Nacional Pro Estudio de la Diabetes, Endocrinología y Metabolismo), and Asociacion Centroamericana y del Caribe de Endocrinologia Pediátrica. The conference was free to participants and comprised 23 sessions that were either synchronous with ability for real-time interactive sessions or asynchronous sessions, where content was available online to access at their convenience. Topics included idiopathic short stature, polycystic ovarian syndrome, diabetes mellitus, telemedicine, Turner syndrome, congenital adrenal hyperplasia, obesity, central precocious puberty, and subclinical hypothyroidism. The participants were asked to evaluate the conference after its completion with a questionnaire. Results: A total of 8 speakers from Spain, Canada, Costa Rica, and the United States delivered the virtual event to 668 health care professionals from Guatemala, Venezuela, Dominican Republic, Costa Rica, Ecuador, Peru, Uruguay, Mexico, Honduras, Argentina, the United States, Bolivia, Chile, Panama, El Salvador, Nicaragua, Paraguay, Belize, Spain, and Colombia. Name, profession, and country were fully disclosed by 410 (61.4%) of the 668 health care professionals. The profession or level of training of participants were as follows: pediatric endocrinologists (n=129, 19.3%), pediatricians (n=116, 17.4%), general practitioners (n=77, 11.5%), adult endocrinologists (n=34, 5.1%), medical students (n=23, 3.4%), residents in various specialties (n=14, 2.1%), and others (n=17, 2.6%). A total of 23 sessions were offered, most of which were bilingual (Spanish and English). Feedback from the evaluation questionnaire indicated that the content of the conference was very relevant to the participants? professional practice. Additionally, the participants reported that they were very satisfied with the organization, the web-based platform, and the sessions of the conference. Conclusions: Lack of accessibility to the latest and cutting-edge medical education in pediatric endocrinology and diabetes for medical professionals from low- and middle-income countries can be overcome with a virtual conference. Online availability, low cost, and easy-to-use technology were well received from the participants, who were overall very satisfied by the quality and the relevance of the sessions to their professional practice. UR - https://www.i-jmr.org/2023/1/e41353 UR - http://dx.doi.org/10.2196/41353 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155229 ID - info:doi/10.2196/41353 ER - TY - JOUR AU - Giannos, Panagiotis AU - Delardas, Orestis PY - 2023/4/26 TI - Performance of ChatGPT on UK Standardized Admission Tests: Insights From the BMAT, TMUA, LNAT, and TSA Examinations JO - JMIR Med Educ SP - e47737 VL - 9 KW - standardized admissions tests KW - GPT KW - ChatGPT KW - medical education KW - medicine KW - law KW - natural language processing KW - BMAT KW - TMUA KW - LNAT KW - TSA N2 - Background: Large language models, such as ChatGPT by OpenAI, have demonstrated potential in various applications, including medical education. Previous studies have assessed ChatGPT?s performance in university or professional settings. However, the model?s potential in the context of standardized admission tests remains unexplored. Objective: This study evaluated ChatGPT?s performance on standardized admission tests in the United Kingdom, including the BioMedical Admissions Test (BMAT), Test of Mathematics for University Admission (TMUA), Law National Aptitude Test (LNAT), and Thinking Skills Assessment (TSA), to understand its potential as an innovative tool for education and test preparation. Methods: Recent public resources (2019-2022) were used to compile a data set of 509 questions from the BMAT, TMUA, LNAT, and TSA covering diverse topics in aptitude, scientific knowledge and applications, mathematical thinking and reasoning, critical thinking, problem-solving, reading comprehension, and logical reasoning. This evaluation assessed ChatGPT?s performance using the legacy GPT-3.5 model, focusing on multiple-choice questions for consistency. The model?s performance was analyzed based on question difficulty, the proportion of correct responses when aggregating exams from all years, and a comparison of test scores between papers of the same exam using binomial distribution and paired-sample (2-tailed) t tests. Results: The proportion of correct responses was significantly lower than incorrect ones in BMAT section 2 (P<.001) and TMUA paper 1 (P<.001) and paper 2 (P<.001). No significant differences were observed in BMAT section 1 (P=.2), TSA section 1 (P=.7), or LNAT papers 1 and 2, section A (P=.3). ChatGPT performed better in BMAT section 1 than section 2 (P=.047), with a maximum candidate ranking of 73% compared to a minimum of 1%. In the TMUA, it engaged with questions but had limited accuracy and no performance difference between papers (P=.6), with candidate rankings below 10%. In the LNAT, it demonstrated moderate success, especially in paper 2?s questions; however, student performance data were unavailable. TSA performance varied across years with generally moderate results and fluctuating candidate rankings. Similar trends were observed for easy to moderate difficulty questions (BMAT section 1, P=.3; BMAT section 2, P=.04; TMUA paper 1, P<.001; TMUA paper 2, P=.003; TSA section 1, P=.8; and LNAT papers 1 and 2, section A, P>.99) and hard to challenging ones (BMAT section 1, P=.7; BMAT section 2, P<.001; TMUA paper 1, P=.007; TMUA paper 2, P<.001; TSA section 1, P=.3; and LNAT papers 1 and 2, section A, P=.2). Conclusions: ChatGPT shows promise as a supplementary tool for subject areas and test formats that assess aptitude, problem-solving and critical thinking, and reading comprehension. However, its limitations in areas such as scientific and mathematical knowledge and applications highlight the need for continuous development and integration with conventional learning strategies in order to fully harness its potential. UR - https://mededu.jmir.org/2023/1/e47737 UR - http://dx.doi.org/10.2196/47737 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099373 ID - info:doi/10.2196/47737 ER - TY - JOUR AU - Kanzow, Philipp AU - Schmidt, Dennis AU - Herrmann, Manfred AU - Wassmann, Torsten AU - Wiegand, Annette AU - Raupach, Tobias PY - 2023/3/27 TI - Use of Multiple-Select Multiple-Choice Items in a Dental Undergraduate Curriculum: Retrospective Study Involving the Application of Different Scoring Methods JO - JMIR Med Educ SP - e43792 VL - 9 KW - dental education KW - education system KW - educational assessment KW - educational measurement KW - examination KW - k of n KW - Kprim KW - K? KW - MTF KW - Multiple-True-False KW - Pick-N KW - scoring KW - scoring system KW - Type X KW - undergraduate KW - undergraduate curriculum KW - undergraduate education N2 - Background: Scoring and awarding credit are more complex for multiple-select items than for single-choice items. Forty-one different scoring methods were retrospectively applied to 2 multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF]) from existing examination data. Objective: This study aimed to calculate and compare the mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above the pass level (?0.6). Methods: Items and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing examination data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using the Kruskal-Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P<.05). Results: We analyzed 1931 marking events of 48 Pick-N items and 828 marking events of 18 MTF items. For both item types, scoring results widely differed between scoring methods (minimum: 0.02, maximum: 0.98; P<.001). Both the use of an inappropriate item type (34 items) and the presence of cues (30 items) impacted the scoring results. Inappropriately used Pick-N items resulted in lower mean raw scores (0.88 vs 0.93; P<.001), while inappropriately used MTF items resulted in higher mean raw scores (0.88 vs 0.85; P=.001). Mean raw scores were higher for MTF items with cues than for those without cues (0.91 vs 0.8; P<.001), while mean raw scores for Pick-N items with and without cues did not differ (0.89 vs 0.90; P=.09). Item quality also impacted the likelihood of resulting scores at or above the pass level (odds ratio ?6.977). Conclusions: Educators should pay attention when using multiple-select multiple-choice items and select the most appropriate item type. Different item types, different scoring methods, and presence of cues are likely to impact examinees? scores and overall examination results. UR - https://mededu.jmir.org/2023/1/e43792 UR - http://dx.doi.org/10.2196/43792 UR - http://www.ncbi.nlm.nih.gov/pubmed/36841970 ID - info:doi/10.2196/43792 ER - TY - JOUR AU - Martín-Carbonell, Marta AU - Espejo, Begoña AU - Castro-Melo, Patricia Greys AU - Sequeira-Daza, Doris AU - Checa, Irene PY - 2023/3/9 TI - Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study JO - J Med Internet Res SP - e42340 VL - 25 KW - psychometric properties KW - structural equation modeling KW - older adulthood KW - geriatric KW - gerontology KW - health care college students KW - health care professionals KW - questionnaire KW - stereotype KW - agism N2 - Background: In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. Objective: The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. Methods: A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. Results: The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. Conclusions: The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism. UR - https://www.jmir.org/2023/1/e42340 UR - http://dx.doi.org/10.2196/42340 UR - http://www.ncbi.nlm.nih.gov/pubmed/36892936 ID - info:doi/10.2196/42340 ER - TY - JOUR AU - Eysenbach, Gunther PY - 2023/3/6 TI - The Role of ChatGPT, Generative Language Models, and Artificial Intelligence in Medical Education: A Conversation With ChatGPT and a Call for Papers JO - JMIR Med Educ SP - e46885 VL - 9 KW - artificial intelligence KW - AI KW - ChatGPT KW - generative language model KW - medical education KW - interview KW - future of education UR - https://mededu.jmir.org/2023/1/e46885 UR - http://dx.doi.org/10.2196/46885 UR - http://www.ncbi.nlm.nih.gov/pubmed/36863937 ID - info:doi/10.2196/46885 ER - TY - JOUR AU - Bieri, Julie AU - Tuor, Carlotta AU - Nendaz, Mathieu AU - L Savoldelli, Georges AU - Blondon, Katherine AU - Schiffer, Eduardo AU - Zamberg, Ido PY - 2023/3/2 TI - Implementation of a Student-Teacher?Based Blended Curriculum for the Training of Medical Students for Nasopharyngeal Swab and Intramuscular Injection: Mixed Methods Pre-Post and Satisfaction Surveys JO - JMIR Med Educ SP - e38870 VL - 9 KW - peer-learning KW - educator KW - education method KW - knowledge acquisition KW - training KW - student-teacher KW - COVID-19 KW - nasal swab KW - vaccine KW - injection KW - skill assessment KW - skill development KW - vaccination KW - blended learning KW - blended education KW - hybrid education KW - medical education KW - pandemic KW - teaching KW - health care sector KW - medical student KW - hybrid learning KW - online learning KW - digital education KW - online education KW - online course KW - online class KW - simulation N2 - Background: The COVID-19 pandemic caused a major disruption in the health care sector with increased workload and the need for new staff to assist with screening and vaccination tasks. Within this context, teaching medical students to perform intramuscular injections and nasal swabs could help address workforce needs. Although several recent studies discuss medical students? role and integration in clinical activities during the pandemic, knowledge gaps exist concerning their role and potential benefit in designing and leading teaching activities during this period. Objective: The aim of our study was to prospectively assess the impact in terms of confidence, cognitive knowledge, and perceived satisfaction of a student-teacher?designed educational activity consisting of nasopharyngeal swabs and intramuscular injections for the training of second-year medical students in the Faculty of Medicine, University of Geneva, Switzerland. Methods: This was a mixed methods pre-post surveys and satisfaction survey study. Activities were designed using evidence-based teaching methodologies based on the SMART (specific, measurable, achievable, realistic, and timely) criteria. All second-year medical students who did not participate in the activity?s old format were recruited unless they explicitly stated that they wanted to opt out. Pre-post activity surveys were designed to assess perception of confidence and cognitive knowledge. An additional survey was designed to assess satisfaction in the mentioned activities. Instructional design was blended with a presession e-learning activity and a 2-hour practice session with simulators. Results: Between December 13, 2021, and January 25, 2022, a total of 108 second-year medical students were recruited; 82 (75.9%) students participated in the preactivity survey and 73 (67.6%) in the postactivity survey. Students? confidence in performing intramuscular injections and nasal swabs significantly increased on a 5-point Likert scale for both procedures?from 3.31 (SD 1.23) and 3.59 (SD 1.13) before the activity to 4.45 (SD 0.62) and 4.32 (SD 0.76) after the activity (P<.001), respectively. Perceptions of cognitive knowledge acquisition also significantly increased for both activities. For the nasopharyngeal swab, knowledge acquisition concerning indications increased from 2.7 (SD 1.24) to 4.15 (SD 0.83), and for the intramuscular injection, knowledge acquisition concerning indications increased from 2.64 (SD 1.1) to 4.34 (SD 0.65) (P<.001). Knowledge of contraindications for both activities increased from 2.43 (SD 1.1) to 3.71 (SD 1.12) and from 2.49 (SD 1.13) to 4.19 (SD 0.63), respectively (P<.001). High satisfaction rates were reported for both activities. Conclusions: Student-teacher?based blended activities for training novice medical students in commonly performed procedural skills seem effective for increasing their confidence and cognitive knowledge and should be further integrated within a medical school curriculum. Blended learning instructional design increases students? satisfaction about clinical competency activities. Future research should elucidate the impact of student-teacher?designed and student-teacher?led educational activities. UR - https://mededu.jmir.org/2023/1/e38870 UR - http://dx.doi.org/10.2196/38870 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862500 ID - info:doi/10.2196/38870 ER - TY - JOUR AU - Papan, Cihan AU - Schmitt, Monika AU - Becker, L. Sören PY - 2023/2/27 TI - Teaching Medical Microbiology With a Web-Based Course During the COVID-19 Pandemic: Retrospective Before-and-After Study JO - JMIR Med Educ SP - e39680 VL - 9 KW - SARS-CoV-2 KW - COVID-19 KW - online learning KW - web-based learning KW - web-based course KW - medical students KW - medical microbiology KW - microbiology KW - medical education KW - medical school KW - online teaching KW - online course KW - online class KW - online instruction KW - distance learning KW - distant learning KW - performance KW - student KW - learning outcome KW - perception KW - opinion KW - attitude KW - examination KW - practical course N2 - Background: The COVID-19 pandemic has imposed unprecedented hurdles on health care systems and medical faculties alike. Lecturers of practical courses at medical schools have been confronted with the challenge of transferring knowledge remotely. Objective: We sought to evaluate the effects of a web-based medical microbiology course on learning outcomes and student perceptions. Methods: During the summer term of 2020, medical students at Saarland University, Germany, participated in a web-based medical microbiology course. Teaching content comprised clinical scenarios, theoretical knowledge, and instructive videos on microbiological techniques. Test performance, failure rate, and student evaluations, which included open-response items, for the web-based course were compared to those of the on-site course from the summer term of 2019. Results: Student performance was comparable between both the online-only group and the on-site comparator for both the written exam (n=100 and n=131, respectively; average grade: mean 7.6, SD 1.7 vs mean 7.3, SD 1.8; P=.20) and the oral exam (n=86 and n=139, respectively; average grade: mean 33.6, SD 4.9 vs mean 33.4, SD 4.8; P=.78). Failure rate did not significantly differ between the online-only group and the comparator group (2/84, 2.4% vs 4/120, 3.3%). While lecturer expertise was rated similarly as high by students in both groups (mean 1.47, SD 0.62 vs mean 1.27, SD 0.55; P=.08), students who took the web-based course provided lower scores for interdisciplinarity (mean 1.7, SD 0.73 vs mean 2.53, SD 1.19; P<.001), opportunities for interaction (mean 1.46, SD 0.67 vs mean 2.91, SD 1.03; P<.001), and the extent to which the educational objectives were defined (mean 1.61, SD 0.76 vs mean 3.41, SD 0.95; P<.001). Main critiques formulated within the open-response items concerned organizational deficits. Conclusions: Web-based courses in medical microbiology are a feasible teaching option, especially in the setting of a pandemic, leading to similar test performances in comparison to on-site courses. The lack of interaction and the sustainability of acquired manual skills warrant further research. UR - https://mededu.jmir.org/2023/1/e39680 UR - http://dx.doi.org/10.2196/39680 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848212 ID - info:doi/10.2196/39680 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 - Perrin, Julien AU - Meeus, Amélie AU - Broseus, Julien AU - Morieux, Pierre-Jean AU - Di Ceglie, Valentine AU - Gravoulet, Julien AU - D'Aveni, Maud PY - 2023/2/13 TI - A Serious Game About Hematology for Health Care Workers (SUPER HEMO): Development and Validation Study JO - JMIR Serious Games SP - e40350 VL - 11 KW - educational technology KW - hematology KW - health care students KW - education KW - teaching KW - validation KW - methodological study KW - video support tool KW - continuing education KW - serious games KW - educational games N2 - Background: Complete blood count (CBC) and hemostatic screening tests are among the most commonly prescribed blood tests worldwide. All health care workers (nurse practitioners, pharmacists, dentists, midwives, and physicians) are expected to correctly interpret the results in their daily practice. Currently, the undergraduate hematology curriculum consists predominantly of lecture-based teaching. Because hematology combines basic science (blood cells and hemostasis physiology) and clinical skills, students report that they do not easily master hematology with only lecture-based teaching. Having interviewed students at the University of Lorraine, we considered it necessary to develop new teaching approaches and methods. Objective: We aimed to develop and validate a serious game about CBC analysis for health care students. Our primary objective was to help students perceive hematology as being a playful and easy topic and for them to feel truly involved in taking care of their patients by analyzing blood tests. We considered that this game-based approach would be attractive to students as an addition to the classic lecture-based approach and improve their knowledge and skills in hematology. Methods: We developed an adventure game called SUPER HEMO, a video game in which the player assumes the role of a protagonist in an interactive story driven by exploration and problem-solving tests. Following validation with beta testing by a panel of volunteer students, we used a novel, integrated teaching approach. We added 1.5 hours of gaming to the standard curriculum for a small group of volunteer students. Physician and pharmacy students in their third year at a single French university were invited to attend this extracurricular course. Pregame and postgame tests and satisfaction surveys were immediately recorded. Final hematology exam results were analyzed. Results: A total of 86 of 324 physician students (26.5%) and 67 of 115 pharmacy students (58%) opted to participate. Median scores on the pre- and posttests were 6 out of 10 versus 7 out of 10, respectively, for the physician students, (P<.001) and 7.5 out of 10 versus 8 out of 10, respectively, for the pharmacy students (P<.001). At the final hematology evaluation, physician students who played SUPER HEMO had a slightly better median score than those who did not: 13 out of 20 versus 12 out of 20, respectively (P=.002). Pharmacy students who played SUPER HEMO had a median score of 21.75 out of 30; this was not significantly different from pharmacy students who did not play SUPER HEMO (20/30; P=.12). Among the participants who answered the survey (n=143), more than 86% (123/143) believed they had strengthened their knowledge and nearly 80% (114/143) of them had fun. Conclusions: Feedback from this game session provided evidence to support the integration of interactive teaching methods in undergraduate hematology teaching. The development of SUPER HEMO is intended to be completed so that it can become a support tool for continuing education. UR - https://games.jmir.org/2023/1/e40350 UR - http://dx.doi.org/10.2196/40350 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780215 ID - info:doi/10.2196/40350 ER - TY - JOUR AU - Tran, Carrie AU - Toth-Pal, Eva AU - Ekblad, Solvig AU - Fors, Uno AU - Salminen, Helena PY - 2023/1/17 TI - Medical Students? Learning About Other Professions Using an Interprofessional Virtual Patient While Remotely Connected With a Study Group: Mixed Methods Study JO - JMIR Med Educ SP - e38599 VL - 9 KW - interprofessional learning KW - virtual patient KW - medical students KW - remote learning KW - distance learning KW - medical education N2 - Background: Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and virtual patients (VPs) may be useful additional methods to increase students? possibilities for interprofessional learning. Objective: This study had two aims. The first was to assess if an interprofessional VP case could facilitate medical students? learning about team collaboration in online groups. The second was to assess how students experienced learning with the VP when remotely connected with their group. Methods: A mixed methods design was used. The VP case was a 73-year-old man who needed help from different health professions in his home after a hip fracture. Questionnaires were answered by the students before and directly after each session. Qualitative group interviews were performed with each group of students directly after the VP sessions, and the interviews were analyzed using qualitative content analysis. Results: A total of 49 third-year medical students divided into 15 groups participated in the study. Each group had 2 to 5 students who worked together with the interprofessional VP without a teacher?s guidance. In the analysis of the group interviews, a single theme was identified: the interprofessional VP promoted student interaction and gave insight into team collaboration. Two categories were found: (1) the structure of the VP facilitated students? learning and (2) students perceived the collaboration in their remotely connected groups as functioning well and being effective. The results from the questionnaires showed that the students had gained insights into the roles and competencies of other health care professions. Conclusions: This study demonstrates that an interprofessional VP enabled insights into team collaboration and increased understanding of other professions among student groups comprising only medical students. The interprofessional VP seemed to benefit students? learning in an online, remote-learning context. Although our VP was not used as an interprofessional student activity according to the common definition of interprofessional education, the results imply that it still contributed to students? interprofessional learning. UR - https://mededu.jmir.org/2023/1/e38599 UR - http://dx.doi.org/10.2196/38599 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649071 ID - info:doi/10.2196/38599 ER - TY - JOUR AU - Lim, Amanda Xiu Ming AU - Liao, Ariel Wenxin AU - Wang, Wenru AU - Seah, Betsy PY - 2022/12/15 TI - The Effectiveness of Technology-Based Cardiopulmonary Resuscitation Training on the Skills and Knowledge of Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e36423 VL - 24 IS - 12 KW - cardiac arrest KW - education KW - methods KW - first responders KW - resuscitation training KW - effectiveness KW - adolescents KW - schoolchildren N2 - Background: Cardiopulmonary resuscitation (CPR) training for adolescents is a prominent strategy to increase the number of community first responders who can recognize cardiac arrest and initiate CPR. More schools are adopting technology-based CPR training modalities to reduce class time and reliance on instructor availability and increase their capacity for wider training dissemination. However, it remains unclear whether these technology-based modalities are comparable with standard training. Objective: This study aimed to systematically review and perform meta-analyses to evaluate the effectiveness of technology-based CPR training on adolescents? CPR skills and knowledge. Methods: Searches were conducted in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL, PsycINFO, Education Resources Information Center, ProQuest Dissertations and Theses Global, and Scopus from inception to June 25, 2021. Eligible randomized controlled trials (RCTs) compared technology-based training with standard training for adolescents aged 12 to 18 years. Studies were appraised using the Cochrane risk-of-bias tool. Random-effects meta-analyses were performed using Review Manager (The Cochrane Collaboration). Subgroup analyses were conducted to explore sources of heterogeneity. