TY - JOUR AU - Samson, Juliana AU - Gilbey, Marc AU - Taylor, Natasha AU - Kneafsey, Rosie PY - 2025/6/10 TI - Virtual Simulated Placements in Health Care Education: Scoping Review JO - JMIR Med Educ SP - e58794 VL - 11 KW - technology KW - students KW - learning KW - scoping review KW - simulation KW - healthcare education KW - virtual simulated placement KW - practice placement KW - clinical placement N2 - Background: A virtual simulated placement (VSP) is a computer-based version of a practice placement. COVID-19 drove increased adoption of web-based technology in clinical education. Accordingly, the number of VSP publications increased from 2020. This review determines the scope of this literature to inform future research questions. Objective: This study aimed to assess the range and types of evidence related to VSPs across the health care professions. Methods: Studies that focussed on health care students participating in VSPs. Hybrid, augmented reality, and mixed reality placements were excluded. In total, 14 databases were searched, limited to English, and dated from January 1, 2020. Supplementary searches were employed, and an updated search was conducted on July 9, 2023. Themes were synthesized using the PAGER (patterns, advances, gaps, evidence for practice, and research recommendations) framework to highlight patterns, advances, gaps, evidence for practice, and research recommendations. Results: In total, 28 papers were reviewed. All VSPs were designed in response to pandemic restrictions. Students were primarily from medicine and nursing. Few publications were from low and middle-income countries. There was limited stakeholder involvement in the VSP designs and a lack of robust research designs, consistent outcome measures, conceptual underpinnings, and immersive technologies. Despite this, promising trends for student experience, knowledge, communication, and critical thinking skills using VSPs have emerged. Conclusions: This review maps the VSP evidence across health care education. Allied health and midwifery research require greater representation, and based on the highlighted gaps, other areas for future research are suggested. Trial Registration: OSF Registries osf.io/ay5gh; https://osf.io/ay5gh/ UR - https://mededu.jmir.org/2025/1/e58794 UR - http://dx.doi.org/10.2196/58794 ID - info:doi/10.2196/58794 ER - TY - JOUR AU - D'Amiano, Anjali AU - Kollings, Jack AU - Sunshine, Joel PY - 2025/5/28 TI - The Quality of Dermatology Match Information on Social Media Platforms: Cross-Sectional Analysis JO - JMIR Dermatol SP - e65217 VL - 8 KW - residency KW - dermatology match KW - Reddit KW - Student Doctor Network KW - dermatology KW - information KW - cross-section KW - cross-sectional analysis KW - online KW - qualifications KW - misinformation KW - media KW - online data KW - TikTok KW - online platform KW - health platform KW - web platform KW - online health KW - health information KW - social media KW - digital health KW - social media posts KW - online content KW - health content KW - social media content KW - residency program KW - medical residency KW - MD KW - medical school UR - https://derma.jmir.org/2025/1/e65217 UR - http://dx.doi.org/10.2196/65217 ID - info:doi/10.2196/65217 ER - TY - JOUR AU - Tahmasebi, Houman AU - Ko, Gary AU - Lam, M. Christine AU - Bilgen, Idil AU - Freeman, Zachary AU - Varghese, Rhea AU - Reel, Emma AU - Englesakis, Marina AU - Cil, D. Tulin PY - 2025/5/26 TI - Multidisciplinary Oncology Education Among Postgraduate Trainees: Systematic Review JO - JMIR Med Educ SP - e63655 VL - 11 KW - multidisciplinary KW - oncology KW - postgraduate medical education KW - resident KW - fellow KW - surgery KW - hematology KW - radiation oncology KW - geriatrics KW - palliative N2 - Background: Understanding the