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Seventeen RCTs involving 5578 adolescents were included. Most of the studies had unclear risks of selection bias (9/17, 53%) and high risks of performance bias (16/17, 94%). Interventions that included instructor guidance increased the likelihood of adolescents checking the responsiveness of the person experiencing cardiac arrest (risk ratio 1.39, 95% CI 1.19-1.63) and calling the emergency medical services (risk ratio 1.11, 95% CI 1.00-1.24). Self-directed technology-based CPR training without instructor guidance was associated with poorer overall skill performance (Cohen d=?0.74, 95% CI ?1.02 to ?0.45). Training without hands-on practice increased mean compression rates (mean difference 9.38, 95% CI 5.75-13.01), whereas real-time feedback potentially yielded slower compression rates. Instructor-guided training with hands-on practice (Cohen d=0.45, 95% CI 0.13-0.78) and the use of computer programs or mobile apps (Cohen d=0.62, 95% CI 0.37-0.86) improved knowledge scores. However, certainty of evidence was very low. Conclusions: Instructor-guided technology-based CPR training that includes hands-on practice and real-time feedback is noninferior to standard training in CPR skills and knowledge among adolescents. Our findings supported the use of technology-based components such as videos, computer programs, or mobile apps for self-directed theoretical instruction. However, instructor guidance, hands-on practice, and real-time feedback are still necessary components of training to achieve better learning outcomes for adolescents. Such a blended learning approach may reduce class time and reliance on instructor availability. Because of the high heterogeneity of the studies reviewed, the findings from this study should be interpreted with caution. More high-quality RCTs with large sample sizes and follow-up data are needed. Finally, technology-based training can be considered a routine refresher training modality in schools for future research. UR - https://www.jmir.org/2022/12/e36423 UR - http://dx.doi.org/10.2196/36423 UR - http://www.ncbi.nlm.nih.gov/pubmed/36520524 ID - info:doi/10.2196/36423 ER - TY - JOUR AU - Kamat, Samir AU - Danias, George AU - Agarwal, Aneesh AU - Chennareddy, Sumanth AU - Han, Joseph AU - Lee, Samuel PY - 2022/12/9 TI - Incorporating Paid Caregivers Into Medical Education to Enhance Medical Student Exposure to This Essential Workforce JO - JMIR Med Educ SP - e38329 VL - 8 IS - 4 KW - medical education KW - education KW - student KW - communication KW - perspective KW - medical student KW - paid caregiver KW - caregiver KW - health care model KW - home-based health care KW - patient care KW - health care provider KW - student experience KW - training KW - care team KW - integration KW - clinical decision UR - https://mededu.jmir.org/2022/4/e38329 UR - http://dx.doi.org/10.2196/38329 UR - http://www.ncbi.nlm.nih.gov/pubmed/36485028 ID - info:doi/10.2196/38329 ER - TY - JOUR AU - Diouf, Thiab Ndeye AU - Musabyimana, Angèle AU - Blanchette, Virginie AU - Lépine, Johanie AU - Guay-Bélanger, Sabrina AU - Tremblay, Marie-Claude AU - Dogba, Joyce Maman AU - Légaré, France PY - 2022/12/7 TI - Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review JO - JMIR Med Educ SP - e42033 VL - 8 IS - 4 KW - shared decision-making KW - reflexivity KW - training KW - health care professionals KW - implementation N2 - Background: Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. Objective: In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. Methods: From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. Results: Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. Conclusions: Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training. UR - https://mededu.jmir.org/2022/4/e42033 UR - http://dx.doi.org/10.2196/42033 UR - http://www.ncbi.nlm.nih.gov/pubmed/36318726 ID - info:doi/10.2196/42033 ER - TY - JOUR AU - Du, Wenqiong AU - Zhong, Xin AU - Jia, Yijun AU - Jiang, Renqing AU - Yang, Haoyang AU - Ye, Zhao AU - Zong, Zhaowen PY - 2022/12/6 TI - A Novel Scenario-Based, Mixed-Reality Platform for Training Nontechnical Skills of Battlefield First Aid: Prospective Interventional Study JO - JMIR Serious Games SP - e40727 VL - 10 IS - 4 KW - mixed reality KW - decision-making KW - team work KW - battlefield first aid KW - nontechnical skills KW - training KW - next-generation modeling KW - virtual reality KW - medical education N2 - Background: Although battlefield first aid (BFA) training shares many common features with civilian training, such as the need to address technical skills and nontechnical skills (NTSs), it is more highly scenario-dependent. Studies into extended reality show clear benefits in medical training; however, the training effects of extended reality on NTSs, including teamwork and decision-making in BFA, have not been fully proven. Objective: The current study aimed to create and test a scenario-based, mixed-reality platform suitable for training NTSs in BFA. Methods: First, using next-generation modeling technology and an animation synchronization system, a 10-person offensive battle drill was established. Decision-making training software addressing basic principles of tactical combat casualty care was constructed and integrated into the scenarios with Unreal Engine 4 (Epic Games). Large-space teamwork and virtual interaction systems that made sense in the proposed platform were developed. Unreal Engine 4 and software engineering technology were used to combine modules to establish a mixed-reality BFA training platform. A total of 20 Grade 4 medical students were recruited to accept BFA training with the platform. Pretraining and posttraining tests were carried out in 2 forms to evaluate the training effectiveness: one was knowledge acquisition regarding the NTS and the other was a real-world, scenario-based test. In addition, the students were asked to rate their agreement with a series of survey items on a 5-point Likert scale. Results: A battlefield geographic environment, tactical scenarios, scenario-based decision software, large-space teamwork, and virtual interaction system modules were successfully developed and combined to establish the mixed-reality training platform for BFA. The posttraining score of the students? knowledge acquisition was significantly higher than that of pretraining (t=?12.114; P?.001). Furthermore, the NTS score and the total score that the students obtained in the real-world test were significantly higher than those before training (t=?17.756 and t=?21.354, respectively; P?.001). However, there was no significant difference between the scores of technical skills that the students obtained before and after training. A posttraining survey revealed that the students found the platform helpful in improving NTSs for BFA, and they were confident in applying BFA skills after training. However, most trainees thought that the platform was not helpful for improving the technical skills of BFA, and 45% (9/20) of the trainees were not satisfied with the simulation effect. Conclusions: A scenario-based, mixed-reality platform was constructed in this study. In this platform, interaction of the movement of multiple players in a large space and the interaction of decision-making by the trainees between the real world and the virtual world were accomplished. The platform could improve the NTSs of BFA. Future works, including improvement of the simulation effects and development of a training platform that could effectively improve both the technical skills and NTSs of BFA, will be carried out. UR - https://games.jmir.org/2022/4/e40727 UR - http://dx.doi.org/10.2196/40727 UR - http://www.ncbi.nlm.nih.gov/pubmed/36472903 ID - info:doi/10.2196/40727 ER - TY - JOUR AU - Lin, Michelle AU - Phipps, Mina AU - Yilmaz, Yusuf AU - Nash, J. Christopher AU - Gisondi, A. Michael AU - Chan, M. Teresa PY - 2022/10/28 TI - A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study JO - JMIR Med Educ SP - e39946 VL - 8 IS - 4 KW - open educational resource KW - free open-access meducation KW - FOAM KW - meducation KW - open-access KW - internet based KW - web based KW - website KW - social media KW - medical education KW - disruptive innovation KW - blog KW - podcast KW - emergency KW - critical care N2 - Background: Free open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown. Objective: This study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework. Methods: The authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework. Results: The authors identified 109 emergency medicine and critical care websites, which comprised 45.9% (n=50) blogs, 22.9% (n=25) podcasts, and 31.2% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5% (n=30) sold products, 18.3% (n=20) used advertisements, 44.0% (n=48) had institutional funding, and 27.5% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9%) to ?5 (n=60, 55%) individuals. Conclusions: There was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education. UR - https://mededu.jmir.org/2022/4/e39946 UR - http://dx.doi.org/10.2196/39946 UR - http://www.ncbi.nlm.nih.gov/pubmed/36306167 ID - info:doi/10.2196/39946 ER - TY - JOUR AU - Chartash, David AU - Rosenman, Marc AU - Wang, Karen AU - Chen, Elizabeth PY - 2022/9/13 TI - Informatics in Undergraduate Medical Education: Analysis of Competency Frameworks and Practices Across North America JO - JMIR Med Educ SP - e39794 VL - 8 IS - 3 KW - undergraduate medical education KW - medical informatics KW - curriculum KW - medical education KW - education KW - North America KW - framework KW - clinical KW - informatics KW - Canada KW - United States KW - US KW - teaching KW - management KW - cognitive N2 - Background: With the advent of competency-based medical education, as well as Canadian efforts to include clinical informatics within undergraduate medical education, competency frameworks in the United States have not emphasized the skills associated with clinical informatics pertinent to the broader practice of medicine. Objective: By examining the competency frameworks with which undergraduate medical education in clinical informatics has been developed in Canada and the United States, we hypothesized that there is a gap: the lack of a unified competency set and frame for clinical informatics education across North America. Methods: We performed directional competency mapping between Canadian and American graduate clinical informatics competencies and general graduate medical education competencies. Directional competency mapping was performed between Canadian roles and American common program requirements using keyword matching at the subcompetency and enabling competency levels. In addition, for general graduate medical education competencies, the Physician Competency Reference Set developed for the Liaison Committee on Medical Education was used as a direct means of computing the ontological overlap between competency frameworks. Results: Upon mapping Canadian roles to American competencies via both undergraduate and graduate medical education competency frameworks, the difference in focus between the 2 countries can be thematically described as a difference between the concepts of clinical and management reasoning. Conclusions: We suggest that the development or deployment of informatics competencies in undergraduate medical education should focus on 3 items: the teaching of diagnostic reasoning, such that the information tasks that comprise both clinical and management reasoning can be discussed; precision medical education, where informatics can provide for more fine-grained evaluation; and assessment methods to support traditional pedagogical efforts (both at the bedside and beyond). Assessment using cases or structured assessments (eg, Objective Structured Clinical Examinations) would help students draw parallels between clinical informatics and fundamental clinical subjects and would better emphasize the cognitive techniques taught through informatics. UR - https://mededu.jmir.org/2022/3/e39794 UR - http://dx.doi.org/10.2196/39794 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099007 ID - info:doi/10.2196/39794 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 - Toohey, Shannon AU - Wray, Alisa AU - Hunter, John AU - Waldrop, Ian AU - Saadat, Soheil AU - Boysen-Osborn, Megan AU - Sudario, Gabriel AU - Smart, Jonathan AU - Wiechmann, Warren AU - Pressman, D. Sarah PY - 2022/8/1 TI - Comparing the Psychological Effects of Manikin-Based and Augmented Reality?Based Simulation Training: Within-Subjects Crossover Study JO - JMIR Med Educ SP - e36447 VL - 8 IS - 3 KW - augmented reality KW - AR KW - salivary cortisol KW - galvanic skin conductance KW - medical simulation KW - medical education N2 - Background: Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators. Objective: The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations. Methods: A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use. Results: Of the total 86 medical students who participated, 37 (43%) were male and 49 (57%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: ?0.11, 95% CI ?0.18 to ?0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95% CI ?0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95% CI ?2.35 to 3.42; P=.71) or simulation stress (AR-manikin: ?2.17, 95% CI ?6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: ?4.0, 95% CI ?0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: ?0.33, 95% CI ?1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95% CI ?0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95% CI ?0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR. Conclusions: AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm. UR - https://mededu.jmir.org/2022/3/e36447 UR - http://dx.doi.org/10.2196/36447 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916706 ID - info:doi/10.2196/36447 ER - TY - JOUR AU - Heo, Sejin AU - Moon, Suhyeon AU - Kim, Minha AU - Park, Minsu AU - Cha, Chul Won AU - Son, Hi Meong PY - 2022/7/22 TI - An Augmented Reality?Based Guide for Mechanical Ventilator Setup: Prospective Randomized Pilot Trial JO - JMIR Serious Games SP - e38433 VL - 10 IS - 3 KW - augmented reality KW - mechanical ventilation education KW - medical education KW - critical care KW - medical training KW - virtual reality KW - virtual education KW - nurse KW - nursing education KW - nursing KW - health care professional KW - learning platform KW - digital learning KW - digital health N2 - Background: Recently, the demand for mechanical ventilation (MV) has increased with the COVID-19 pandemic; however, the conventional approaches to MV training are resource intensive and require on-site training. Consequently, the need for independent learning platforms with remote assistance in institutions without resources has surged. Objective: This study aimed to determine the feasibility and effectiveness of an augmented reality (AR)?based self-learning platform for novices to set up a ventilator without on-site assistance. Methods: This prospective randomized controlled pilot study was conducted at Samsung Medical Center, Korea, from January to February 2022. Nurses with no prior experience of MV or AR were enrolled. We randomized the participants into 2 groups: manual and AR groups. Participants in the manual group used a printed manual and made a phone call for assistance, whereas participants in the AR group were guided by AR-based instructions and requested assistance with the head-mounted display. We compared the overall score of the procedure, required level of assistance, and user experience between the groups. Results: In total, 30 participants completed the entire procedure with or without remote assistance. Fewer participants requested assistance in the AR group compared to the manual group (7/15, 47.7% vs 14/15, 93.3%; P=.02). The number of steps that required assistance was also lower in the AR group compared to the manual group (n=13 vs n=33; P=.004). The AR group had a higher rating in predeveloped questions for confidence (median 3, IQR 2.50-4.00 vs median 2, IQR 2.00-3.00; P=.01), suitability of method (median 4, IQR 4.00-5.00 vs median 3, IQR 3.00-3.50; P=.01), and whether they intended to recommend AR systems to others (median 4, IQR 3.00-5.00 vs median 3, IQR 2.00-3.00; P=.002). Conclusions: AR-based instructions to set up a mechanical ventilator were feasible for novices who had no prior experience with MV or AR. Additionally, participants in the AR group required less assistance compared with those in the manual group, resulting in higher confidence after training. Trial Registration: ClinicalTrials.gov NCT05446896; https://beta.clinicaltrials.gov/study/NCT05446896 UR - https://games.jmir.org/2022/3/e38433 UR - http://dx.doi.org/10.2196/38433 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867382 ID - info:doi/10.2196/38433 ER - TY - JOUR AU - Lakhtakia, Ritu AU - Otaki, Farah AU - Alsuwaidi, Laila AU - Zary, Nabil PY - 2022/7/22 TI - Assessment as Learning in Medical Education: Feasibility and Perceived Impact of Student-Generated Formative Assessments JO - JMIR Med Educ SP - e35820 VL - 8 IS - 3 KW - self-regulated learning KW - assessment as learning KW - student-generated assessments KW - lifelong learning KW - medical education N2 - Background: Self-regulated learning (SRL) is gaining widespread recognition as a vital competency that is desirable to sustain lifelong learning, especially relevant to health professions education. Contemporary educational practices emphasize this aspect of undergraduate medical education through innovative designs of teaching and learning, such as the flipped classroom and team-based learning. Assessment practices are less commonly deployed to build capacity for SRL. Assessment as learning (AaL) can be a unique way of inculcating SRL by enabling active learning habits. It charges students to create formative assessments, reinforcing student-centered in-depth learning and critical thinking. Objective: This study aimed to explore, from the learners? perspectives, the feasibility and perceived learning impact of student-generated formative assessments. Methods: This study relied on a convergent mixed methods approach. An educational intervention was deployed on a cohort of 54 students in the second year of a 6-year undergraduate medical program as part of a single-course curriculum. The AaL intervention engaged students in generating assessments using peer collaboration, tutor facilitation, and feedback. The outcomes of the intervention were measured through quantitative and qualitative data on student perceptions, which were collected through an anonymized web-based survey and in-person focus groups, respectively. Quantitative survey data were analyzed using SPSS (IBM), and qualitative inputs underwent thematic analysis. Results: The students? overall score of agreement with the AaL educational intervention was 84%, which was strongly correlated with scores for ease and impact on a 5-point Likert-type scale. The themes that emerged from the qualitative analysis included prominent characteristics, immediate gains, and expected long-term benefits of engagement. The prominent characteristics included individuals? engagement, effective interdependencies, novelty, and time requirements. The identified immediate gains highlighted increased motivation and acquisition of knowledge and skills. The expected long-term benefits included critical thinking, problem solving, and clinical reasoning. Conclusions: As a form of AaL, student-generated assessments were perceived as viable, constructive, and stimulating educational exercises by the student authors. In the short term, the activity provided students with a fun and challenging opportunity to dive deeply into the content, be creative in designing questions, and improve exam-taking skills. In the long term, students expected an enhancement of critical thinking and the inculcation of student-centered attributes of self-regulated lifelong learning and peer collaboration, which are vital to the practice of medicine. UR - https://mededu.jmir.org/2022/3/e35820 UR - http://dx.doi.org/10.2196/35820 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867379 ID - info:doi/10.2196/35820 ER - TY - JOUR AU - Wong, Yuen-Ha Janet AU - Ko, Joanna AU - Nam, Sujin AU - Kwok, Tyrone AU - Lam, Sheila AU - Cheuk, Jessica AU - Chan, Maggie AU - Lam, Veronica AU - Wong, C. Gordon T. AU - Ng, H. Zoe L. AU - Wai, Ka-Chung Abraham PY - 2022/7/14 TI - Virtual ER, a Serious Game for Interprofessional Education to Enhance Teamwork in Medical and Nursing Undergraduates: Development and Evaluation Study JO - JMIR Serious Games SP - e35269 VL - 10 IS - 3 KW - game KW - interprofessional education KW - teamwork KW - learning style KW - emergency medicine KW - emergency nursing N2 - Background: Engaging students in interprofessional education for higher order thinking and collaborative problem-solving skills is challenging. This study reports the development of Virtual ER, a serious game played on a virtual platform, and how it can be an innovative way for delivering interprofessional education to medical and nursing undergraduates. Objective: We report the development of a serious online game, Virtual ER, and evaluate its effect on teamwork enhancement and clinical competence. We also explore if Virtual ER can be an effective pedagogical tool to engage medical and nursing students with different learning styles. Methods: Virtual ER is a custom-made, learning outcome?driven, case-based web app. We developed a game performance scoring system with specific mechanisms to enhance serious gaming elements. Sixty-two students were recruited from our medical and nursing programs. They played the games in teams of 4 or 5, followed by an instructor-led debriefing for concept consolidation. Teamwork attitudes, as measured by the Human Factors Attitude Survey, were compared before and after the game. Learning style was measured with a modified Honey and Mumford learning style questionnaire. Results: Students were satisfied with Virtual ER (mean satisfaction score 5.44, SD 0.95, of a possible 7). Overall, Virtual ER enhanced teamwork attitude by 3.02 points (95% CI 1.15-4.88, P=.002). Students with higher scores as activists (estimate 9.09, 95% CI 5.17-13.02, P<.001) and pragmatists (estimate 5.69, 95% CI 1.18-10.20, P=.01) had a significantly higher degree of teamwork attitude enhancement, while students with higher scores as theorists and reflectors did not demonstrate significant changes. However, there was no difference in game performance scores between students with different learning styles. Conclusions: There was considerable teamwork enhancement after playing Virtual ER for interprofessional education, in particular for students who had activist or pragmatist learning styles. Serious online games have potential in interprofessional education for the development of 21st century life skills. Our findings also suggest that Virtual ER for interprofessional education delivery could be expanded locally and globally. UR - https://games.jmir.org/2022/3/e35269 UR - http://dx.doi.org/10.2196/35269 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834309 ID - info:doi/10.2196/35269 ER - TY - JOUR AU - Kiyozumi, Tetsuro AU - Ishigami, Norio AU - Tatsushima, Daisuke AU - Araki, Yoshiyuki AU - Yoshimura, Yuya AU - Saitoh, Daizoh PY - 2022/6/29 TI - Instructor Development Workshops for Advanced Life Support Training Courses Held in a Fully Virtual Space: Observational Study JO - JMIR Serious Games SP - e38952 VL - 10 IS - 2 KW - virtual reality KW - virtual space KW - instructor development workshop KW - resuscitation training course KW - advanced life support KW - resuscitation training KW - digital training KW - virtual learning KW - digital education KW - medical education N2 - Background: Various face-to-face training opportunities have been lost due to the COVID-19 pandemic. Instructor development workshops for advanced resuscitation (ie, advanced life support) training courses are no exception. Virtual reality (VR) is an attractive strategy for remote training. However, to our knowledge, there are no reports of resuscitation instructor training programs being held in a virtual space. Objective: This study aimed to investigate the learning effects of an instructor development workshop that was conducted in a virtual space. Methods: In this observational study, we created a virtual workshop space by using NEUTRANS (Synamon Inc)?a commercial VR collaboration service. The instructor development workshop for the advanced life support training course was held in a virtual space (ie, termed the VR course) as a certified workshop by the Japanese Association of Acute Medicine. We asked 13 instructor candidates (students) who participated in the VR course to provide a workshop report (VR group). Reports from a previously held face-to-face workshop (ie, the face-to-face course and group) were likewise prepared for comparison. A total of 5 certified instructor trainers viewed and scored the reports on a 5-point Likert scale. Results: All students completed the VR course without any problems and received certificates of completion. The scores for the VR group and the face-to-face group did not differ at the level of statistical significance (median 3.8, IQR 3.8-4.0 and median 4.2, IQR 3.9-4.2, respectively; P=.41). Conclusions: We successfully conducted an instructor development workshop in a virtual space. The degree of learning in the virtual workshop was the same as that in the face-to-face workshop. UR - https://games.jmir.org/2022/2/e38952 UR - http://dx.doi.org/10.2196/38952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767318 ID - info:doi/10.2196/38952 ER - TY - JOUR AU - James, K. Hannah AU - Fawdington, A. Ross PY - 2022/6/29 TI - Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study JO - JMIR Med Educ SP - e34791 VL - 8 IS - 2 KW - simulation KW - high fidelity simulation KW - orthopedic residency KW - surgical training KW - postgraduate education KW - medical education KW - medical student KW - surgeon KW - hand KW - hand surgery KW - surgery KW - orthopedic KW - cadaver KW - cadaveric simulation KW - cadaveric KW - training KW - cadaveric training KW - DP KW - deliberate practice N2 - Background: Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact. Objective: The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training. Methods: This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study. Results: The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training. Conclusions: Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work. UR - https://mededu.jmir.org/2022/2/e34791 UR - http://dx.doi.org/10.2196/34791 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767315 ID - info:doi/10.2196/34791 ER - TY - JOUR AU - Gosselin Boucher, Vincent AU - Bacon, Simon AU - Voisard, Brigitte AU - Dragomir, I. Anda AU - Gemme, Claudia AU - Larue, Florent AU - Labbé, Sara AU - Szczepanik, Geneviève AU - Corace, Kimberly AU - Campbell, Tavis AU - Vallis, Michael AU - Garber, Gary AU - Rouleau, Codie AU - Diodati, G. Jean AU - Rabi, Doreen AU - Sultan, Serge AU - Lavoie, Kim AU - PY - 2022/6/24 TI - Assessing Physician?s Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test JO - JMIR Med Educ SP - e31489 VL - 8 IS - 2 KW - assessment KW - motivational communication KW - tool development KW - physicians KW - health promotion N2 - Background: Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. Objective: The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC?the Motivational Communication Competency Assessment Test (MC-CAT). Methods: Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. Results: The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (?=.78). Conclusions: The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases. UR - https://mededu.jmir.org/2022/2/e31489 UR - http://dx.doi.org/10.2196/31489 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749167 ID - info:doi/10.2196/31489 ER - TY - JOUR AU - Bergeron, Lysa AU - Décary, Simon AU - Djade, Djignefa Codjo AU - Daniel, J. Sam AU - Tremblay, Martin AU - Rivest, Louis-Paul AU - Légaré, France PY - 2022/6/2 TI - Factors Associated With Specialists? Intention to Adopt New Behaviors After Taking Web-Based Continuing Professional Development Courses: Cross-sectional Study JO - JMIR Med Educ SP - e34299 VL - 8 IS - 2 KW - continuing professional development KW - CPD-Reaction KW - behavioral intention KW - medical specialists KW - web-based training KW - medical education KW - education KW - physician KW - psychosocial KW - online course N2 - Background: Web-based continuing professional development (CPD) is a convenient and low-cost way for physicians to update their knowledge. However, little is known about the factors that influence their intention to put this new knowledge into practice. Objective: We aimed to identify sociocognitive factors associated with physicians? intention to adopt new behaviors as well as indications of Bloom?s learning levels following their participation in 5 web-based CPD courses. Methods: We performed a cross-sectional study of specialist physicians who had completed 1 of 5 web-based CPD courses offered by the Federation of Medical Specialists of Quebec. The participants then completed CPD-Reaction, a questionnaire based on Godin?s integrated model for health professional behavior change and with evidence of validity that measures behavioral intention (dependent variable) and psychosocial factors influencing intention (n=4). We also assessed variables related to sociodemographics (n=5), course content (n=9), and course format (eg, graphic features and duration) (n=8). Content variables were derived from CanMEDS competencies, Bloom?s learning levels, and Godin?s integrated model. We conducted ANOVA single-factor analysis, calculated the intraclass correlation coefficient (ICC), and performed bivariate and multivariate analyses. Results: A total of 400 physicians participated in the courses (range: 38-135 physicians per course). Average age was 50 (SD 12) years; 56% (n=223) were female, and 44% (n=177) were male. Among the 259 who completed CPD-Reaction, behavioral intention scores ranged from 5.37 (SD 1.17) to 6.60 (SD 0.88) out of 7 and differed significantly from one course to another (P<.001). The ICC indicated that 17% of the total variation in the outcome of interest, the behavioral intention of physicians, could be explained at the level of the CPD course (ICC=0.17). In bivariate analyses, social influences (P<.001), beliefs about capabilities (P<.001), moral norm (P<.001), beliefs about consequences (P<.001), and psychomotor learning (P=.04) were significantly correlated with physicians? intention to adopt new behaviors. Multivariate analysis showed the same factors, except for social influences and psychomotor learning, as significantly correlated with intention. Conclusions: We observed average to high behavioral intention scores after all 5 web-based courses, with some variations by course taken. Factors affecting physicians? intention were beliefs about their capabilities and about the consequences of adopting new clinical behaviors, as well as doubts about whether the new behavior aligned with their moral values. Our results will inform design of future web-based CPD courses to ensure they contribute to clinical behavior change. UR - https://mededu.jmir.org/2022/2/e34299 UR - http://dx.doi.org/10.2196/34299 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476039 ID - info:doi/10.2196/34299 ER - TY - JOUR AU - Røynesdal, Øystein AU - Magnus, H. Jeanette AU - Moen, Anne PY - 2022/5/30 TI - Pedagogical Approaches and Learning Activities, Content, and Resources Used in the Design of Massive Open Online Courses (MOOCs) in the Health Sciences: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e35878 VL - 11 IS - 5 KW - MOOC KW - scoping review KW - collaborative learning KW - PhD KW - postgraduate KW - education KW - health sciences KW - massive open online course N2 - Background: Developing online, widely accessible educational courses, such as Massive Open Online Courses (MOOCs), offer novel opportunities to advancing academic research and the educational system in resource-constrained countries. Despite much literature on the use of design-related features and principles of different pedagogical approaches when developing MOOCs, there are reports of inconsistency between the pedagogical approach and the learning activities, content, or resources in MOOCs. Objective: We present a protocol for a scoping review aiming to systematically identify and synthesize literature on the pedagogical approaches used, and the learning activities, content, and resources used to facilitate social interaction and collaboration among postgraduate learners in MOOCs across the health sciences. Methods: We will follow a 6-step procedure for scoping reviews to conduct a search of published and gray literature in the following databases: Medline via Ovid, ERIC, SCOPUS, Web of Science, and PsychINFO. Two reviewers will screen titles, abstracts, and relevant full texts independently to determine eligibility for inclusion. The team will extract data using a predefined charting form and synthesize results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Results: The scoping review is currently ongoing. As of March 2022, we have performed initial data searches and screened titles and abstracts of the studies we found but revised the search string owing to inaccurate results. We aim to start analyzing the data in June 2022 and expect to complete the scoping review by February 2023. Conclusions: With the results of this review, we hope to report on the use of pedagogical approaches and what learning activities, content, and resources foster social and collaborative learning processes, and to further elucidate how practitioners and academics can harvest our findings to bridge the gap between pedagogics and learning activities in the instructional design of MOOCs for postgraduate students in the health sciences. International Registered Report Identifier (IRRID): DERR1-10.2196/35878 UR - https://www.researchprotocols.org/2022/5/e35878 UR - http://dx.doi.org/10.2196/35878 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635750 ID - info:doi/10.2196/35878 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 - Krause-Jüttler, Grit AU - Weitz, Jürgen AU - Bork, Ulrich PY - 2022/5/4 TI - Interdisciplinary Collaborations in Digital Health Research: Mixed Methods Case Study JO - JMIR Hum Factors SP - e36579 VL - 9 IS - 2 KW - team science KW - interdisciplinary KW - research collaboration KW - digital health KW - team processes N2 - Background: Digital innovations in medicine are disruptive technologies that can change the way diagnostic procedures and treatments are delivered. Such innovations are typically designed in teams with different disciplinary backgrounds. This paper concentrates on 2 interdisciplinary research teams with 20 members from the medicine and engineering sciences working jointly on digital health solutions. Objective: The aim of this paper was to identify factors on the individual, team, and organizational levels that influence the implementation of interdisciplinary research projects elaborating on digital applications for medicine and, based on the results, to draw conclusions for the proactive design of the interdisciplinary research process to make these projects successful. Methods: To achieve this aim, 2 interdisciplinary research teams were observed, and a small case study (response rate: 15/20, 75%) was conducted using a web-based questionnaire containing both closed and open self-report questions. The Spearman rank correlation coefficient was calculated to analyze the quantitative data. The answers to the open-ended questions were subjected to qualitative content analysis. Results: With regard to the interdisciplinary research projects investigated, the influencing factors of the three levels presented (individual, team, and organization) have proven to be relevant for interdisciplinary research cooperation. Conclusions: With regard to recommendations for the future design of interdisciplinary cooperation, management aspects are addressed, that is, the installation of a coordinator, systematic definition of goals, required resources, and necessary efforts on the part of the involved interdisciplinary research partners. As only small groups were investigated, further research in this field is necessary to derive more general recommendations for interdisciplinary research teams. Trial Registration: German Clinical Trials Register, DRKS00023909, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023909?; German Clinical Trials Register, DRKS00025077, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025077 UR - https://humanfactors.jmir.org/2022/2/e36579 UR - http://dx.doi.org/10.2196/36579 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507400 ID - info:doi/10.2196/36579 ER - TY - JOUR AU - Ayivi-Vinz, Gloria AU - Bakwa Kanyinga, Felly AU - Bergeron, Lysa AU - Décary, Simon AU - Adisso, Lionel Évèhouénou AU - Zomahoun, Vignon Hervé Tchala AU - Daniel, J. Sam AU - Tremblay, Martin AU - Plourde, V. Karine AU - Guay-Bélanger, Sabrina AU - Légaré, France PY - 2022/5/2 TI - Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review JO - JMIR Med Educ SP - e36948 VL - 8 IS - 2 KW - CPD-REACTION KW - behavior KW - intention KW - education medical KW - continuing KW - health care professionals KW - questionnaire KW - web-based KW - continuing professional development N2 - Background: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory?informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory?informed tool that evaluates the impact of CPD activities on clinicians? behavioral intentions. Objective: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals? intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. Methods: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants? completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%). Conclusions: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. Trial Registration: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492 UR - https://mededu.jmir.org/2022/2/e36948 UR - http://dx.doi.org/10.2196/36948 UR - http://www.ncbi.nlm.nih.gov/pubmed/35318188 ID - info:doi/10.2196/36948 ER - TY - JOUR AU - Yan, Hui AU - Rahgozar, Arya AU - Sethuram, Claire AU - Karunananthan, Sathya AU - Archibald, Douglas AU - Bradley, Lindsay AU - Hakimjavadi, Ramtin AU - Helmer-Smith, Mary AU - Jolin-Dahel, Kheira AU - McCutcheon, Tess AU - Puncher, Jeffrey AU - Rezaiefar, Parisa AU - Shoppoff, Lina AU - Liddy, Clare PY - 2022/5/2 TI - Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e34575 VL - 11 IS - 5 KW - digital learning tools KW - medical education KW - primary care KW - digital learning KW - scoping review KW - family medicine KW - bibliometric KW - scientometric KW - natural language processing KW - e-learning KW - medical curriculum KW - medical curricula KW - medical school N2 - Background: The COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learning needs of trainees. Objective: This scoping review will aim to explore and organize the breadth of knowledge regarding digital learning tools in family medicine training. Methods: This scoping review follows the 6 stages of the methodological framework outlined first by Arksey and O?Malley, then refined by Levac et al, including a search of published academic literature in 6 databases (MEDLINE, ERIC, Education Source, Embase, Scopus, and Web of Science) and gray literature. Following title and abstract and full text screening, characteristics and main findings of the included studies and resources will be tabulated and summarized. Thematic analysis and natural language processing (NLP) will be conducted in parallel using a 9-step approach to identify common themes and synthesize the literature. Additionally, NLP will be employed for bibliometric and scientometric analysis of the identified literature. Results: The search strategy has been developed and launched. As of October 2021, we have completed stages 1, 2, and 3 of the scoping review. We identified 132 studies for inclusion through the academic literature search and 127 relevant studies in the gray literature search. Further refinement of the eligibility criteria and data extraction has been ongoing since September 2021. Conclusions: In this scoping review, we will identify and consolidate information and evidence related to the use and effectiveness of existing digital learning tools in postgraduate family medicine training. Our findings will improve the understanding of the current landscape of digital learning tools, which will be of great value to educators and trainees interested in using existing tools, innovators looking to design digital learning tools that meet current needs, and researchers involved in the study of digital tools. Trial Registration: OSF Registries osf.io/wju4k; https://osf.io/wju4k International Registered Report Identifier (IRRID): DERR1-10.2196/34575 UR - https://www.researchprotocols.org/2022/5/e34575 UR - http://dx.doi.org/10.2196/34575 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499861 ID - info:doi/10.2196/34575 ER - TY - JOUR AU - Beverly, Elizabeth AU - Rigot, Brooke AU - Love, Carrie AU - Love, Matt PY - 2022/4/29 TI - Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals JO - JMIR Med Educ SP - e32657 VL - 8 IS - 2 KW - virtual reality KW - qualitative KW - medical education KW - health care KW - digital learning KW - learning platform KW - health care providers N2 - Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals? experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67%, women; n=22, 92%, White; and n=4, 17%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character?s frustrations and disappointments; perceived ease of use of cine-VR: 96% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. UR - https://mededu.jmir.org/2022/2/e32657 UR - http://dx.doi.org/10.2196/32657 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486427 ID - info:doi/10.2196/32657 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 - Ewais, Tatjana AU - Hunt, Georgia AU - Munro, Jonathan AU - Pun, Paul AU - Hogan, Christy AU - William, Leeroy AU - Teodorczuk, Andrew PY - 2022/4/27 TI - Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial JO - JMIR Res Protoc SP - e35083 VL - 11 IS - 4 KW - Schwartz Rounds KW - compassionate care KW - health care staff well-being N2 - Background: Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective: Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods: This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory?Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results: The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions: The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/35083 UR - https://www.researchprotocols.org/2022/4/e35083 UR - http://dx.doi.org/10.2196/35083 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475785 ID - info:doi/10.2196/35083 ER - TY - JOUR AU - Cercel, Ovidiu Mihai PY - 2022/4/25 TI - Gamification in Diplomacy Studies as an Effective Tool for Knowledge Transfer: Questionnaire Study JO - JMIR Serious Games SP - e32996 VL - 10 IS - 2 KW - modern diplomacy KW - international relations KW - innovations in learning experience KW - gamification KW - serious games KW - role play design KW - knowledge transfer KW - competency development N2 - Background: Graduate education in modern diplomacy poses several challenges, as it requires several competencies to be developed before diplomatic service is joined. Incorporation of simulation games can have a positive impact on the design of international relations and diplomacy learning process. We have designed a novel role play game (MAEDRI) to simulate part of the activities of a typical Ministry of Foreign Affairs. Objective: This study aims to evaluate the effectiveness of MAEDRI in transferring knowledge in international relations education programs at the National University of Political Studies and Public Administration, Bucharest, Romania, across a 4-year period. Methods: The game enrolled master?s level graduate students. The data were collected through a voluntary and anonymous questionnaire between 2017 and 2020. At the end of each of the 4 editions we organized debriefing sessions that gave students the opportunity to provide feedback on their experience with this exercise, level of collaboration within the team, lessons learned, and to make suggestions for improvements. Using an online questionnaire, we measured the participants? perception regarding the level of effectiveness in increasing knowledge transfer, motivation, and engagement. Questionnaire data were consolidated in percentages for each item. Results: A total of 49 participants completed the study. A total of 24 skills (13 professional and 11 social skills) were assessed. We identified a strong positive correlation between stress management and conflict management (r=.86; P<.001) as well as significantly positive correlations between building relations within the team and the ability to dialog and be persuasive (r=.7; P<.001), between procedure compliance and planning and organizing the work (r=.69; P<.001), and between analysis capacity and decision based on data received (r=.68; P<.001). Among social skills, self-control, confidence, and flexibility were the most substantially improved. Conclusions: We describe several benefits of a novel game, used as an education tool to enhance a series of competencies necessary in international relations studies. Our results demonstrate a significant level of student engagement and motivation while playing MAEDRI, improvement of several essential skills, and enhanced knowledge transfer to real-life situations. While the data are encouraging, further research is needed to evaluate the full impact of role play as an effective experiential learning method. UR - https://games.jmir.org/2022/2/e32996 UR - http://dx.doi.org/10.2196/32996 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468081 ID - info:doi/10.2196/32996 ER - TY - JOUR AU - Jalali, Alireza AU - Nyman, A. Jacline AU - Hamelin-Mitchell, Elaine PY - 2022/4/5 TI - Fundraising in Education: Road Map to Involving Medical Educators in Fundraising JO - JMIR Med Educ SP - e32597 VL - 8 IS - 2 KW - fundraising KW - philanthropy KW - crowdfunding KW - funding KW - charity KW - higher education KW - university KW - business model KW - revenue streams KW - medical education KW - educators KW - academia KW - academic environments UR - https://mededu.jmir.org/2022/2/e32597 UR - http://dx.doi.org/10.2196/32597 UR - http://www.ncbi.nlm.nih.gov/pubmed/35380542 ID - info:doi/10.2196/32597 ER - TY - JOUR AU - Stenseth, Vistven Hege AU - Steindal, Alexander Simen AU - Solberg, Trygg Marianne AU - Ølnes, Alexandra Mia AU - Mohallem, Andrea AU - Sørensen, Lene Anne AU - Strandell-Laine, Camilla AU - Olaussen, Camilla AU - Aure, Farsjø Caroline AU - Riegel, Fernando AU - Pedersen, Ingunn AU - Zlamal, Jaroslav AU - Martini, Gue Jussara AU - Bresolin, Paula AU - Linnerud, Wang Silje Christin AU - Nes, Gonçalves Andréa Aparecida PY - 2022/4/4 TI - Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e36725 VL - 11 IS - 4 KW - simulation-based learning KW - technological supported simulation-based learning KW - critical thinking KW - nursing students KW - nursing education, educational approach KW - education KW - nursing N2 - Background: Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students. Objective: The proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students. Methods: The proposed scoping review will use the framework established by Arksey and O?Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized. Results: The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023. Conclusions: The results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students? reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students? firsthand experiences and further development of successful teaching strategies in nursing education. International Registered Report Identifier (IRRID): DERR1-10.2196/36725 UR - https://www.researchprotocols.org/2022/4/e36725 UR - http://dx.doi.org/10.2196/36725 UR - http://www.ncbi.nlm.nih.gov/pubmed/35373777 ID - info:doi/10.2196/36725 ER - TY - JOUR AU - Nozari, Ala AU - Mukerji, Shivali AU - Lok, Ling-Ling AU - Gu, Qingrou AU - Buhl, Lauren AU - Jain, Sanjay AU - Ortega, Rafael PY - 2022/3/31 TI - Perception of Web-Based Didactic Activities During the COVID-19 Pandemic Among Anesthesia Residents: Pilot Questionnaire Study JO - JMIR Med Educ SP - e31080 VL - 8 IS - 1 KW - resident education KW - COVID-19 KW - barriers to education KW - didactic KW - medical education KW - online education KW - web-based education KW - virtual training KW - anesthesiology residents KW - medical residents KW - pandemic KW - virtual didactics N2 - Background: Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. Objective: In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineate the perceived barriers to the successful implementation of web-based medical education. Methods: A 19-item survey was compiled and distributed electronically using Qualtrics. This anonymous survey included information on the training level of each resident, their participation in formal didactics before and during the pandemic, and their perception of the ease and limitations of virtual didactics. The resident?s opinions on specific educational resources were assessed, and the effectiveness of new delivery methods on resident engagement and learning was examined. Results: Thirty anesthesiology residents were surveyed, 19 of whom agreed to participate in the pilot study. One participant with incomplete responses was excluded, yielding a final cohort of 18 respondents. Most residents (56%, 10/18) reported that the COVID-19 pandemic negatively affected their residency training. The time spent on didactic training and independent studies was, nevertheless, not affected by the pandemic for 90% (16/18) of respondents. Nonetheless, 72% (13/18) of residents were less engaged during virtual lectures in comparison to in-person didactics. Important limitations included distraction from the physical environment (67%, 12/18), internet instability (67%, 12/18), less obligation to participate (44%, 8/18), technical difficulty and unmuted microphones (33%, 6/18, each), and people speaking over each other (28%, 5/18). Despite these limitations, most residents stated that they would like to keep a combination of virtual didactics including live Zoom lectures (56%, 10/18), prerecorded web didactics (56%, 10/18), and virtual ground rounds via Zoom (50%, 9/18) as the ?new normal.? Conclusions: Despite important limitations listed in this report, anesthesia residents would like to keep a combination of virtual lectures and presentations as the new normal after the COVID-19 pandemic. UR - https://mededu.jmir.org/2022/1/e31080 UR - http://dx.doi.org/10.2196/31080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275840 ID - info:doi/10.2196/31080 ER - TY - JOUR AU - Sukhera, Javeed AU - Ahmed, Hasan PY - 2022/3/30 TI - Leveraging Machine Learning to Understand How Emotions Influence Equity Related Education: Quasi-Experimental Study JO - JMIR Med Educ SP - e33934 VL - 8 IS - 1 KW - bias KW - equity KW - sentiment analysis KW - medical education KW - emotion KW - education N2 - Background: Teaching and learning about topics such as bias are challenging due to the emotional nature of bias-related discourse. However, emotions can be challenging to study in health professions education for numerous reasons. With the emergence of machine learning and natural language processing, sentiment analysis (SA) has the potential to bridge the gap. Objective: To improve our understanding of the role of emotions in bias-related discourse, we developed and conducted a SA of bias-related discourse among health professionals. Methods: We conducted a 2-stage quasi-experimental study. First, we developed a SA (algorithm) within an existing archive of interviews with health professionals about bias. SA refers to a mechanism of analysis that evaluates the sentiment of textual data by assigning scores to textual components and calculating and assigning a sentiment value to the text. Next, we applied our SA algorithm to an archive of social media discourse on Twitter that contained equity-related hashtags to compare sentiment among health professionals and the general population. Results: When tested on the initial archive, our SA algorithm was highly accurate compared to human scoring of sentiment. An analysis of bias-related social media discourse demonstrated that health professional tweets (n=555) were less neutral than the general population (n=6680) when discussing social issues on professionally associated accounts (?2 [2, n=555)]=35.455; P<.001), suggesting that health professionals attach more sentiment to their posts on Twitter than seen in the general population. Conclusions: The finding that health professionals are more likely to show and convey emotions regarding equity-related issues on social media has implications for teaching and learning about sensitive topics related to health professions education. Such emotions must therefore be considered in the design, delivery, and evaluation of equity and bias-related education. UR - https://mededu.jmir.org/2022/1/e33934 UR - http://dx.doi.org/10.2196/33934 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353048 ID - info:doi/10.2196/33934 ER - TY - JOUR AU - Ricci, Serena AU - Calandrino, Andrea AU - Borgonovo, Giacomo AU - Chirico, Marco AU - Casadio, Maura PY - 2022/3/23 TI - Viewpoint: Virtual and Augmented Reality in Basic and Advanced Life Support Training JO - JMIR Serious Games SP - e28595 VL - 10 IS - 1 KW - basic and advanced life support KW - first aid KW - cardiopulmonary resuscitation KW - emergency KW - training KW - simulation training KW - medical simulation KW - healthcare simulation KW - virtual reality KW - augmented reality UR - https://games.jmir.org/2022/1/e28595 UR - http://dx.doi.org/10.2196/28595 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319477 ID - info:doi/10.2196/28595 ER - TY - JOUR AU - Tudor Car, Lorainne AU - Poon, Selina AU - Kyaw, Myint Bhone AU - Cook, A. David AU - Ward, Victoria AU - Atun, Rifat AU - Majeed, Azeem AU - Johnston, Jamie AU - van der Kleij, J. Rianne M. J. AU - Molokhia, Mariam AU - V Wangenheim, Florian AU - Lupton, Martin AU - Chavannes, Niels AU - Ajuebor, Onyema AU - Prober, G. Charles AU - Car, Josip PY - 2022/3/17 TI - Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda JO - J Med Internet Res SP - e31977 VL - 24 IS - 3 KW - digital education KW - health professions education KW - evidence map KW - systematic review KW - research questions KW - conceptual framework KW - mobile phone N2 - Background: Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. Objective: This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. Methods: We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. Results: We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants? skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). Conclusions: We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed. UR - https://www.jmir.org/2022/3/e31977 UR - http://dx.doi.org/10.2196/31977 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297767 ID - info:doi/10.2196/31977 ER - TY - JOUR AU - Ozkara, Berksu Burak AU - Karabacak, Mert AU - Alpaydin, Demet Duygu PY - 2022/3/7 TI - Student-Run Online Journal Club Initiative During a Time of Crisis: Survey Study JO - JMIR Med Educ SP - e33612 VL - 8 IS - 1 KW - online journal club KW - medical student KW - distance learning KW - COVID-19 KW - undergraduate education KW - student journal club KW - online education KW - establishment KW - initiative KW - literature KW - research KW - publishing KW - education N2 - Background: Since the closure of university campuses due to COVID-19 in spring 2020 necessitated a quick transition to online courses, medical students were isolated from hospitals and universities, negatively impacting their education. During this time, medical students had no opportunity to participate in academic discussions and were also socially isolated. Furthermore, medical doctors and professors of medical schools were given additional responsibilities during the pandemic because they were the frontliners in the fight against COVID-19. As a result, they did not have enough time to contribute effectively to medical student education. Objective: This paper describes the establishment of the Cerrahpasa Neuroscience Society Journal Clubs, a group of entirely student-run online journal clubs at Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa. Methods: The website, mass emailing, and social media accounts were used to announce the online journal clubs. Only medical students were eligible to apply. Journal clubs included psychiatry, neuroradiology, neurosurgery, neurology, and neuroscience. Following the last journal club meeting, a questionnaire created by the society?s board was distributed to the participants. SPSS Statistics (version 26) was used for statistical analysis. Results: Since March 15, 2021, synchronous online journal club meetings have been held every 2 weeks on a weekday using Google Meet, Microsoft Teams, or Zoom. Meetings of each journal club lasted approximately 1 hour on average. Interstudent interaction across multiple institutions was achieved since a total of 45 students from 11 different universities attended the meetings on a regular basis. Students on the society?s board served as academic mentors for the clubs. The clubs received excellent feedback from participants, with an overall contentment score of 4.32 out of 5. Conclusions: By establishing these clubs, we have created a venue for academic discussions, which helps to reduce the negative impact of the pandemic on education. In addition, we believe it greatly aided students in staying in touch with their peers, thereby reducing the sense of isolation. We realize that traditional journal clubs are run by faculty; however, we believe that this experience demonstrated that medical students could run a journal club on their own since the feedback from participants was excellent. Additionally, as a medical student, being a journal club academic mentor is a challenging responsibility; however, having this responsibility significantly improved our academic mentors? leadership abilities. UR - https://mededu.jmir.org/2022/1/e33612 UR - http://dx.doi.org/10.2196/33612 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148270 ID - info:doi/10.2196/33612 ER - TY - JOUR AU - Kernan, D. William AU - Basch, H. Corey PY - 2022/3/4 TI - Adaptation of an In-Person Internship to a Virtual Format for Public Health Undergraduates JO - JMIR Public Health Surveill SP - e35252 VL - 8 IS - 3 KW - internship KW - remote learning KW - high-impact practice KW - COVID-19 KW - public health education KW - learning outcomes KW - virtual learning KW - virtual internship KW - public health KW - health education KW - undergraduate education KW - virtual education UR - https://publichealth.jmir.org/2022/3/e35252 UR - http://dx.doi.org/10.2196/35252 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089869 ID - info:doi/10.2196/35252 ER - TY - JOUR AU - Jarratt, LynnMarie AU - Situ, Jenny AU - King, D. Rachel AU - Montanez Ramos, Estefania AU - Groves, Hannah AU - Ormesher, Ryen AU - Cossé, Melissa AU - Raboff, Alyse AU - Mahajan, Avanika AU - Thompson, Jennifer AU - Ko, F. Randy AU - Paltrow-Krulwich, Samantha AU - Price, Allison AU - Hurwitz, May-Ling Ariel AU - CampBell, Timothy AU - Epler, T. Lauren AU - Nguyen, Fiona AU - Wolinsky, Emma AU - Edwards-Fligner, Morgan AU - Lobo, Jolene AU - Rivera, Danielle AU - Langsjoen, Jens AU - Sloane, Lori AU - Hendrix, Ingrid AU - Munde, O. Elly AU - Onyango, O. Clinton AU - Olewe, K. Perez AU - Anyona, B. Samuel AU - Yingling, V. Alexandra AU - Lauve, R. Nicolas AU - Kumar, Praveen AU - Stoicu, Shawn AU - Nestsiarovich, Anastasiya AU - Bologa, G. Cristian AU - Oprea, I. Tudor AU - Tollestrup, Kristine AU - Myers, B. Orrin AU - Anixter, Mari AU - Perkins, J. Douglas AU - Lambert, Gerard Christophe PY - 2022/2/23 TI - A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study JO - JMIR Med Educ SP - e23845 VL - 8 IS - 1 KW - COVID-19 KW - pandemic KW - daily report KW - policy KW - epidemics KW - global health KW - SARS-CoV-2 KW - New Mexico KW - medical education N2 - Background: On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico?s pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the ?UNM Global Health COVID-19 Intelligence Briefing.? Objective: In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. Methods: Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. Results: An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. Conclusions: The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty. UR - https://mededu.jmir.org/2022/1/e23845 UR - http://dx.doi.org/10.2196/23845 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142625 ID - info:doi/10.2196/23845 ER - TY - JOUR AU - Gasteiger, Norina AU - van der Veer, N. Sabine AU - Wilson, Paul AU - Dowding, Dawn PY - 2022/2/14 TI - How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis JO - JMIR Serious Games SP - e31644 VL - 10 IS - 1 KW - realist synthesis KW - realist review KW - review KW - virtual reality KW - augmented reality KW - simulation KW - training KW - health KW - health personnel KW - education KW - mobile phone N2 - Background: Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective: The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods: We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results: Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions: Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations. UR - https://games.jmir.org/2022/1/e31644 UR - http://dx.doi.org/10.2196/31644 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156931 ID - info:doi/10.2196/31644 ER - TY - JOUR AU - Samarasekara, Keshinie PY - 2022/2/10 TI - e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates JO - JMIR Med Educ SP - e22096 VL - 8 IS - 1 KW - medical education KW - e-learning KW - Sri Lanka KW - medical students N2 - Background: Medical education has undergone drastic changes with the advent of novel technologies that enable e-learning. Medical students are increasingly using e-learning methods, and universities have incorporated them into their curricula. Objective: This study aimed at delineating the pattern of use of e-learning methods among medical undergraduates and new graduates of the Faculty of Medicine, University of Colombo, and identifying the challenges faced by these students in using e-learning methods. Methods: A cross-sectional descriptive study was conducted in the Faculty of Medicine, University of Colombo, in April 2020, with the participation of current undergraduates and pre-intern medical graduates, using a self-administered questionnaire that collected data on sociodemographic details, pattern of use of learning methods, and challenges faced using e-learning methods. Results: There were 778 respondents, with a response rate of 65.1% (778/1195). All the study participants used e-learning resources with varying frequencies, and all of them had at least 1 smart device with access to the internet. Electronic versions of standard textbooks (e-books), nonmedical websites, online lectures, medical websites, and medical phone apps were used by the majority. When comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. The preference was influenced by the year of study and family income. The 3 most commonly used modalities for learning new study material and revising previously learned content were notes on paper material, textbooks (paper version), and e-books. The majority (98.7% [n=768]) of participants have encountered problems using e-learning resources. The most commonly faced problems were unavailability of free-of-charge access to some e-learning methods, expenses related to internet connection, poor connectivity of mobile internet, distractions while using online resources, and lack of storage space on electronic devices. Conclusions: There is a high uptake of e-learning methods among Sri Lankan medical students. However, when comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. A majority of the students have encountered problems when using e-learning methods, and most of these problems were related to poor economic status. Universities should take these factors into consideration when developing curricula in medical education. UR - https://mededu.jmir.org/2022/1/e22096 UR - http://dx.doi.org/10.2196/22096 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142626 ID - info:doi/10.2196/22096 ER - TY - JOUR AU - Yeung, Kan Andy Wai AU - Parvanov, D. Emil AU - Hribersek, Mojca AU - Eibensteiner, Fabian AU - Klager, Elisabeth AU - Kletecka-Pulker, Maria AU - Rössler, Bernhard AU - Schebesta, Karl AU - Willschke, Harald AU - Atanasov, G. Atanas AU - Schaden, Eva PY - 2022/2/9 TI - Digital Teaching in Medical Education: Scientific Literature Landscape Review JO - JMIR Med Educ SP - e32747 VL - 8 IS - 1 KW - medical education KW - digital teaching KW - virtual reality KW - augmented reality KW - anatomy KW - basic life support KW - satisfaction KW - bibliometric KW - medicine KW - life support KW - online learning KW - literature KW - trend KW - citation N2 - Background: Digital teaching in medical education has grown in popularity in the recent years. However, to the best of our knowledge, no bibliometric report to date has been published that analyzes this important literature set to reveal prevailing topics and trends and their impacts reflected in citation counts. Objective: We used a bibliometric approach to unveil and evaluate the scientific literature on digital teaching research in medical education, demonstrating recurring research topics, productive authors, research organizations, countries, and journals. We further aimed to discuss some of the topics and findings reported by specific highly cited works. Methods: The Web of Science electronic database was searched to identify relevant papers on digital teaching research in medical education. Basic bibliographic data were obtained by the ?Analyze? and ?Create Citation Report? functions of the database. Complete bibliographic data were exported to VOSviewer for further analyses. Visualization maps were generated to display the recurring author keywords and terms mentioned in the titles and abstracts of the publications. Results: The analysis was based on data from 3978 papers that were identified. The literature received worldwide contributions with the most productive countries being the United States and United Kingdom. Reviews were significantly more cited, but the citations between open access vs non?open access papers did not significantly differ. Some themes were cited more often, reflected by terms such as virtual reality, innovation, trial, effectiveness, and anatomy. Different aspects in medical education were experimented for digital teaching, such as gross anatomy education, histology, complementary medicine, medicinal chemistry, and basic life support. Some studies have shown that digital teaching could increase learning satisfaction, knowledge gain, and even cost-effectiveness. More studies were conducted on trainees than on undergraduate students. Conclusions: Digital teaching in medical education is expected to flourish in the future, especially during this era of COVID-19 pandemic. UR - https://mededu.jmir.org/2022/1/e32747 UR - http://dx.doi.org/10.2196/32747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138260 ID - info:doi/10.2196/32747 ER - TY - JOUR AU - Jiang, Haowen AU - Vimalesvaran, Sunitha AU - Wang, King Jeremy AU - Lim, Boon Kee AU - Mogali, Reddy Sreenivasulu AU - Car, Tudor Lorainne PY - 2022/2/2 TI - Virtual Reality in Medical Students? Education: Scoping Review JO - JMIR Med Educ SP - e34860 VL - 8 IS - 1 KW - virtual reality KW - medical education KW - medical students KW - virtual worlds KW - digital health education N2 - Background: Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. Objective: The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. Methods: We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. Conclusions: Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046986 UR - https://mededu.jmir.org/2022/1/e34860 UR - http://dx.doi.org/10.2196/34860 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107421 ID - info:doi/10.2196/34860 ER - TY - JOUR AU - Jung, Dukyoo AU - De Gagne, C. Jennie AU - Choi, Eunju AU - Lee, Kyuri PY - 2022/1/24 TI - An Online International Collaborative Learning Program During the COVID-19 Pandemic for Nursing Students: Mixed Methods Study JO - JMIR Med Educ SP - e34171 VL - 8 IS - 1 KW - COVID-19 KW - distance education KW - global competencies KW - nursing students KW - program evaluation KW - synchronous virtual classroom KW - video conferencing N2 - Background: Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments. Objective: We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students? international and global competencies in South Korea. Methods: We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants? global leadership competencies, and the focus group interviews were used to evaluate the program?s effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods. Results: Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative. Conclusions: The online international collaborative learning program had a positive impact on the development of students? international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era. UR - https://mededu.jmir.org/2022/1/e34171 UR - http://dx.doi.org/10.2196/34171 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982035 ID - info:doi/10.2196/34171 ER - TY - JOUR AU - Herrera, Tara AU - Fiori, P. Kevin AU - Archer-Dyer, Heather AU - Lounsbury, W. David AU - Wylie-Rosett, Judith PY - 2022/1/17 TI - Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study JO - JMIR Med Educ SP - e32818 VL - 8 IS - 1 KW - social determinants of health KW - service-based learning KW - telehealth KW - preclinical education KW - screening KW - referral KW - community health workers KW - determinant KW - medical student KW - case study KW - service KW - preparation KW - pilot KW - feasibility KW - training KW - assessment KW - needs KW - electronic health record KW - questionnaire N2 - Background: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. Objective: This pilot project?s objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020). Methods: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers? notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum. Results: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need. Conclusions: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures. UR - https://mededu.jmir.org/2022/1/e32818 UR - http://dx.doi.org/10.2196/32818 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037885 ID - info:doi/10.2196/32818 ER - TY - JOUR AU - Dederichs, Melina AU - Nitsch, Jan Felix AU - Apolinário-Hagen, Jennifer PY - 2022/1/10 TI - Piloting an Innovative Concept of e?Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study JO - JMIR Med Educ SP - e32017 VL - 8 IS - 1 KW - participatory design KW - co-design KW - mHealth KW - medical student KW - eHealth KW - medical education KW - mental health KW - mobile phone N2 - Background: Medical students show low levels of e?mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students? well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students? preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. Objective: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students? preferences and ideas for mHealth apps through the design of a hypothetical prototype. Methods: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e?mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students? permission. Results: The participants? feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. Conclusions: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education. UR - https://mededu.jmir.org/2022/1/e32017 UR - http://dx.doi.org/10.2196/32017 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006085 ID - info:doi/10.2196/32017 ER - TY - JOUR AU - Cabrera, Daniel AU - Nickson, P. Christopher AU - Roland, Damian AU - Hall, Elissa AU - Ankel, Felix PY - 2022/1/4 TI - Distributed Autonomous Organization of Learning: Future Structure for Health Professions Education Institutions JO - JMIR Med Educ SP - e28770 VL - 8 IS - 1 KW - blockchain KW - multidisciplinary KW - credentialing KW - medical education KW - health professionals KW - education KW - decentralization KW - training KW - curriculum KW - instruction UR - https://mededu.jmir.org/2022/1/e28770 UR - http://dx.doi.org/10.2196/28770 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982722 ID - info:doi/10.2196/28770 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 - Bouamra, Benjamin AU - Chakroun, Karim AU - Medeiros De Bustos, Elisabeth AU - Dobson, Jennifer AU - Rouge, Jeanne-Antide AU - Moulin, Thierry PY - 2021/12/22 TI - Simulation-Based Teaching of Telemedicine for Future Users of Teleconsultation and Tele-Expertise: Feasibility Study JO - JMIR Med Educ SP - e30440 VL - 7 IS - 4 KW - telemedicine KW - teleconsultation KW - simulation training KW - health care KW - training KW - education KW - digital training KW - medical education N2 - Background: Health care professionals worldwide are increasingly using telemedicine in their daily clinical practice. However, there is still a lack of dedicated education and training even though it is needed to improve the quality of the diverse range of telemedicine activities. Simulation-based training may be a useful tool in telemedicine education and training delivery. Objective: This study aims to assess the feasibility and acceptability of simulation-based telemedicine training. Methods: We assessed five telemedicine training sessions conducted in a simulation laboratory. The training was focused on video teleconsultations between a patient and a health care professional. The assessment included the participants? satisfaction and attitudes toward the training. Results: We included 29 participants in total. Participant satisfaction was high (mean score 4.9 of 5), and those that took part stated the high applicability of the simulation-based training to their telemedicine practices (mean score 4.6 of 5). They also stated that they intended to use telemedicine in the future (mean score 4.5 of 5). Conclusions: Simulation-based training of telemedicine dedicated to video teleconsultation was feasible and showed high satisfaction from participants. However, it remains difficult to scale for a high number of health care professionals. UR - https://mededu.jmir.org/2021/4/e30440 UR - http://dx.doi.org/10.2196/30440 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941553 ID - info:doi/10.2196/30440 ER - TY - JOUR AU - Chao, Yi-Ping AU - Chuang, Hai-Hua AU - Hsin, Li-Jen AU - Kang, Chung-Jan AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu AU - Huang, Chung-Guei AU - Kuo, J. Terry B. AU - Yang, H. Cheryl C. AU - Shyu, Hsin-Yih AU - Wang, Shu-Ling AU - Shyu, Liang-Yu AU - Lee, Li-Ang PY - 2021/11/22 TI - Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e13124 VL - 9 IS - 4 KW - cognitive load KW - heart rate variability KW - video learning KW - learning outcome KW - secondary-task reaction time KW - virtual reality N2 - Background: Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective: The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods: This pilot system?design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. Results: All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ?3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ?3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ?3.6 seconds was not related to a Milestone level of ?3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ?1.43 seemed to be inversely associated with a hedonic stimulation score of ?2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. Conclusions: Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners? needs and prompted learning through the different video modules. Trial Registration: ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 UR - https://games.jmir.org/2021/4/e13124 UR - http://dx.doi.org/10.2196/13124 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813485 ID - info:doi/10.2196/13124 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 - Koenig, Leni Julia Felicitas AU - Buentzel, Judith AU - Jung, Wolfram AU - Truemper, Lorenz AU - Wurm-Kuczera, Isabel Rebecca PY - 2021/11/15 TI - Using Instagram to Enhance a Hematology and Oncology Teaching Module During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Med Educ SP - e30607 VL - 7 IS - 4 KW - COVID-19 KW - medical education KW - distance learning KW - undergraduate medical education KW - digital medical education KW - Instagram KW - hematology and medical oncology N2 - Background: The COVID-19 pandemic necessitated the rapid expansion of novel tools for digital medical education. At our university medical center, an Instagram account was developed as a tool for medical education and used for the first time as a supplement to the hematology and medical oncology teaching module of 2020/2021. Objective: We aimed to evaluate the acceptance and role of Instagram as a novel teaching format in the education of medical students in hematology and medical oncology in the German medical curriculum. Methods: To investigate the role of Instagram in student education of hematology and medical oncology, an Instagram account was developed as a tie-in for the teaching module of 2020/21. The account was launched at the beginning of the teaching module, and 43 posts were added over the 47 days of the teaching module (at least 1 post per day). Five categories for the post content were established: (1) engagement, (2) self-awareness, (3) everyday clinical life combined with teaching aids, (4) teaching aids, and (5) scientific resources. Student interaction with the posts was measured based on overall subscription, ?likes,? comments, and polls. Approval to conduct this retrospective study was obtained from the local ethics commission of the University Medical Center Goettingen. Results: Of 164 medical students, 119 (72.6%) subscribed to the Instagram account, showing high acceptance and interest in the use of Instagram for medical education. The 43 posts generated 325 interactions. The highest number of interactions was observed for the category of engagement (mean 15.17 interactions, SD 5.01), followed by self-awareness (mean 14 interactions, SD 7.79). With an average of 7.3 likes per post, overall interaction was relatively low. However, although the category of scientific resources garnered the fewest likes (mean 1.86, SD 1.81), 66% (27/41) of the student participants who answered the related Instagram poll question were interested in studies and reviews, suggesting that although likes aid the estimation of a general trend of interest, there are facets to interest that cannot be represented by likes. Interaction significantly differed between posting categories (P<.001, Welch analysis of variance). Comparing the first category (engagement) with categories 3 to 5 showed a significant difference (Student t test with the Welch correction; category 1 vs 3, P=.01; category 1 vs 4, P=.01; category 1 vs 5, P=.001). Conclusions: Instagram showed high acceptance among medical students participating in the hematology and oncology teaching curriculum. Students were most interested in posts on routine clinical life, self-care topics, and memory aids. More studies need to be conducted to comprehend the use of Instagram in medical education and to define the role Instagram will play in the future. Furthermore, evaluation guidelines and tools need to be developed. UR - https://mededu.jmir.org/2021/4/e30607 UR - http://dx.doi.org/10.2196/30607 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779777 ID - info:doi/10.2196/30607 ER - TY - JOUR AU - Karabacak, Mert AU - Ozkara, Berksu Burak AU - Ozcan, Zeynep PY - 2021/11/12 TI - Adjusting to the Reign of Webinars: Viewpoint JO - JMIR Med Educ SP - e33861 VL - 7 IS - 4 KW - virtual conference KW - student-based organization KW - neuroscience conference KW - COVID-19 KW - medical education KW - webinars KW - web-based education N2 - Background: With the integration of COVID-19 into our lives, the way events are organized has changed. The Cerrahpa?a Neuroscience Days held on May 8-9, 2021, was one of the conferences that was affected. The annual conference of the student-based Cerrahpa?a Neuroscience Society transitioned to the internet for the first time and had the premise of going international. Objective: With this study, we aim to both discuss how a virtual conference is organized and perceived, and where our conference stands within the literature as a completely student-organized event. Methods: The conference was planned in accordance with virtual standards and promoted to primarily medical schools. During the execution, there were no major issues. The feedback was collected via a form developed with Google Forms. Results: Out of 2195 registrations, 299 qualified to receive a certificate. The feedback forms revealed a general satisfaction; the overall quality of the event was rated an average of 4.6 out of 5, and the ratings of various Likert scale?based questions were statistically analyzed. Open-ended questions provided improvement suggestions for future events. Conclusions: The virtual Cerrahpa?a Neuroscience Days was a success in organization and received positive feedback from the participants. We aim to ground future events on this experience. UR - https://mededu.jmir.org/2021/4/e33861 UR - http://dx.doi.org/10.2196/33861 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766916 ID - info:doi/10.2196/33861 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 - Price, Amy AU - Damaraju, Aishini AU - Kushalnagar, Poorna AU - Brunoe, Summer AU - Srivastava, Ujwal AU - Debidda, Marcella AU - Chu, Larry PY - 2021/11/3 TI - Coproduction, Coeducation, and Patient Involvement: Everyone Included Framework for Medical Education Across Age Groups and Cultures JO - JMIR Med Educ SP - e31846 VL - 7 IS - 4 KW - medical education KW - coproduction KW - public and patient involvement KW - education KW - patient KW - involvement KW - age KW - demographic KW - model KW - framework KW - culture KW - exploratory KW - engagement UR - https://mededu.jmir.org/2021/4/e31846 UR - http://dx.doi.org/10.2196/31846 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730539 ID - info:doi/10.2196/31846 ER - TY - JOUR AU - Jordan, Louanne Chloe AU - Sathaananthan, Thillainathan AU - Celi, Anthony Leo AU - Jones, Linda AU - Alagha, Abdulhadi M. PY - 2021/10/18 TI - The Use of a Formative Pedagogy Lens to Enhance and Maintain Virtual Supervisory Relationships: Appreciative Inquiry and Critical Review JO - JMIR Med Educ SP - e26251 VL - 7 IS - 4 KW - medical education KW - virtual learning KW - formative pedagogy KW - supervisory relationships KW - pedagogy KW - mentors KW - education KW - virtual education KW - teaching KW - online platforms KW - web-based N2 - Background: Virtual supervisory relationships provide an infrastructure for flexible learning, global accessibility, and outreach, connecting individuals worldwide. The surge in web-based educational activities in recent years provides an opportunity to understand the attributes of an effective supervisor-student or mentor-student relationship. Objective: The aim of this study is to compare the published literature (through a critical review) with our collective experiences (using small-scale appreciative inquiry [AI]) in an effort to structure and identify the dilemmas and opportunities for virtual supervisory and mentoring relationships, both in terms of stakeholder attributes and skills as well as providing instructional recommendations to enhance virtual learning. Methods: A critical review of the literature was conducted followed by an AI of reflections by the authors. The AI questions were derived from the 4D AI framework. Results: Despite the multitude of differences between face-to-face and web-based supervision and mentoring, four key dilemmas seem to influence the experiences of stakeholders involved in virtual learning: informal discourses and approachability of mentors; effective virtual communication strategies; authenticity, trust, and work ethics; and sense of self and cultural considerations. Conclusions: Virtual mentorship or supervision can be as equally rewarding as an in-person relationship. However, its successful implementation requires active acknowledgment of learners? needs and careful consideration to develop effective and mutually beneficial student-educator relationships. UR - https://mededu.jmir.org/2021/4/e26251 UR - http://dx.doi.org/10.2196/26251 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661542 ID - info:doi/10.2196/26251 ER - TY - JOUR AU - Toto, L. Regina AU - Vorel, S. Ethan AU - Tay, E. Khoon-Yen AU - Good, L. Grace AU - Berdinka, M. Jesse AU - Peled, Adam AU - Leary, Marion AU - Chang, P. Todd AU - Weiss, K. Anna AU - Balamuth, B. Frances PY - 2021/10/6 TI - Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial JO - JMIR Med Educ SP - e29899 VL - 7 IS - 4 KW - augmented reality KW - simulation KW - septic shock KW - children KW - pediatrics KW - simulation-based education KW - application KW - fluid administration N2 - Background: Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. Objective: In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. Methods: We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants? time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. Results: We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient?s perfusion. Conclusions: We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants? awareness of abnormal perfusion. UR - https://mededu.jmir.org/2021/4/e29899 UR - http://dx.doi.org/10.2196/29899 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612836 ID - info:doi/10.2196/29899 ER - TY - JOUR AU - Bragin, Ilya AU - Cohen, T. Dylan PY - 2021/10/6 TI - Certified Examination Assistants in the Age of Telemedicine: A Blueprint Through Neurology JO - JMIR Med Educ SP - e28335 VL - 7 IS - 4 KW - telemedicine KW - physical examination KW - neurological exam KW - telemedicine assistants KW - telemedicine implementation KW - telemedicine certification KW - telemedicine jobs KW - telemedicine education KW - telehealth KW - teleneurology UR - https://mededu.jmir.org/2021/4/e28335 UR - http://dx.doi.org/10.2196/28335 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612828 ID - info:doi/10.2196/28335 ER - TY - JOUR AU - Stouffer, Kaitlin AU - Kagan, J. Heather AU - Kelly-Hedrick, Margot AU - See, Julia AU - Benskin, Elizabeth AU - Wolffe, Suzy AU - Yenawine, Philip AU - Chisolm, S. Margaret PY - 2021/9/22 TI - The Role of Online Arts and Humanities in Medical Student Education: Mixed Methods Study of Feasibility and Perceived Impact of a 1-Week Online Course JO - JMIR Med Educ SP - e27923 VL - 7 IS - 3 KW - visual arts KW - professional identity formation KW - online KW - visual thinking strategies KW - arts and humanities KW - arts KW - humanities KW - education KW - medical students KW - medical education KW - teaching N2 - Background: The arts and humanities have been integrated into medical student education worldwide. Integrated arts and humanities courses have been found to serve four primary functions: mastering skills, perspective taking, personal insight, and social advocacy. To what extent and how arts and humanities programs achieve these educational outcomes remain unclear. Objective: In this study, we aimed to explore how the arts and humanities may lead to perceived benefits in clinical skills development, professional identity formation, and self-care, and to evaluate the feasibility of delivering an arts and humanities?based course online. Methods: We developed and delivered a 1-week online arts and humanities course to second- through fourth-year medical students. A total of 18 students enrolled in the course across its 2 offerings in Spring 2020. The course was primarily visual arts based but also included activities based in other arts and humanities, such as literature, reflective writing, dance, film, music, philosophy, and religion. Using a mixed methods approach, daily polls assessed student engagement in and perceptions of the various activities, and a postcourse survey assessed student perceptions of the course as a whole. Results: At least 93% of poll respondents (14/15 to 17/18) across the 2 cohorts rated each type of activity as good or excellent. Qualitative analysis of student responses to the postcourse survey revealed themes concerning both the form (overall course design and online format) and the function of the course (skills development, appreciation of new perspectives, and personal inquiry). Conclusions: Results suggested that the arts and humanities may support the development of clinically relevant skills and attitudes. A more unique finding was that integrative arts and humanities courses delivered online?including those that are primarily visual arts based?engage students and may yield personal and professional benefits. UR - https://mededu.jmir.org/2021/3/e27923 UR - http://dx.doi.org/10.2196/27923 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550086 ID - info:doi/10.2196/27923 ER - TY - JOUR AU - Abensur Vuillaume, Laure AU - Laudren, Garry AU - Bosio, Alexandre AU - Thévenot, Pauline AU - Pelaccia, Thierry AU - Chauvin, Anthony PY - 2021/8/31 TI - A Didactic Escape Game for Emergency Medicine Aimed at Learning to Work as a Team and Making Diagnoses: Methodology for Game Development JO - JMIR Serious Games SP - e27291 VL - 9 IS - 3 KW - training techniques KW - educational technique KW - game theories KW - emergency medicine KW - games KW - education KW - escape game KW - simulation-based training KW - pedagogical KW - serious games KW - emergency medicine training N2 - Background: In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are ?locked? in the same room and must collaborate to solve puzzles while under pressure from a timer. Objective: The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams. Methods: We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game. Results: By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team. Conclusions: From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation?based learning and thus consolidates traditional education. UR - https://games.jmir.org/2021/3/e27291 UR - http://dx.doi.org/10.2196/27291 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463628 ID - info:doi/10.2196/27291 ER - TY - JOUR AU - Newman, Julliana AU - Liew, Andrew AU - Bowles, Jon AU - Soady, Kelly AU - Inglis, Steven PY - 2021/8/27 TI - Podcasts for the Delivery of Medical Education and Remote Learning JO - J Med Internet Res SP - e29168 VL - 23 IS - 8 KW - digital KW - hepatitis C virus KW - health care professionals KW - hepatology KW - HIV KW - continuous professional development KW - podcasts KW - remote learning KW - virology UR - https://www.jmir.org/2021/8/e29168 UR - http://dx.doi.org/10.2196/29168 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448719 ID - info:doi/10.2196/29168 ER - TY - JOUR AU - Van Gaalen, J. A. E. AU - Jaarsma, C. A. D. AU - Georgiadis, R. J. PY - 2021/7/28 TI - Medical Students? Perceptions of Play and Learning: Qualitative Study With Focus Groups and Thematic Analysis JO - JMIR Serious Games SP - e25637 VL - 9 IS - 3 KW - gamification KW - serious games KW - game-based learning KW - medical education KW - computers KW - new technology KW - focus group KW - play KW - qualitative N2 - Background: In times where distance learning is becoming the norm, game-based learning (GBL) is increasingly applied to health profession education. Yet, decisions for if, when, how, and for whom GBL should be designed cannot be made on a solid empirical basis. Though the act of play seems to be intertwined with GBL, it is generally ignored in the current scientific literature. Objective: The objective of our study was to explore students? perceptions of play in leisure time and of GBL as part of a mechanistic, bottom-up approach towards evidence-informed design and implementation of GBL in health profession education. Methods: We conducted 6 focus group discussions with medical and dentistry students, which were analyzed using thematic analysis. Results: A total of 58 students participated. We identified 4 major themes based on the students? perception of play in leisure time and on the combination of play and learning. Our results indicate that, while play preferences were highly various in our health profession student cohort, pleasure was the common ground reported for playing. Crucially, play and the serious act of learning seemed paradoxical, indicating that the value and meaning of play are strongly context-dependent for students. Conclusions: Four key points can be constructed from our study. First, students play for pleasure. Perceptions of pleasure vary considerably among students. Second, students consider play as inefficient. Inefficiency will only be justified when it increases learning. Third, play should be balanced with the serious and only be used for difficult or tedious courses. Fourth, GBL activities should not be made compulsory for students. We provide practical implications and directions for future research. UR - https://games.jmir.org/2021/3/e25637 UR - http://dx.doi.org/10.2196/25637 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319237 ID - info:doi/10.2196/25637 ER - TY - JOUR AU - Kagawa, Nantamu Mike AU - Chipamaunga, Shalote AU - Prozesky, Detlef AU - Kafumukache, Elliot AU - Gwini, Rudo AU - Kandawasvika, Gwendoline AU - Katowa-Mukwato, Patricia AU - Masanganise, Rangarirai AU - Pretorius, Louise AU - Wessels, Quenton AU - Dithole, S. Kefalotse AU - Marimo, Clemence AU - Mubuuke, Gonzaga Aloysius AU - Mbalinda, Nalugo Scovia AU - van der Merwe, Lynette AU - Nyoni, N. Champion PY - 2021/7/28 TI - Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach JO - JMIR Res Protoc SP - e28905 VL - 10 IS - 7 KW - Africa KW - COVID-19 KW - emergency remote teaching KW - formal online learning KW - pandemic N2 - Background: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask?wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID): DERR1-10.2196/28905 UR - https://www.researchprotocols.org/2021/7/e28905 UR - http://dx.doi.org/10.2196/28905 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254943 ID - info:doi/10.2196/28905 ER - TY - JOUR AU - Nathan, Arjun AU - Fricker, Monty AU - Patel, Sonam AU - Georgi, Maria AU - Hang, Kien Man AU - Asif, Aqua AU - Sinha, Amil AU - Mullins, William AU - Shea, Jessie AU - Hanna, Nancy AU - Lamb, Benjamin AU - Kelly, John AU - Sridhar, Ashwin AU - Collins, Justin PY - 2021/7/22 TI - Virtual Interactive Surgical Skills Classroom: Protocol for a Parallel-Group, Noninferiority, Adjudicator-Blinded, Randomized Controlled Trial (VIRTUAL) JO - JMIR Res Protoc SP - e28671 VL - 10 IS - 7 KW - digital education KW - digital health KW - education KW - surgery KW - surgical skills KW - surgical training KW - surgical KW - suturing KW - telemedicine KW - virtual classroom KW - virtual training N2 - Background: Traditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and increase accessibility. Objective: We aim to investigate whether VCT is superior to computer-based learning and noninferior to FFT in improving proficiency in basic surgical skills. Methods: This is a protocol for a parallel-group, noninferiority, randomized controlled trial. A sample of 72 undergraduates will be recruited from 5 medical schools in London. Participants will be stratified by subjective and objective suturing experience level and allocated to 3 intervention groups at a 1:1:1 ratio. VCT will be delivered using the BARCO weConnect software, and FFT will be provided by expert instructors. Optimal student-to-teacher ratios of 12:1 for VCT and 4:1 for FFT will be maintained. The assessed task will be interrupted suturing with hand-tied knots. Results: The primary outcome will be the postintervention Objective Structured Assessment of Technical Skills score, adjudicated by 2 experts blinded to the study and adjusted for baseline proficiency. The noninferiority margin (?) will be defined using historical data. Conclusions: This study will serve as a comprehensive appraisal of the suitability of virtual basic surgical skills classroom training as an alternative to FFT. Our findings will assist the development and implementation of further resource-efficient, accessible, virtual basic surgical skills training programs during the COVID-19 pandemic and in the future. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN12448098; https://www.isrctn.com/ISRCTN12448098 International Registered Report Identifier (IRRID): PRR1-10.2196/28671 UR - https://www.researchprotocols.org/2021/7/e28671 UR - http://dx.doi.org/10.2196/28671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292162 ID - info:doi/10.2196/28671 ER - TY - JOUR AU - Alzaabi, Shaikha AU - Nasaif, Mohammed AU - Khamis, Hassan Amar AU - Otaki, Farah AU - Zary, Nabil AU - Mascarenhas, Sharon PY - 2021/7/13 TI - Medical Students? Perception and Perceived Value of Peer Learning in Undergraduate Clinical Skill Development and Assessment: Mixed Methods Study JO - JMIR Med Educ SP - e25875 VL - 7 IS - 3 KW - peer learning KW - assessment KW - empowerment KW - undergraduate KW - medical students KW - self-regulated learning N2 - Background: The effectiveness of peer learning in clinical skill development is well recognized and researched, given the many benefits gained such as enhanced learning, alleviation of the burden on faculty, and early development of teaching skills for future doctors. However, little is known in terms of its effectiveness as an assessment tool and the extent to which peer assessment can be relied upon in the absence of faculty support. Objective: This study was conducted to assess medical students? perception toward peer learning, which is based on self-regulated learning as a tool of assessment, and to compare peer evaluation with faculty evaluation of clinical skill performance. Methods: A cohort of 36 third-year medical students were exposed to peer learning (same-level) in clinical skills education for 3 months. A convergent mixed methods approach was adapted to collect data from 3 sources, namely, students? perception of peer learning, performance scores, and reflective observational analysis. A 5-point Likert-type scale was used to assess students? (n=28) perception on the value of peer learning. The students were asked to assess their peers by using a preset checklist on clinical skill performance, and scores were compared to faculty assessment scores. Reflective observational data were collected from observing video recordings of some of the peer learning sessions. The findings from all 3 sources were integrated using joint display analysis. Results: Out of 28 students, 25 students completed the survey and 20 students perceived peer learning as valuable in clinical skills education. The mean score of peer assessment was higher than that of faculty assessment. There was a significant difference in student performance between supervised teaching and peer learning groups (P=.003). Most students focused on the mastery of skill with little attention to the technique?s quality. Further, students were unable to appreciate the relevance of the potential clinical findings of physical examination. Conclusions: Peer learning in clinical skills education, based on self-regulated learning, empowers students to develop a more responsible approach toward their education. However, peer assessment is insufficient to evaluate clinical skill performance in the absence of faculty support. Therefore, we recommend that peer learning activities be preceded by supervised faculty-taught sessions. UR - https://mededu.jmir.org/2021/3/e25875 UR - http://dx.doi.org/10.2196/25875 UR - http://www.ncbi.nlm.nih.gov/pubmed/34021539 ID - info:doi/10.2196/25875 ER - TY - JOUR AU - Milligan, John Kevin AU - Daulton, Scott Robert AU - St Clair, Taylor Zachary AU - Epperson, Veronica Madison AU - Holloway, Mackenzie Rachel AU - Schlaudecker, David Jeffrey PY - 2021/7/8 TI - Creation of a Student-Run Medical Education Podcast: Tutorial JO - JMIR Med Educ SP - e29157 VL - 7 IS - 3 KW - podcast KW - medical student KW - near-peer KW - medical education N2 - Background: Podcasting has become a popular medium for medical education content. Educators and trainees of all levels are turning to podcasts for high-quality, asynchronous content. Although numerous medical education podcasts have emerged in recent years, few student-run podcasts exist. Student-run podcasts are a novel approach to supporting medical students. Near-peer mentoring has been shown to promote medical students? personal and professional identity formation. Student-run podcasts offer a new medium for delivering near-peer advice to medical students in an enduring and accessible manner. Objective: This paper describes the creation of the UnsCripted Medicine Podcast?a student-run medical education podcast produced at the University of Cincinnati College of Medicine. Methods: The planning and preparatory phases spanned 6 months. Defining a target audience and establishing a podcast mission were key first steps. Efforts were directed toward securing funding; obtaining necessary equipment; and navigating the technical considerations of recording, editing, and publishing a podcast. In order to ensure that high professionalism standards were met, key partnerships were created with faculty from the College of Medicine. Results: The UnsCripted Medicine Podcast published 53 episodes in its first 2 years. The number of episodes released per month ranges from 0 to 5, with a mean of 2.0 episodes. The podcast has a Twitter account with 217 followers. The number of listeners who subscribed to the podcast via Apple Podcasts grew to 86 in the first year and then to 218 in the second year. The show has an average rating of 4.8 (out of 5) on Apple Podcasts, which is based on 24 ratings. The podcast has hosted 70 unique guests, including medical students, resident physicians, attending physicians, nurses, physicians? family members, graduate medical education leadership, and educators. Conclusions: Medical student?run podcasts are a novel approach to supporting medical students and fostering professional identity formation. Podcasts are widely available and convenient for listeners. Additionally, podcast creators can publish content with lower barriers of entry compared to those of other forms of published content. Medical schools should consider supporting student podcast initiatives to allow for near-peer mentoring, augment the community, facilitate professional identity formation, and prepare the rising physician workforce for the technological frontier of medical education and practice. UR - https://mededu.jmir.org/2021/3/e29157 UR - http://dx.doi.org/10.2196/29157 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255694 ID - info:doi/10.2196/29157 ER - TY - JOUR AU - Barteit, Sandra AU - Lanfermann, Lucia AU - Bärnighausen, Till AU - Neuhann, Florian AU - Beiersmann, Claudia PY - 2021/7/8 TI - Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review JO - JMIR Serious Games SP - e29080 VL - 9 IS - 3 KW - virtual reality KW - augmented reality KW - global health KW - income-limited countries KW - medical education N2 - Background: Augmented reality (AR), mixed reality (MR), and virtual reality (VR), realized as head-mounted devices (HMDs), may open up new ways of teaching medical content for low-resource settings. The advantages are that HMDs enable repeated practice without adverse effects on the patient in various medical disciplines; may introduce new ways to learn complex medical content; and may alleviate financial, ethical, and supervisory constraints on the use of traditional medical learning materials, like cadavers and other skills lab equipment. Objective: We examine the effectiveness of AR, MR, and VR HMDs for medical education, whereby we aim to incorporate a global health perspective comprising low- and middle-income countries (LMICs). Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and Cochrane guidelines. Seven medical databases (PubMed, Cochrane Library, Web of Science, Science Direct, PsycINFO, Education Resources Information Centre, and Google Scholar) were searched for peer-reviewed publications from January 1, 2014, to May 31, 2019. An extensive search was carried out to examine relevant literature guided by three concepts of extended reality (XR), which comprises the concepts of AR, MR, and VR, and the concepts of medicine and education. It included health professionals who took part in an HMD intervention that was compared to another teaching or learning method and evaluated with regard to its effectiveness. Quality and risk of bias were assessed with the Medical Education Research Study Quality Instrument, the Newcastle-Ottawa Scale-Education, and A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions. We extracted relevant data and aggregated the data according to the main outcomes of this review (knowledge, skills, and XR HMD). Results: A total of 27 studies comprising 956 study participants were included. The participants included all types of health care professionals, especially medical students (n=573, 59.9%) and residents (n=289, 30.2%). AR and VR implemented with HMDs were most often used for training in the fields of surgery (n=13, 48%) and anatomy (n=4, 15%). A range of study designs were used, and quantitative methods were clearly dominant (n=21, 78%). Training with AR- and VR-based HMDs was perceived as salient, motivating, and engaging. In the majority of studies (n=17, 63%), HMD-based interventions were found to be effective. A small number of included studies (n=4, 15%) indicated that HMDs were effective for certain aspects of medical skills and knowledge learning and training, while other studies suggested that HMDs were only viable as an additional teaching tool (n=4, 15%). Only 2 (7%) studies found no effectiveness in the use of HMDs. Conclusions: The majority of included studies suggested that XR-based HMDs have beneficial effects for medical education, whereby only a minority of studies were from LMICs. Nevertheless, as most studies showed at least noninferior results when compared to conventional teaching and training, the results of this review suggest applicability and potential effectiveness in LMICs. Overall, users demonstrated greater enthusiasm and enjoyment in learning with XR-based HMDs. It has to be noted that many HMD-based interventions were small-scale and conducted as short-term pilots. To generate relevant evidence in the future, it is key to rigorously evaluate XR-based HMDs with AR and VR implementations, particularly in LMICs, to better understand the strengths and shortcomings of HMDs for medical education. UR - https://games.jmir.org/2021/3/e29080 UR - http://dx.doi.org/10.2196/29080 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255668 ID - info:doi/10.2196/29080 ER - TY - JOUR AU - Miao, H. Julia PY - 2021/6/14 TI - Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic JO - JMIR Med Educ SP - e26797 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - medical student KW - community service KW - telemedicine KW - telehealth KW - community outreach KW - peer teaching KW - student-led initiative KW - clinical assessment KW - adaptability KW - team-based learning UR - https://mededu.jmir.org/2021/2/e26797 UR - http://dx.doi.org/10.2196/26797 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061763 ID - info:doi/10.2196/26797 ER - TY - JOUR AU - Jacklin, Simon AU - Maskrey, Neal AU - Chapman, Stephen PY - 2021/6/10 TI - Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study JO - JMIR Med Educ SP - e22745 VL - 7 IS - 2 KW - shared decision making KW - virtual patient KW - communication KW - medical education N2 - Background: Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient?s informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. Objective: This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. Methods: Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants? views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants? experience of using the VP. Results: The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. Conclusions: The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice. UR - https://mededu.jmir.org/2021/2/e22745 UR - http://dx.doi.org/10.2196/22745 UR - http://www.ncbi.nlm.nih.gov/pubmed/34110299 ID - info:doi/10.2196/22745 ER - TY - JOUR AU - Godoy, Barros Ivan Rodrigues AU - Neto, Pecci Luís AU - Skaf, Abdalla AU - Leão-Filho, Muniz Hilton AU - Freddi, Lourenço Tomás De Andrade AU - Jasinowodolinski, Dany AU - Yamada, Fukunishi André PY - 2021/5/20 TI - Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study JO - JMIR Med Educ SP - e28733 VL - 7 IS - 2 KW - audiovisual reports KW - COVID-19 KW - fellowship KW - radiology KW - smartphones KW - video recording KW - web technology N2 - Background: Traditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program. Objective: This study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing. Methods: One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation. Results: Most of the applicants (n=122, 99%) answered positively (with responses of ?agree? or ?strongly agree?) that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms. Conclusions: The use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicant?s experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones. UR - https://mededu.jmir.org/2021/2/e28733 UR - http://dx.doi.org/10.2196/28733 UR - http://www.ncbi.nlm.nih.gov/pubmed/33956639 ID - info:doi/10.2196/28733 ER - TY - JOUR AU - Rivera, Ronald AU - Smart, Jonathan AU - Sakaria, Sangeeta AU - Wray, Alisa AU - Wiechmann, Warren AU - Boysen-Osborn, Megan AU - Toohey, Shannon PY - 2021/5/11 TI - Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era JO - JMIR Med Educ SP - e25213 VL - 7 IS - 2 KW - distance education KW - videoconferencing KW - emergency medicine KW - teaching KW - learning KW - web-based lecture KW - medical education KW - technology KW - SARS-CoV-2 KW - COVID-19 UR - https://mededu.jmir.org/2021/2/e25213 UR - http://dx.doi.org/10.2196/25213 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872191 ID - info:doi/10.2196/25213 ER - TY - JOUR AU - Fatima, Rawish AU - Assaly, R. Ahmad AU - Aziz, Muhammad AU - Moussa, Mohamad AU - Assaly, Ragheb PY - 2021/4/30 TI - The United States Medical Licensing Exam Step 2 Clinical Skills Examination: Potential Alternatives During and After the COVID-19 Pandemic JO - JMIR Med Educ SP - e25903 VL - 7 IS - 2 KW - USMLE KW - United States Medical Licensing Examination KW - The National Resident Matching Program KW - NRMP KW - Step 2 Clinical Skills KW - Step 2 CS KW - medical school KW - medical education KW - test KW - medical student KW - United States KW - online learning KW - exam KW - alternative KW - model KW - COVID-19 UR - https://mededu.jmir.org/2021/2/e25903 UR - http://dx.doi.org/10.2196/25903 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878014 ID - info:doi/10.2196/25903 ER - TY - JOUR AU - Wamsley, Maria AU - Cornejo, Laeesha AU - Kryzhanovskaya, Irina AU - Lin, W. Brian AU - Sullivan, Joseph AU - Yoder, Jordan AU - Ziv, Tali PY - 2021/4/21 TI - Best Practices for Integrating Medical Students Into Telehealth Visits JO - JMIR Med Educ SP - e27877 VL - 7 IS - 2 KW - telehealth KW - undergraduate medical education KW - workplace learning KW - ambulatory care KW - telehealth competencies KW - medical education KW - student education KW - digital learning KW - online learning KW - ambulatory KW - digital health UR - https://mededu.jmir.org/2021/2/e27877 UR - http://dx.doi.org/10.2196/27877 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881407 ID - info:doi/10.2196/27877 ER - TY - JOUR AU - Tam, K. Emily AU - Dong, Xuezhi PY - 2021/4/14 TI - Survey of Residency Directors? Views on Entrepreneurship JO - JMIR Med Educ SP - e19079 VL - 7 IS - 2 KW - medical student education KW - medical student innovation KW - health innovation KW - program director UR - https://mededu.jmir.org/2021/2/e19079 UR - http://dx.doi.org/10.2196/19079 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851929 ID - info:doi/10.2196/19079 ER - TY - JOUR AU - Katz, Marc AU - Nandi, Neilanjan PY - 2021/4/12 TI - Social Media and Medical Education in the Context of the COVID-19 Pandemic: Scoping Review JO - JMIR Med Educ SP - e25892 VL - 7 IS - 2 KW - social media KW - medical education KW - COVID-19 KW - medical student KW - review KW - doctor KW - communication KW - online learning KW - e-learning KW - online education KW - delivery KW - dissemination N2 - Background: The COVID-19 pandemic has brought virtual web-based learning to the forefront of medical education as training programs adapt to physical distancing challenges while maintaining the rigorous standards of medical training. Social media has unique and partially untapped potential to supplement formal medical education. Objective: The aim of this review is to provide a summary of the incentives, applications, challenges, and pitfalls of social media?based medical education for both trainees and educators. Methods: We performed a literature review via PubMed of medical research involving social media platforms, including Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts. Papers were reviewed for inclusion based on the integrity and power of the study. Results: The unique characteristics of social media platforms such as Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts endow them with unique communication capabilities that serve different educational purposes in both formal and informal education settings. However, contemporary medical education curricula lack widespread guidance on meaningful use, application, and deployment of social media in medical education. Conclusions: Clinicians and institutions must evolve to embrace the use of social media platforms for medical education. Health care professionals can approach social media engagement in the same ethical manner that they would with patients in person; however, health care institutions ultimately must enable their health care professionals to achieve this by enacting realistic social media policies. Institutions should appoint clinicians with strong social media experience to leadership roles to spearhead these generational and cultural changes. Further studies are needed to better understand how health care professionals can most effectively use social media platforms as educational tools. Ultimately, social media is here to stay, influencing lay public knowledge and trainee knowledge. Clinicians and institutions must embrace this complementary modality of trainee education and champion social media as a novel distribution platform that can also help propagate truth in a time of misinformation, such as the COVID-19 pandemic. UR - https://mededu.jmir.org/2021/2/e25892 UR - http://dx.doi.org/10.2196/25892 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755578 ID - info:doi/10.2196/25892 ER - TY - JOUR AU - Meinert, Edward AU - Eerens, Jessie AU - Banks, Christina AU - Maloney, Stephen AU - Rivers, George AU - Ilic, Dragan AU - Walsh, Kieran AU - Majeed, Azeem AU - Car, Josip PY - 2021/3/11 TI - Exploring the Cost of eLearning in Health Professions Education: Scoping Review JO - JMIR Med Educ SP - e13681 VL - 7 IS - 1 KW - education KW - distance education KW - professional education KW - online education KW - online learning KW - costs and cost analysis KW - economics N2 - Background: Existing research on the costs associated with the design and deployment of eLearning in health professions education is limited. The relative costs of these learning platforms to those of face-to-face learning are also not well understood. The lack of predefined costing models used for eLearning cost data capture has made it difficult to complete cost evaluation. Objective: The key aim of this scoping review was to explore the state of evidence concerning cost capture within eLearning in health professions education. The review explores the available data to define cost calculations related to eLearning. Methods: The scoping review was performed using a search strategy with Medical Subject Heading terms and related keywords centered on eLearning and cost calculation with a population scope of health professionals in all countries. The search was limited to articles published in English. No restriction was placed on literature publication date. Results: In total, 7344 articles were returned from the original search of the literature. Of these, 232 were relevant to associated keywords or abstract references following screening. Full-text review resulted in 168 studies being excluded. Of these, 61 studies were excluded because they were unrelated to eLearning and focused on general education. In addition, 103 studies were excluded because of lack of detailed information regarding costs; these studies referred to cost in ways either indicating cost favorability or unfavorability, but without data to support findings. Finally, 4 studies were excluded because of limited cost data that were insufficient for analysis. In total, 42 studies provided data and analysis of the impact of cost and value in health professions education. The most common data source was total cost of training (n=29). Other sources included cost per learner, referring to the cost for individual students (n=13). The population most frequently cited was medical students (n=15), although 12 articles focused on multiple populations. A further 22 studies provide details of costing approaches for the production and delivery of eLearning. These studies offer insight into the ways eLearning has been budgeted and project-managed through implementation. Conclusions: Although cost is a recognized factor in studies detailing eLearning design and implementation, the way cost is captured is inconsistent. Despite a perception that eLearning is more cost-effective than face-to-face instruction, there is not yet sufficient evidence to assert this conclusively. A rigorous, repeatable data capture method is needed, in addition to a means to leverage existing economic evaluation methods that can then test eLearning cost-effectiveness and how to implement eLearning with cost benefits and advantages over traditional instruction. UR - https://mededu.jmir.org/2021/1/e13681 UR - http://dx.doi.org/10.2196/13681 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704073 ID - info:doi/10.2196/13681 ER - TY - JOUR AU - Olgers, Joan Tycho AU - bij de Weg, Akke Anne AU - ter Maaten, Cornelis Jan PY - 2021/1/25 TI - Serious Games for Improving Technical Skills in Medicine: Scoping Review JO - JMIR Serious Games SP - e24093 VL - 9 IS - 1 KW - serious games KW - technical skills KW - ultrasound skills KW - validity of serious games N2 - Background: Serious games are being used to train specific technical skills in medicine, and most research has been done for surgical skills. It is not known if these games improve technical skills in real life as most games have not been completely validated. Objective: This scoping review aimed to evaluate the current use of serious games for improving technical skills in medicine and to determine their current validation state using a validation framework specifically designed for serious games. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A multidatabase search strategy was adopted, after which a total of 17 publications were included in this review. Results: These 17 publications described five different serious games for improving technical skills. We discuss these games in detail and report about their current validation status. Only one game was almost fully validated. We also discuss the different frameworks that can be used for validation of serious games. Conclusions: Serious games are not extensively used for improving technical skills in medicine, although they may represent an attractive alternative way of learning. The validation of these games is mostly incomplete. Additionally, several frameworks for validation exist, but it is unknown which one is the best. This review may assist game developers or educators in validating serious games. UR - http://games.jmir.org/2021/1/e24093/ UR - http://dx.doi.org/10.2196/24093 UR - http://www.ncbi.nlm.nih.gov/pubmed/33492234 ID - info:doi/10.2196/24093 ER - TY - JOUR AU - Carson, Y. Thaddeus AU - Hatzigeorgiou, Christos AU - Wyatt, R. Tasha AU - Egan, Sarah AU - Beidas, O. Sary PY - 2020/12/29 TI - Development and Implementation of a Web-Based Learning Environment for an Inpatient Internal Medicine Team: Questionnaire Study JO - JMIR Med Educ SP - e18102 VL - 6 IS - 2 KW - inpatient internal medicine KW - academic hospitalist KW - medical education KW - blended learning environment KW - social media KW - online education KW - internal medicine ward KW - internal medicine education N2 - Background: The notion of anytime, anyplace communication is characteristic of the current generation of learners. Such communications have facilitated the growth and integration of a blended or hybrid learning platform in multiple educational settings. However, there are limited reports on the use of an anytime, anyplace communication platform in clinical inpatient medical education. Objective: The setting of a high-demand inpatient clinical rotation is ideal for the use of collaborative software, and this integration is expected to positively influence medical education. The purpose of this study is to evaluate medical students? and residents? educational experiences with incorporating a simple, web-based content management and file sharing platform into an internal medicine inpatient rotation. Methods: During an inpatient internal medicine rotation, faculty and learners jointly used collaborative software for educational purposes, and a postrotation survey tool was used to measure the educational influence of the software. Results: Based on the results of the postrotation survey, the integration of a collaborative software application during clinical rotations improved the learning experience. Learning climate, the communication of rotation goals, and self-directed learning all scored favorably, but feedback from the survey participants was mixed. The learners enthusiastically accepted the practical use of this tool for both communication and information sharing. Conclusions: This generation of learners is accustomed to frequent electronic communication. Based on our survey, these learners appear to be highly receptive to this web-based intervention design for improving clinical education during active patient care. Adding effective blended learning features to a traditional clinical setting is achievable. UR - http://mededu.jmir.org/2020/2/e18102/ UR - http://dx.doi.org/10.2196/18102 UR - http://www.ncbi.nlm.nih.gov/pubmed/33372895 ID - info:doi/10.2196/18102 ER - TY - JOUR AU - Ho, Michelle AU - Goldfarb, Jared AU - Moayer, Roxana AU - Nwagu, Uche AU - Ganti, Rohan AU - Krein, Howard AU - Heffelfinger, Ryan AU - Hutchinson, Leigh Morgan PY - 2020/11/17 TI - Design and Printing of a Low-Cost 3D-Printed Nasal Osteotomy Training Model: Development and Feasibility Study JO - JMIR Med Educ SP - e19792 VL - 6 IS - 2 KW - 3D printing KW - nasal osteotomy KW - simulation KW - education KW - low-cost N2 - Background: Nasal osteotomy is a commonly performed procedure during rhinoplasty for both functional and cosmetic reasons. Teaching and learning this procedure proves difficult due to the reliance on nuanced tactile feedback. For surgical simulation, trainees are traditionally limited to cadaveric bones, which can be costly and difficult to obtain. Objective: This study aimed to design and print a low-cost midface model for nasal osteotomy simulation. Methods: A 3D reconstruction of the midface was modified using the free open-source design software Meshmixer (Autodesk Inc). The pyriform aperture was smoothed, and support rods were added to hold the fragments generated from the simulation in place. Several models with various infill densities were printed using a desktop 3D printer to determine which model best mimicked human facial bone. Results: A midface simulation set was designed using a desktop 3D printer, polylactic acid filament, and easily accessible tools. A nasal osteotomy procedure was successfully simulated using the model. Conclusions: 3D printing is a low-cost, accessible technology that can be used to create simulation models. With growing restrictions on trainee duty hours, the simulation set can be used by programs to augment surgical training. UR - http://mededu.jmir.org/2020/2/e19792/ UR - http://dx.doi.org/10.2196/19792 UR - http://www.ncbi.nlm.nih.gov/pubmed/33200998 ID - info:doi/10.2196/19792 ER - TY - JOUR AU - Khalil, Carine AU - Van Deen, Welmoed AU - Dupuy, Taylor AU - Bonthala, Nirupama AU - Almario, Christopher AU - Spiegel, Brennan PY - 2020/10/20 TI - Developing Patient-Centered Inflammatory Bowel Disease?Related Educational Videos Optimized for Social Media: Qualitative Research Study JO - JMIR Med Educ SP - e21639 VL - 6 IS - 2 KW - inflammatory bowel disease KW - educational videos KW - patient education KW - design thinking KW - qualitative research KW - mobile phone N2 - Background: Important knowledge gaps have been identified related to the causes and symptoms of inflammatory bowel disease (IBD) and medical treatments and their side effects. Patients with IBD turn to social media to learn more about their disease. However, such information found on the web is misleading and often of low quality. Objective: This study aims to gain an in-depth understanding of the unmet educational needs of patients with IBD and to use the resulting insights to develop a collection of freely available, evidence-based educational videos optimized for dissemination through social media. Methods: We used design thinking, a human-centered approach, to guide our qualitative research methodology. We performed focus groups and interviews with a diverse sample of 29 patients with IBD. Data collection was performed in 3 phases (inspiration, ideation, and implementation) based on IDEO design thinking. Phase 1 offered insights into the needs of patients with IBD, whereas phases 2 and 3 involved ideation, prototyping, and video testing. A thematic analysis was performed to analyze the resulting data. Results: Patients emphasized the need for educational videos that address their challenges, needs, and expectations. From the data analysis, 5 video topics and their content emerged: IBD treatments? risks and benefits; how to be a self-advocate; how to stay healthy with IBD; how to cope with IBD; and educating families, friends, and colleagues about experiences of patients with IBD. Conclusions: Design thinking offers a deep understanding and recognition of the unmet educational needs of patients with IBD; this approach informed the development of 5 evidence-based educational videos. Future research will formally test and disseminate these freely available videos through social media. UR - http://mededu.jmir.org/2020/2/e21639/ UR - http://dx.doi.org/10.2196/21639 UR - http://www.ncbi.nlm.nih.gov/pubmed/33079065 ID - info:doi/10.2196/21639 ER - TY - JOUR AU - Grima-Murcia, D. M. AU - Sanchez-Ferrer, Francisco AU - Ramos-Rincón, Manuel Jose AU - Fernández, Eduardo PY - 2020/8/21 TI - Use of Eye-Tracking Technology by Medical Students Taking the Objective Structured Clinical Examination: Descriptive Study JO - J Med Internet Res SP - e17719 VL - 22 IS - 8 KW - visual perception KW - medical education KW - eye tracking KW - objective structured clinical examination KW - medical evaluation N2 - Background: The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students. Objective: The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement. Methods: We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary. Results: Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided. Conclusions: Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies. UR - http://www.jmir.org/2020/8/e17719/ UR - http://dx.doi.org/10.2196/17719 UR - http://www.ncbi.nlm.nih.gov/pubmed/32821060 ID - info:doi/10.2196/17719 ER - TY - JOUR AU - Sapci, Hasan A. AU - Sapci, Aylin H. PY - 2020/6/30 TI - Artificial Intelligence Education and Tools for Medical and Health Informatics Students: Systematic Review JO - JMIR Med Educ SP - e19285 VL - 6 IS - 1 KW - artificial intelligence KW - education KW - machine learning KW - deep learning KW - medical education KW - health informatics KW - systematic review N2 - Background: The use of artificial intelligence (AI) in medicine will generate numerous application possibilities to improve patient care, provide real-time data analytics, and enable continuous patient monitoring. Clinicians and health informaticians should become familiar with machine learning and deep learning. Additionally, they should have a strong background in data analytics and data visualization to use, evaluate, and develop AI applications in clinical practice. Objective: The main objective of this study was to evaluate the current state of AI training and the use of AI tools to enhance the learning experience. Methods: A comprehensive systematic review was conducted to analyze the use of AI in medical and health informatics education, and to evaluate existing AI training practices. PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guidelines were followed. The studies that focused on the use of AI tools to enhance medical education and the studies that investigated teaching AI as a new competency were categorized separately to evaluate recent developments. Results: This systematic review revealed that recent publications recommend the integration of AI training into medical and health informatics curricula. Conclusions: To the best of our knowledge, this is the first systematic review exploring the current state of AI education in both medicine and health informatics. Since AI curricula have not been standardized and competencies have not been determined, a framework for specialized AI training in medical and health informatics education is proposed. UR - http://mededu.jmir.org/2020/1/e19285/ UR - http://dx.doi.org/10.2196/19285 UR - http://www.ncbi.nlm.nih.gov/pubmed/32602844 ID - info:doi/10.2196/19285 ER - TY - JOUR AU - Lara, Sebastian Juan AU - Braga, Minatel Mariana AU - Zagatto, Gustavo Carlos AU - Wen, Lung Chao AU - Mendes, Medeiros Fausto AU - Murisi, Uribe Pedroza AU - Haddad, Estela Ana PY - 2020/5/22 TI - A Virtual 3D Dynamic Model of Caries Lesion Progression as a Learning Object for Caries Detection Training and Teaching: Video Development Study JO - JMIR Med Educ SP - e14140 VL - 6 IS - 1 KW - 3d virtual models KW - dental education KW - e-learning KW - learning object KW - caries KW - cariology N2 - Background: In the last decade, 3D virtual models have been used for educational purposes in the health sciences, specifically for teaching human anatomy and pathology. These models provide an opportunity to didactically visualize key spatial relations that can be poorly understood when taught by traditional educational approaches. Caries lesion detection is a crucial process in dentistry that has been reported to be difficult to learn. One especially difficult aspect is linking clinical characteristics of the different severity stages with their histological features, which is fundamental for treatment decision-making. Objective: This project was designed to develop a virtual 3D digital model of caries lesion formation and progression to aid the detection of lesions at different severity stages as a potential complement to traditional lectures. Methods: Pedagogical planning, including identification of objectives, exploration of the degree of difficulty of caries diagnosis?associated topics perceived by dental students and lecturers, review of the literature regarding key concepts, and consultation of experts, was performed prior to constructing the model. An educational script strategy was created based on the topics to be addressed (dental tissues, biofilm stagnation areas, the demineralization process, caries lesion progression on occlusal surfaces, clinical characteristics related to different stages of caries progression, and histological correlations). Virtual 3D models were developed using the Virtual Man Project and refined using multiple 3D software applications. In the next phase, computer graphic modelling and previsualization were executed. After that, the video was revised and edited based on suggestions. Finally, explanatory subtitles were generated, the models were textured and rendered, and voiceovers in 3 languages were implemented. Results: We developed a 6-minute virtual 3D dynamic video in 3 languages (English, Spanish, and Brazilian Portuguese) intended for dentists and dental students to support teaching and learning of caries lesion detection. The videos were made available on YouTube; to date, they have received more than 100,000 views. Conclusions: Complementary pedagogical tools are valuable to support cariology education. This tool will be further tested in terms of utility and usability as well as user satisfaction in achieving the proposed objectives in specific contexts. UR - http://mededu.jmir.org/2020/1/e14140/ UR - http://dx.doi.org/10.2196/14140 UR - http://www.ncbi.nlm.nih.gov/pubmed/32441661 ID - info:doi/10.2196/14140 ER - TY - JOUR AU - Rössler, Julian AU - Kaserer, Alexander AU - Albiez, Benjamin AU - Braun, Julia AU - Breckwoldt, Jan AU - Spahn, Rudolf Donat AU - Nöthiger, Christoph AU - Tscholl, Werner David PY - 2020/4/23 TI - Comparing Classroom Instruction to Individual Instruction as an Approach to Teach Avatar-Based Patient Monitoring With Visual Patient: Simulation Study JO - JMIR Med Educ SP - e17922 VL - 6 IS - 1 KW - avatar KW - computer-assisted KW - diagnosis N2 - Background: Visual Patient is an avatar-based alternative to standard patient monitor displays that significantly improves the perception of vital signs. Implementation of this technology in larger organizations would require it to be teachable by brief class instruction to large groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction to Visual Patient. Objective: In this study, we aimed to compare 2 different educational methods, one-on-one instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring. Methods: We presented 42 anesthesia providers with 30 minutes of class instruction on Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study who each received individual instruction (individual instruction group). After the instruction, the participants were shown monitors with either conventional displays or Visual Patient displays and were asked to interpret vital signs. In the class instruction group, the participants were shown scenarios for either 3 or 10 seconds, and the numbers of correct perceptions with each technology were compared. Then, the teaching efficacy of the class instruction was compared with that of the individual instruction in the historical sample by 2-way mixed analysis of variance and mixed regression. Results: In the class instruction group, when participants were presented with the 3-second scenario, there was a statistically significant median increase in the number of perceived vital signs when the participants were shown the Visual Patient compared to when they were shown the conventional display (3 vital signs, P<.001; effect size ?0.55). No significant difference was found for the 10-second scenarios. There was a statistically significant interaction between the teaching intervention and display technology in the number of perceived vital signs (P=.04; partial ?2=.076). The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95% CI 1.41-2.52; P<.001) for individual instruction compared to class instruction as well as an OR of 3.03 (95% CI 2.50-3.70; P<.001) for the Visual Patient compared to conventional monitoring. Conclusions: Although individual instruction on Visual Patient is slightly more effective, class instruction is a viable teaching method; thus, large-scale introduction of health care providers to this novel technology is feasible. UR - http://mededu.jmir.org/2020/1/e17922/ UR - http://dx.doi.org/10.2196/17922 UR - http://www.ncbi.nlm.nih.gov/pubmed/32205304 ID - info:doi/10.2196/17922 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 - Chan, Siang Kai AU - Zary, Nabil PY - 2019/6/15 TI - Applications and Challenges of Implementing Artificial Intelligence in Medical Education: Integrative Review JO - JMIR Med Educ SP - e13930 VL - 5 IS - 1 KW - medical education KW - evaluation of AIED systems KW - real world applications of AIED systems KW - artificial intelligence N2 - Background: Since the advent of artificial intelligence (AI) in 1955, the applications of AI have increased over the years within a rapidly changing digital landscape where public expectations are on the rise, fed by social media, industry leaders, and medical practitioners. However, there has been little interest in AI in medical education until the last two decades, with only a recent increase in the number of publications and citations in the field. To our knowledge, thus far, a limited number of articles have discussed or reviewed the current use of AI in medical education. Objective: This study aims to review the current applications of AI in medical education as well as the challenges of implementing AI in medical education. Methods: Medline (Ovid), EBSCOhost Education Resources Information Center (ERIC) and Education Source, and Web of Science were searched with explicit inclusion and exclusion criteria. Full text of the selected articles was analyzed using the Extension of Technology Acceptance Model and the Diffusions of Innovations theory. Data were subsequently pooled together and analyzed quantitatively. Results: A total of 37 articles were identified. Three primary uses of AI in medical education were identified: learning support (n=32), assessment of students? learning (n=4), and curriculum review (n=1). The main reasons for use of AI are its ability to provide feedback and a guided learning pathway and to decrease costs. Subgroup analysis revealed that medical undergraduates are the primary target audience for AI use. In addition, 34 articles described the challenges of AI implementation in medical education; two main reasons were identified: difficulty in assessing the effectiveness of AI in medical education and technical challenges while developing AI applications. Conclusions: The primary use of AI in medical education was for learning support mainly due to its ability to provide individualized feedback. Little emphasis was placed on curriculum review and assessment of students? learning due to the lack of digitalization and sensitive nature of examinations, respectively. Big data manipulation also warrants the need to ensure data integrity. Methodological improvements are required to increase AI adoption by addressing the technical difficulties of creating an AI application and using novel methods to assess the effectiveness of AI. To better integrate AI into the medical profession, measures should be taken to introduce AI into the medical school curriculum for medical professionals to better understand AI algorithms and maximize its use. UR - http://mededu.jmir.org/2019/1/e13930/ UR - http://dx.doi.org/10.2196/13930 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199295 ID - info:doi/10.2196/13930 ER - TY - JOUR AU - Waseh, Shayan AU - Dicker, P. Adam PY - 2019/04/08 TI - Telemedicine Training in Undergraduate Medical Education: Mixed-Methods Review JO - JMIR Med Educ SP - e12515 VL - 5 IS - 1 KW - telemedicine KW - education, medical, undergraduate KW - schools N2 - Background: Telemedicine has grown exponentially in the United States over the past few decades, and contemporary trends in the health care environment are serving to fuel this growth into the future. Therefore, medical schools are learning to incorporate telemedicine competencies into the undergraduate medical education of future physicians so that they can more effectively leverage telemedicine technologies for improving the quality of care, increasing patient access, and reducing health care expense. This review articulates the efforts of allopathic-degree-granting medical schools in the United States to characterize and systematize the learnings that have been generated thus far in the domain of telemedicine training in undergraduate medical education. Objective: The aim of this review was to collect and outline the current experiences and learnings that have been generated as medical schools have sought to implement telemedicine capacity-building into undergraduate medical education. Methods: We performed a mixed-methods review, starting with a literature review via Scopus, tracking with Excel, and an email outreach effort utilizing telemedicine curriculum data gathered by the Liaison Committee on Medical Education. This outreach included 70 institutions and yielded 7 interviews, 4 peer-reviewed research papers, 6 online documents, and 3 completed survey responses. Results: There is an emerging, rich international body of learning being generated in the field of telemedicine training in undergraduate medical education. The integration of telemedicine-based lessons, ethics case-studies, clinical rotations, and even teleassessments are being found to offer great value for medical schools and their students. Most medical students find such training to be a valuable component of their preclinical and clinical education for a variety of reasons, which include fostering greater familiarity with telemedicine and increased comfort with applying telemedical approaches in their future careers. Conclusions: These competencies are increasingly important in tackling the challenges facing health care in the 21st century, and further implementation of telemedicine curricula into undergraduate medical education is highly merited. UR - http://mededu.jmir.org/2019/1/e12515/ UR - http://dx.doi.org/10.2196/12515 UR - http://www.ncbi.nlm.nih.gov/pubmed/30958269 ID - info:doi/10.2196/12515 ER - TY - JOUR AU - Aylwin, Christopher PY - 2019/4/4 TI - Faculty and Student Interaction in an Online Master?s Course: Survey and Content Analysis JO - JMIR Med Educ SP - e10464 VL - 5 IS - 1 KW - online learning KW - faculty & student interaction KW - Community of Inquiry KW - medicine N2 - Background: The provision of online educational courses has soared since the creation of the World Wide Web, with most universities offering some degree of distance-based programs. The social constructivist pedagogy is widely accepted as the framework to provide education, but it largely relies on the face-to-face presence of students and faculty to foster a learning environment. The concern with online courses is that this physical interaction is removed, and therefore learning may be diminished. Objective: The Community of Inquiry (CoI) is a framework designed to support the educational experience of such courses. This study aims to examine the characteristics of the CoI across the whole of an entirely online master?s course. Methods: This research used a case study method, using a convergent parallel design to study the interactions described by the CoI model in an online master?s program. The MSc program studied is a postgraduate medical degree for doctors or allied health professionals. Different data sources were used to corroborate this dataset including content analysis of both asynchronous and synchronous discussion forums. Results: This study found that a CoI can be created within the different learning activities of the course. The discussion forums integral to online courses are a rich source of interaction, with the ability to promote social interaction, teaching presence, and cognitive learning. Conclusions: The results show that meaningful interaction between faculty and student can be achieved in online courses, which is important to ensure deep learning and reflection. UR - http://mededu.jmir.org/2019/1/e10464/ UR - http://dx.doi.org/10.2196/10464 UR - http://www.ncbi.nlm.nih.gov/pubmed/30958274 ID - info:doi/10.2196/10464 ER - TY - JOUR AU - Alturkistani, Abrar AU - Majeed, Azeem AU - Car, Josip AU - Brindley, David AU - Wells, Glenn AU - Meinert, Edward PY - 2019/04/02 TI - Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study JO - JMIR Med Educ SP - e10982 VL - 5 IS - 1 KW - education, distance KW - education KW - teaching KW - online learning KW - online education KW - MOOC KW - massive open online course N2 - Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark?s method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners? experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology. UR - http://mededu.jmir.org/2019/1/e10982/ UR - http://dx.doi.org/10.2196/10982 UR - http://www.ncbi.nlm.nih.gov/pubmed/30938683 ID - info:doi/10.2196/10982 ER - TY - JOUR AU - Zafar, Sidra AU - Habboush, Yacob AU - Beidas, Sary PY - 2018/11/07 TI - Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy JO - JMIR Med Educ SP - e10347 VL - 4 IS - 2 KW - GRADE KW - influenza KW - vaccination KW - spontaneous abortion KW - miscarriage N2 - Background: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework is a validated evaluation tool used to assess the quality of scientific publications. It helps in enhancing clinicians? decision-making process and supports production of informed healthy policy. Objective: The purpose of this report was two-fold. First, we reviewed the interpretation of observational studies. The second purpose was to share or provide an example using the GRADE criteria. Methods: To illustrate the use of the GRADE framework to assess publications, we selected a study evaluating the risk of spontaneous abortion (SAB) after influenza vaccine administration. Results: Since 2004, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practice have recommended influenza vaccination of pregnant women. Previous studies have not found an association between influenza vaccination and SAB. However, in a recent case-control study by Donahue et al, a correlation with SAB in women who received the H1N1 influenza vaccine was identified. For women who received H1N1?containing vaccine in the previous and current influenza season, the adjusted odds ratio (aOR) for SAB was 7.7 (95% CI, 2.2-27.3), while the aOR for women not vaccinated in the previous season but vaccinated in the current season was 1.3 (95% CI, 0.7-2.7). Conclusions: Our goal is to enable the readers to critique published literature using appropriate evaluation tools such as GRADE. UR - http://mededu.jmir.org/2018/2/e10347/ UR - http://dx.doi.org/10.2196/10347 UR - http://www.ncbi.nlm.nih.gov/pubmed/30404772 ID - info:doi/10.2196/10347 ER - TY - JOUR AU - Tambi, Richa AU - Bayoumi, Riad AU - Lansberg, Peter AU - Banerjee, Yajnavalka PY - 2018/10/25 TI - Blending Gagne?s Instructional Model with Peyton?s Approach to Design an Introductory Bioinformatics Lesson Plan for Medical Students: Proof-of-Concept Study JO - JMIR Med Educ SP - e11122 VL - 4 IS - 2 KW - bioinformatics KW - Gagne?s instructional model KW - genetics KW - lesson plan KW - medical education KW - Peyton?s approach KW - undergraduate medical education N2 - Background: With the rapid integration of genetics into medicine, it has become evident that practicing physicians as well as medical students and clinical researchers need to be updated on the fundamentals of bioinformatics. To achieve this, the following gaps need to be addressed: a lack of defined learning objectives for ?Bioinformatics for Medical Practitioner? courses, an absence of a structured lesson plan to disseminate the learning objectives, and no defined step-by-step strategy to teach the essentials of bioinformatics in the medical curriculum. Objective: The objective of this study was to address these gaps to design a streamlined pedagogical strategy for teaching basics of bioinformatics in the undergraduate medical curriculum. Methods: The established instructional design strategies employed in medical education?Gagne?s 9 events of instruction?were followed with further contributions from Peyton?s four-step approach to design a structured lesson plan in bioinformatics. Results: First, we defined the specifics of bioinformatics that a medical student or health care professional should be introduced to use this knowledge in a clinical context. Second, we designed a structured lesson plan using a blended approach from both Gagne?s and Peyton?s instructional models. Lastly, we delineated a step-by-step strategy employing free Web-based bioinformatics module, combining it with a clinical scenario of familial hypercholesterolemia to disseminate the defined specifics of bioinformatics. Implementation of Schon?s reflective practice model indicated that the activity was stimulating for the students with favorable outcomes regarding their basic training in bioinformatics. Conclusions: To the best of our knowledge, the present lesson plan is the first that outlines an effective dissemination strategy for integrating introductory bioinformatics into a medical curriculum. Further, the lesson plan blueprint can be used to develop similar skills in workshops, continuing professional development, or continuing medical education events to introduce bioinformatics to practicing physicians. UR - http://mededu.jmir.org/2018/2/e11122/ UR - http://dx.doi.org/10.2196/11122 UR - http://www.ncbi.nlm.nih.gov/pubmed/30361192 ID - info:doi/10.2196/11122 ER - TY - JOUR AU - Vaysse, Charlotte AU - Chantalat, Elodie AU - Beyne-Rauzy, Odile AU - Morineau, Louise AU - Despas, Fabien AU - Bachaud, Jean-Marc AU - Caunes, Nathalie AU - Poublanc, Muriel AU - Serrano, Elie AU - Bugat, Roland AU - Rougé Bugat, Marie-Eve AU - Fize, Anne-Laure PY - 2018/03/05 TI - The Impact of a Small Private Online Course as a New Approach to Teaching Oncology: Development and Evaluation JO - JMIR Med Educ SP - e6 VL - 4 IS - 1 KW - oncology KW - health education KW - continuing education KW - e-learning KW - SPOC KW - small private online course KW - education, medical KW - education, medical, continuing N2 - Background: Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. Objective: The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). Methods: A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants? satisfaction rate through a questionnaire and the success of the SPOC by participants? completion, success, and commitment rates. Results: Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients? associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7% (90/446) had an independent medical practice, 38.5% (140/446) worked in a public institution, and 36.8% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9% (384/446) thought they had learned new information, 90.8% (405/446) felt their expectations were met, and 90.4% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51% (559/1574), the success rate was 71.47% (1025/1574), and the commitment rate was 64.67% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants. Conclusions: SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students? expectations. UR - http://mededu.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/mededu.9185 UR - http://www.ncbi.nlm.nih.gov/pubmed/29506968 ID - info:doi/10.2196/mededu.9185 ER - TY - JOUR AU - Drozd, Brandy AU - Couvillon, Emily AU - Suarez, Andrea PY - 2018/02/12 TI - Medical YouTube Videos and Methods of Evaluation: Literature Review JO - JMIR Med Educ SP - e3 VL - 4 IS - 1 KW - social media KW - YouTube KW - internet KW - health literacy KW - online education KW - videos N2 - Background: Online medical education has relevance to public health literacy and physician efficacy, yet it requires a certain standard of reliability. While the internet has the potential to be a viable medical education tool, the viewer must be able to discern which information is reliable. Objective: Our aim was to perform a literature review to determine and compare the various methods used when analyzing YouTube videos for patient education efficacy, information accuracy, and quality. Methods: In November 2016, a comprehensive search within PubMed and Embase resulted in 37 included studies. Results: The review revealed that each video evaluation study first established search terms, exclusion criteria, and methods to analyze the videos in a consistent manner. The majority of the evaluators devised a scoring system, but variations were innumerable within each study?s methods. Conclusions: In comparing the 37 studies, we found that overall, common steps were taken to evaluate the content. However, a concrete set of methods did not exist. This is notable since many patients turn to the internet for medical information yet lack the tools to evaluate the advice being given. There was, however, a common aim of discovering what health-related content the public is accessing, and how credible that material is. UR - http://mededu.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/mededu.8527 UR - http://www.ncbi.nlm.nih.gov/pubmed/29434018 ID - info:doi/10.2196/mededu.8527 ER - TY - JOUR AU - Alkureishi, Alcocer Maria AU - Lee, Wei Wei AU - Webb, Sandra AU - Arora, Vineet PY - 2018/01/04 TI - Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey Among Housestaff JO - JMIR Med Educ SP - e1 VL - 4 IS - 1 KW - electronic health records KW - EHR KW - patient-doctor relationship KW - communication N2 - Background: Electronic health record (EHR) use can enhance or undermine the ability of providers to deliver effective, humanistic patient-centered care. Given patient-centered care has been found to positively impact patient health outcomes, it is critical to provide formal education on patient-centered EHR communication skills. Unfortunately, despite increasing worldwide EHR adoption, few institutions educate trainees on EHR communication best practices. Objective: The goal of this research was to develop and deliver mandatory patient-centered EHR training to all incoming housestaff at the University of Chicago. Methods: We developed a brief patient-centered EHR use curriculum highlighting best practices based on a literature search. Training was embedded into required EHR onboarding for all incoming housestaff (interns, residents, and fellows) at the University of Chicago in 2015 and was delivered by institutional Clinical Applications Trainers. An 11-item posttraining survey consisting of ten 5-point Likert scale questions and 1 open-ended question was administered. Responses at the high end of the scale were grouped to dichotomize data. Results: All 158 of the incoming 2015 postgraduate trainees participated in training and completed surveys (158/158, 100.0%). Just over half (86/158, 54.4%) were interns and the remaining were residents and fellows (72/158, 45.6%). One-fifth of respondents (32/158, 20.2%) were primary care trainees (defined as internal medicine, pediatric, and medicine-pediatric trainees), and the remaining 79.7% (126/158) were surgical or specialty trainees. Self-perceived pre- versus posttraining knowledge of barriers, best practices, and ability to implement patient-centered EHR skills significantly increased (3.1 vs 3.9, P<.001 for all). Most felt training was effective (90.5%), should be required (86.7%), and would change future practice as a result (70.9%). The only significant difference between intern and resident/fellow responses was prior knowledge of patient-centered EHR use barriers; interns endorsed higher prior knowledge than resident peers (3.27 vs 2.94 respectively, P=.03). Response comparison of specialty or surgical trainees (n=126) to primary care trainees (n=32) showed no significant differences in prior knowledge of barriers (3.09 vs 3.22, P=.50), of best practices (3.08 vs 2.94, P=.37), or prior ability to implement best practices (3.11 vs 2.84, P=.15). Primary care trainees had larger increases posttraining than surgical/specialty peers in knowledge of barriers (0.8 vs 0.7, P=.62), best practices (1.1 vs 0.8, P=.08), and ability to implement best practices (1.1 vs 0.7, P=.07), although none reached statistical significance. Primary care trainees also rated training as more effective (4.34 vs 4.09, P=.03) and felt training should be required (4.34 vs 4.09, P=.10) and would change their future practice as a result (4.13 vs 3.73, P=.02). Conclusions: Embedding EHR communication skills training into required institutional EHR training is a novel and effective way to teach key EHR skills to trainees. Such training may help ground trainees in best practices and contribute to cultivating an institutional culture of humanistic, patient-centered EHR use. UR - http://mededu.jmir.org/2018/1/e1/ UR - http://dx.doi.org/10.2196/mededu.8976 UR - http://www.ncbi.nlm.nih.gov/pubmed/29301735 ID - info:doi/10.2196/mededu.8976 ER - TY - JOUR AU - Perry, Suzanne AU - Bridges, M. Susan AU - Zhu, Frank AU - Leung, Keung W. AU - Burrow, F. Michael AU - Poolton, Jamie AU - Masters, SW Rich PY - 2017/12/12 TI - Getting to the Root of Fine Motor Skill Performance in Dentistry: Brain Activity During Dental Tasks in a Virtual Reality Haptic Simulation JO - J Med Internet Res SP - e371 VL - 19 IS - 12 KW - simulation KW - fNIRS KW - functional near-infrared spectroscopy KW - spectroscopy, near-infrared KW - virtual reality KW - psychomotor skills training KW - dentistry KW - education, medical N2 - Background: There is little evidence considering the relationship between movement-specific reinvestment (a dimension of personality which refers to the propensity for individuals to consciously monitor and control their movements) and working memory during motor skill performance. Functional near-infrared spectroscopy (fNIRS) measuring oxyhemoglobin demands in the frontal cortex during performance of virtual reality (VR) psychomotor tasks can be used to examine this research gap. Objective: The aim of this study was to determine the potential relationship between the propensity to reinvest and blood flow to the dorsolateral prefrontal cortices of the brain. A secondary aim was to determine the propensity to reinvest and performance during 2 dental tasks carried out using haptic VR simulators. Methods: We used fNIRS to assess oxygen demands in 24 undergraduate dental students during 2 dental tasks (clinical, nonclinical) on a VR haptic simulator. We used the Movement-Specific Reinvestment Scale questionnaire to assess the students? propensity to reinvest. Results: Students with a high propensity for movement-specific reinvestment displayed significantly greater oxyhemoglobin demands in an area associated with working memory during the nonclinical task (Spearman correlation, rs=.49, P=.03). Conclusions: This small-scale study suggests that neurophysiological differences are evident between high and low reinvesters during a dental VR task in terms of oxyhemoglobin demands in an area associated with working memory. UR - http://www.jmir.org/2017/12/e371/ UR - http://dx.doi.org/10.2196/jmir.8046 UR - http://www.ncbi.nlm.nih.gov/pubmed/29233801 ID - info:doi/10.2196/jmir.8046 ER - TY - JOUR AU - Shah, H. Shikhar AU - Clark, D. Maureen AU - Hu, Kimberly AU - Shoener, A. Jalene AU - Fogel, Joshua AU - Kling, C. William AU - Ronayne, James PY - 2017/10/17 TI - Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study JO - JMIR Med Educ SP - e18 VL - 3 IS - 2 KW - health policy KW - education, public health professional KW - education, medical KW - legislation, medical KW - problem-based learning KW - knowledge management KW - interdisciplinary communication N2 - Background: There is a dearth of advocacy training in graduate medical education in the United States. To address this void, the Legislative Education and Advocacy Development (LEAD) course was developed as an interprofessional experience, partnering a cohort of pediatrics residents, fourth-year medical students, and public health students to be trained in evidence-informed health policy making. Objective: The objective of our study was to evaluate the usefulness and acceptability of a service-based legislative advocacy course. Methods: We conducted a pilot study using a single-arm pre-post study design with 10 participants in the LEAD course. The course?s didactic portion taught learners how to define policy problems, research the background of the situation, brainstorm solutions, determine evaluation criteria, develop communication strategies, and formulate policy recommendations for state legislators. Learners worked in teams to create and present policy briefs addressing issues submitted by participating Illinois State legislators. We compared knowledge and attitudes of learners from pre- and postcourse surveys. We obtained qualitative feedback from legislators and pediatric residency directors. Results: Self-reported understanding of the health care system increased (mean score from 4 to 3.3, P=.01), with answers scored from 1=highly agree to 5=completely disagree. Mean knowledge-based scores improved (6.8/15 to 12.0/15 correct). Pediatric residency program directors and state legislators provided positive feedback about the LEAD course. Conclusions: Promising results were demonstrated for the LEAD approach to incorporate advocacy training into graduate medical education. UR - http://mededu.jmir.org/2017/2/e18/ UR - http://dx.doi.org/10.2196/mededu.7730 UR - http://www.ncbi.nlm.nih.gov/pubmed/29042343 ID - info:doi/10.2196/mededu.7730 ER - TY - JOUR AU - Liu, Chunfeng AU - Lim, L. Renee AU - McCabe, L. Kathryn AU - Taylor, Silas AU - Calvo, A. Rafael PY - 2016/09/12 TI - A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study JO - J Med Internet Res SP - e246 VL - 18 IS - 9 KW - nonverbal communication KW - nonverbal behavior KW - clinical consultation KW - medical education KW - communication skills KW - nonverbal behavior detection KW - automated feedback KW - affective computing N2 - Background: In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students? awareness of their nonverbal communication. Objective: This study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students. Methods: We conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1?5 (group A) or to complete EQClinic training during weeks 8?11 (group B). EQClinic delivered an automated visual presentation of students? nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6?7 and 12?13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students? performance during face-to-face consultations pre- and postexposure to EQClinic. Results: We randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4?16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement. Conclusions: The EQClinic is a useful tool for medical students? clinical communication skills training that can be applied to university settings to improve students clinical communication skills development. UR - http://www.jmir.org/2016/9/e246/ UR - http://dx.doi.org/10.2196/jmir.6299 UR - http://www.ncbi.nlm.nih.gov/pubmed/27619564 ID - info:doi/10.2196/jmir.6299 ER - TY - JOUR AU - Ahmed, Laura AU - Seal, H. Leonard AU - Ainley, Carol AU - De la Salle, Barbara AU - Brereton, Michelle AU - Hyde, Keith AU - Burthem, John AU - Gilmore, Samuel William PY - 2016/08/11 TI - Web-Based Virtual Microscopy of Digitized Blood Slides for Malaria Diagnosis: An Effective Tool for Skills Assessment in Different Countries and Environments JO - J Med Internet Res SP - e213 VL - 18 IS - 8 KW - Malaria KW - Virtual microscopy KW - External quality assessment KW - Internet N2 - Background: Morphological examination of blood films remains the reference standard for malaria diagnosis. Supporting the skills required to make an accurate morphological diagnosis is therefore essential. However, providing support across different countries and environments is a substantial challenge. Objective: This paper reports a scheme supplying digital slides of malaria-infected blood within an Internet-based virtual microscope environment to users with different access to training and computing facilities. The feasibility of the approach was established, allowing users to test, record, and compare their own performance with that of other users. Methods: From Giemsa stained thick and thin blood films, 56 large high-resolution digital slides were prepared, using high-quality image capture and 63x oil-immersion objective lens. The individual images were combined using the photomerge function of Adobe Photoshop and then adjusted to ensure resolution and reproduction of essential diagnostic features. Web delivery employed the Digital Slidebox platform allowing digital microscope viewing facilities and image annotation with data gathering from participants. Results: Engagement was high with images viewed by 38 participants in five countries in a range of environments and a mean completion rate of 42/56 cases. The rate of parasite detection was 78% and accuracy of species identification was 53%, which was comparable with results of similar studies using glass slides. Data collection allowed users to compare performance with other users over time or for each individual case. Conclusions: Overall, these results demonstrate that users worldwide can effectively engage with the system in a range of environments, with the potential to enhance personal performance through education, external quality assessment, and personal professional development, especially in regions where educational resources are difficult to access. UR - http://www.jmir.org/2016/8/e213/ UR - http://dx.doi.org/10.2196/jmir.6027 UR - http://www.ncbi.nlm.nih.gov/pubmed/27515009 ID - info:doi/10.2196/jmir.6027 ER - TY - JOUR AU - Cameron, Blake Christian AU - Nair, Vinay AU - Varma, Manu AU - Adams, Martha AU - Jhaveri, D. Kenar AU - Sparks, A. Matthew PY - 2016/06/23 TI - Does Academic Blogging Enhance Promotion and Tenure? A Survey of US and Canadian Medicine and Pediatric Department Chairs JO - JMIR Med Educ SP - e10 VL - 2 IS - 1 KW - social media KW - blogging KW - promotion KW - tenure KW - survey KW - medicine KW - pediatrics N2 - Background: Electronic educational (e-learning) technology usage continues to grow. Many medical journals operate companion blogs (an application of e-learning technology) that enable rapid dissemination of scientific knowledge and discourse. Faculty members participating in promotion and tenure academic tracks spend valuable time and effort contributing, editing, and directing these medical journal blogs. Objective: We sought to understand whether chairs of medicine and pediatric departments acknowledge blog authorship as academic achievement. Methods: The authors surveyed 267 chairs of US and Canadian medicine and pediatric departments regarding their attitudes toward the role of faculty participation in e-learning and blogging in the promotion and tenure process. The survey completion rate was 22.8% (61/267). Results: A majority of respondents (87%, 53/61) viewed educational scholarship as either important or very important for promotion. However, only 23% (14/61) perceived importance to faculty effort in producing content for journal-based blogs. If faculty were to participate in blog authorship, 72% (44/61) of surveyed chairs favored involvement in a journal-based versus a society-based or a personal (nonaffiliated) blog. We identified a ?favorable group? of chairs (19/59, 32%), who rated leadership roles in e-learning tools as important or very important, and an ?unfavorable group? of chairs (40/59, 68%), who rated leadership roles in e-learning tools as somewhat important or not important. The favorable group were more likely to be aware of faculty bloggers within their departments (58%, 11/19 vs 25%, 10/40), viewed serving on editorial boards of e-learning tools more favorably (79%, 15/19 vs 31%, 12/39), and were more likely to value effort spent contributing to journal-based blogs (53%, 10/19 vs 10%, 4/40). Conclusions: Our findings demonstrate that although the majority of department chairs value educational scholarship, only a minority perceive value in faculty blogging effort. UR - http://mededu.jmir.org/2016/1/e10/ UR - http://dx.doi.org/10.2196/mededu.4867 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731858 ID - info:doi/10.2196/mededu.4867 ER - TY - JOUR AU - Pennaforte, Thomas AU - Moussa, Ahmed AU - Loye, Nathalie AU - Charlin, Bernard AU - Audétat, Marie-Claude PY - 2016/02/17 TI - Exploring a New Simulation Approach to Improve Clinical Reasoning Teaching and Assessment: Randomized Trial Protocol JO - JMIR Res Protoc SP - e26 VL - 5 IS - 1 KW - clinical reasoning KW - simulation KW - debriefing KW - iterative discussions KW - diagnostic errors KW - cognitive bias KW - verbalization KW - dual-process theory N2 - Background: Helping trainees develop appropriate clinical reasoning abilities is a challenging goal in an environment where clinical situations are marked by high levels of complexity and unpredictability. The benefit of simulation-based education to assess clinical reasoning skills has rarely been reported. More specifically, it is unclear if clinical reasoning is better acquired if the instructor's input occurs entirely after or is integrated during the scenario. Based on educational principles of the dual-process theory of clinical reasoning, a new simulation approach called simulation with iterative discussions (SID) is introduced. The instructor interrupts the flow of the scenario at three key moments of the reasoning process (data gathering, integration, and confirmation). After each stop, the scenario is continued where it was interrupted. Finally, a brief general debriefing ends the session. System-1 process of clinical reasoning is assessed by verbalization during management of the case, and System-2 during the iterative discussions without providing feedback. Objective: The aim of this study is to evaluate the effectiveness of Simulation with Iterative Discussions versus the classical approach of simulation in developing reasoning skills of General Pediatrics and Neonatal-Perinatal Medicine residents. Methods: This will be a prospective exploratory, randomized study conducted at Sainte-Justine hospital in Montreal, Qc, between January and March 2016. All post-graduate year (PGY) 1 to 6 residents will be invited to complete one SID or classical simulation 30 minutes audio video-recorded complex high-fidelity simulations covering a similar neonatology topic. Pre- and post-simulation questionnaires will be completed and a semistructured interview will be conducted after each simulation. Data analyses will use SPSS and NVivo softwares. Results: This study is in its preliminary stages and the results are expected to be made available by April, 2016. Conclusions: This will be the first study to explore a new simulation approach designed to enhance clinical reasoning. By assessing more closely reasoning processes throughout a simulation session, we believe that Simulation with Iterative Discussions will be an interesting and more effective approach for students. The findings of the study will benefit medical educators, education programs, and medical students. UR - http://www.researchprotocols.org/2016/1/e26/ UR - http://dx.doi.org/10.2196/resprot.4938 UR - http://www.ncbi.nlm.nih.gov/pubmed/26888076 ID - info:doi/10.2196/resprot.4938 ER - TY - JOUR AU - Liu, Qian AU - Peng, Weijun AU - Zhang, Fan AU - Hu, Rong AU - Li, Yingxue AU - Yan, Weirong PY - 2016/01/04 TI - The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e2 VL - 18 IS - 1 KW - blended learning KW - effectiveness KW - knowledge KW - health professions KW - meta-analysis N2 - Background: Blended learning, defined as the combination of traditional face-to-face learning and asynchronous or synchronous e-learning, has grown rapidly and is now widely used in education. Concerns about the effectiveness of blended learning have led to an increasing number of studies on this topic. However, there has yet to be a quantitative synthesis evaluating the effectiveness of blended learning on knowledge acquisition in health professions. Objective: We aimed to assess the effectiveness of blended learning for health professional learners compared with no intervention and with nonblended learning. We also aimed to explore factors that could explain differences in learning effects across study designs, participants, country socioeconomic status, intervention durations, randomization, and quality score for each of these questions. Methods: We conducted a search of citations in Medline, CINAHL, Science Direct, Ovid Embase, Web of Science, CENTRAL, and ERIC through September 2014. Studies in any language that compared blended learning with no intervention or nonblended learning among health professional learners and assessed knowledge acquisition were included. Two reviewers independently evaluated study quality and abstracted information including characteristics of learners and intervention (study design, exercises, interactivity, peer discussion, and outcome assessment). Results: We identified 56 eligible articles. Heterogeneity across studies was large (I2 ?93.3) in all analyses. For studies comparing knowledge gained from blended learning versus no intervention, the pooled effect size was 1.40 (95% CI 1.04-1.77; P<.001; n=20 interventions) with no significant publication bias, and exclusion of any single study did not change the overall result. For studies comparing blended learning with nonblended learning (pure e-learning or pure traditional face-to-face learning), the pooled effect size was 0.81 (95% CI 0.57-1.05; P<.001; n=56 interventions), and exclusion of any single study did not change the overall result. Although significant publication bias was found, the trim and fill method showed that the effect size changed to 0.26 (95% CI -0.01 to 0.54) after adjustment. In the subgroup analyses, pre-posttest study design, presence of exercises, and objective outcome assessment yielded larger effect sizes. Conclusions: Blended learning appears to have a consistent positive effect in comparison with no intervention, and to be more effective than or at least as effective as nonblended instruction for knowledge acquisition in health professions. Due to the large heterogeneity, the conclusion should be treated with caution. UR - http://www.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/jmir.4807 UR - http://www.ncbi.nlm.nih.gov/pubmed/26729058 ID - info:doi/10.2196/jmir.4807 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 - Mesko, Bertalan AU - Gy?rffy, Zsuzsanna AU - Kollár, János PY - 2015/10/01 TI - Digital Literacy in the Medical Curriculum: A Course With Social Media Tools and Gamification JO - JMIR Medical Education SP - e6 VL - 1 IS - 2 KW - medical education KW - social media KW - digital literacy N2 - Background: The profession of practicing medicine is based on communication, and as social media and other digital technologies play a major role in today?s communication, digital literacy must be included in the medical curriculum. The value of social media has been demonstrated several times in medicine and health care, therefore it is time to prepare medical students for the conditions they will have to face when they graduate. Objective: The aim of our study was to design a new e-learning-based curriculum and test it with medical students. Method: An elective course was designed to teach students how to use the Internet, with a special emphasis on social media. An e-learning platform was also made available and students could access material about using digital technologies on the online platforms they utilized the most. All students filled in online surveys before and after the course in order to provide feedback about the curriculum. Results: Over a 3-year period, 932 students completed the course. The course did not increase the number of hours spent online but aimed at making that time more efficient and useful. Based on the responses of students, they found the information provided by the curriculum useful for their studies and future practices. Conclusions: A well-designed course, improved by constant evaluation-based feedback, can be suitable for preparing students for the massive use of the Internet, social media platforms, and digital technologies. New approaches must be applied in modern medical education in order to teach students new skills. Such curriculums that put emphasis on reaching students on the online channels they use in their studies and everyday lives introduce them to the world of empowered patients and prepare them to deal with the digital world. UR - http://mededu.jmir.org/2015/2/e6/ UR - http://dx.doi.org/10.2196/mededu.4411 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731856 ID - info:doi/10.2196/mededu.4411 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 - Raupach, Tobias AU - Grefe, Clemens AU - Brown, Jamie AU - Meyer, Katharina AU - Schuelper, Nikolai AU - Anders, Sven PY - 2015/09/28 TI - Moving Knowledge Acquisition From the Lecture Hall to the Student Home: A Prospective Intervention Study JO - J Med Internet Res SP - e223 VL - 17 IS - 9 KW - knowledge KW - lecture KW - medical education KW - podcast KW - retention N2 - Background: Podcasts are popular with medical students, but the impact of podcast use on learning outcomes in undergraduate medical education has not been studied in detail. Objective: Our aim was to assess the impact of podcasts accompanied by quiz questions and lecture attendance on short- and medium-term knowledge retention. Methods: Students enrolled for a cardio-respiratory teaching module were asked to prepare for 10 specific lectures by watching podcasts and submitting answers to related quiz questions before attending live lectures. Performance on the same questions was assessed in a surprise test and a retention test. Results: Watching podcasts and submitting answers to quiz questions (versus no podcast/quiz use) was associated with significantly better test performance in all items in the surprise test and 7 items in the retention test. Lecture attendance (versus no attendance) was associated with higher test performance in 3 items and 1 item, respectively. In a linear regression analysis adjusted for age, gender, and overall performance levels, both podcast/quiz use and lecture attendance were significant predictors of student performance. However, the variance explained by podcast/quiz use was greater than the variance explained by lecture attendance in the surprise test (38.7% vs 2.2%) and retention test (19.1% vs 4.0%). Conclusions: When used in conjunction with quiz questions, podcasts have the potential to foster knowledge acquisition and retention over and above the effect of live lectures. UR - http://www.jmir.org/2015/9/e223/ UR - http://dx.doi.org/10.2196/jmir.3814 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416467 ID - info:doi/10.2196/jmir.3814 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 - El Bialy, Safaa AU - Jalali, Alireza PY - 2015/09/08 TI - Go Where the Students Are: A Comparison of the Use of Social Networking Sites Between Medical Students and Medical Educators JO - JMIR Medical Education SP - e7 VL - 1 IS - 2 KW - social media KW - e-learning KW - innovations in medical education N2 - Background: Medical education has grown beyond the boundaries of the classroom, and social media is seen as the bridge between informal and formal learning as it keeps students highly engaged with educational content outside the classroom. Objective: The purpose of this study is to explore the perceptions of medical educators and medical students regarding the use of social media for educational purposes. Methods: Both groups (medical educators and students) were invited to take a survey. The surveys consisted of 29 questions, including Likert-style, multiple choice, yes/no, ranking, and short answer questions. The survey forms and statistics were built using Google Drive analytics with the free Spanning Stats module.To compare between professors and students, results were exported to a Microsoft Office Excel spreadsheet (Microsoft Corp, Redmond, WA). The study protocol was approved by The Ottawa Health Science Network Research Ethics Board (OHSN-REB:20140680-01H). Results: The overall response rate to the survey was 40.9% (63/154) for students, and 36% (72/200) for medical educators. The majority of educators (79%, 57/72) and students (100.0%, 63/63) had presence on social networking sites (SNSs). Only (33% 19/57) of educators used SNSs with their students, the most used sites were Facebook (52%, 10/19) and Twitter (47%, 9/19), followed by LinkedIn (21%, 4/19), Google+ (16%, 3/19),YouTube (11%, 2/19), and blogs (11%, 2/19). Facebook (100%, 63/63), YouTube (43%, 27/63), Twitter (31%, 20/63), and Instagram (30%, 19/63) were the sites most commonly used by students. The educators used SNSs mainly to post opinions (86%, 49/57), share videos (81%, 46/57), chat (71%, 41/57), engage in medical education (68%, 40/57), take surveys (24%, 14/57), and play games (5%, 3/57). On the other hand, students used SNSs mainly to chat with friends (94%, 59/63), for medical education purposes (67%, 42/63), to share videos (62%, 39/63), to post opinions (49%, 31/63), to take surveys (11%, 7/63), and to play games (6%, 4/63). Most educators (67%, 38/57) do not use social media in their education Although most of the educators (89%, 17/19) and students (73%, 46/63) found the use of social media time-effective, that it offered an inviting atmosphere (89%, 17/19 and 70%, 44/63), and that it enhanced the learning experience (95%, 18/19 and 70%, 44/63), both groups stated that they had colleagues who refused to use social media. The detractors? concerns included privacy issues (47%, 18/38), time-wasting (34%, 13/38), distraction (21%, 8/38), and that these media might not be suitable for education (11%, 4/38). When it came to using SNSs with the students, the educators most often used SNSs to post articles (42%, 8/19), explanatory comments (31%, 6/19), and videos (27%, 5/19).While students preferred the following posts : Quizzes (87% 55/63), revision files (82% 52/63) and explanatory comments (29% 21/63). Conclusions: Although social media continue to grow, some educators find that they do not offer suitable modes of learning. However, it is important to acknowledge that there are persistent differences in technology adoption and use along gender, racial, and socioeconomic lines; this is often referred to as the ?digital divide?. The current study shows that students prefer certain posts like quizzes and revision files, while educators are focused on posting videos, articles, and explanatory comments. Medical educators are encouraged to focus on the students in a way to minimize the gap between learners and educators. It will remain our responsibility as educators to focuson the student, use SNSs at their fullest, and integrate them into traditional Web-based management systems and into existingcurricula to best benefit the students. UR - http://mededu.jmir.org/2015/2/e7/ UR - http://dx.doi.org/10.2196/mededu.4908 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731847 ID - info:doi/10.2196/mededu.4908 ER - TY - JOUR AU - Bergl, A. Paul AU - Narang, Akhil AU - Arora, M. Vineet PY - 2015/07/10 TI - Maintaining a Twitter Feed to Advance an Internal Medicine Residency Program?s Educational Mission JO - JMIR Medical Education SP - e5 VL - 1 IS - 2 KW - social media KW - medical education KW - Twitter messaging KW - Internet/ethics N2 - Background: Residency programs face many challenges in educating learners. The millennial generation?s learning preferences also force us to reconsider how to reach physicians in training. Social media is emerging as a viable tool for advancing curricula in graduate medical education. Objective: The authors sought to understand how social media enhances a residency program?s educational mission. Methods: While chief residents in the 2013-2014 academic year, two of the authors (PB, AN) maintained a Twitter feed for their academic internal medicine residency program. Participants included the chief residents and categorical internal medicine house staff. Results: At the year?s end, the authors surveyed residents about uses and attitudes toward this initiative. Residents generally found the chief residents? tweets informative, and most residents (42/61, 69%) agreed that Twitter enhanced their overall education in residency. Conclusions: Data from this single-site intervention corroborate that Twitter can strengthen a residency program?s educational mission. The program?s robust following on Twitter outside of the home program also suggests a need for wider adoption of social media in graduate medical education. Improved use of data analytics and dissemination of these practices to other programs would lend additional insight into social media?s role in improving residents? educational experiences. UR - http://mededu.jmir.org/2015/2/e5/ UR - http://dx.doi.org/10.2196/mededu.4434 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731845 ID - info:doi/10.2196/mededu.4434 ER - TY - JOUR AU - Nicolaidou, Iolie AU - Antoniades, Athos AU - Constantinou, Riana AU - Marangos, Charis AU - Kyriacou, Efthyvoulos AU - Bamidis, Panagiotis AU - Dafli, Eleni AU - Pattichis, S. Constantinos PY - 2015/06/17 TI - A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study JO - J Med Internet Res SP - e150 VL - 17 IS - 6 KW - telemedicine KW - emergency telemedicine KW - serious games KW - virtual patients KW - medical education KW - professional feedback-informed evaluation KW - emergency assessment and management N2 - Background: Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students? preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. Objective: The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: ?What are professionals? perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?? Methods: The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with the game. Results: Overall, the results were positive in all dimensions of the game that were assessed as means ranged from 3.2 to 3.99 out of 5, with user engagement receiving the highest score (mean 3.99, SD 0.87). Users? perceived difficulty level received the lowest score (mean 3.20, SD 0.65), a finding which agrees with the analysis of log files that showed a rather low success rate (20.6%). Even though professionals saw the educational value and usefulness of the tool for pre-hospital emergency training (mean 3.83, SD 1.05), they identified confusing features and provided input for improving them. Conclusions: Overall, the results of the professional feedback-informed evaluation of the game provide a strong indication of its potential as an educational tool for emergency training. Professionals? input will serve to improve the game. Further research will aim to validate VETM, in a randomized pre-test, post-test control group study to examine possible learning gains in participants? problem-solving skills in treating a patient?s symptoms in an emergency situation. UR - http://www.jmir.org/2015/6/e150/ UR - http://dx.doi.org/10.2196/jmir.3667 UR - http://www.ncbi.nlm.nih.gov/pubmed/26084866 ID - info:doi/10.2196/jmir.3667 ER - TY - JOUR AU - Chang, Ying Huan AU - Poh, Hong David Yan AU - Wong, Lian Li AU - Yap, Gwee John Yin AU - Yap, Yi-Lwern Kevin PY - 2015/05/11 TI - Student Preferences on Gaming Aspects for a Serious Game in Pharmacy Practice Education: A Cross-Sectional Study JO - JMIR Medical Education SP - e2 VL - 1 IS - 1 KW - gaming aspects KW - pharmacy-related serious game KW - pharmacy practice education KW - reward systems KW - game settings KW - storylines KW - viewing perspectives KW - gaming styles N2 - Background: Serious games are motivating and provide a safe environment for students to learn from their mistakes without experiencing any negative consequences from their actions. However, little is known about students? gaming preferences and the types of serious games they like to play for education. Objective: This study aims to determine the types of gaming aspects that students would like to play in a pharmacy-related serious game. Methods: A cross-sectional study was conducted using a self-administered survey, which obtained students? responses on their preferences regarding various gaming aspects (reward systems, game settings, storylines, viewing perspectives, and gaming styles) and for a hypothetical gaming scenario (authentic simulation or post-apocalyptic fantasy). Descriptive statistics, chi-square, and Fisher?s exact tests were used for statistical analyses. Results: Response rate was 72.7% (497/684 undergraduates). The most popular game reward systems were unlocking mechanisms (112/497, 22.5%) and experience points (90/497, 18.1%). Most students preferred fantasy/medieval/mythic (253/497, 50.9%) and modern (117/497, 23.5%) settings, but lower year undergraduates preferred modern settings less than upper year seniors (47/236, 19.9% vs 70/242, 28.9%, P=.022). Almost one-third (147/497, 29.6%) preferred an adventurer storyline or an authentic pharmacy-related plot (119/497, 23.9%), and a collaborative game style was most preferred by the students (182/497, 36.6%). Three-dimensional game perspectives (270/497, 54.3%) were more popular than two-dimensional perspectives (221/497, 44.5%), especially among males than females (126/185, 68.1% vs 142/303, 46.9%, P<.001). In terms of choice for a pharmacy-related serious game, a post-apocalyptic fantasy game (scenario B, 287/497, 57.7%) was more popular than an authentic simulation game (scenario A, 209/497, 42.1%). More males preferred the post-apocalyptic fantasy scenario than females (129/187, 69.0% vs 155/306, 50.7%, P<.001). Conclusions: In general, students want a three-dimensional, fantasy/medieval/mythic post-apocalyptic game, based on an adventurer storyline with an unlocking mechanism reward system. A balance between real-life and fantasy elements needs to be struck in order for the game to cater students towards health care practices. UR - http://mededu.jmir.org/2015/1/e2/ UR - http://dx.doi.org/10.2196/mededu.3754 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731304 ID - info:doi/10.2196/mededu.3754 ER -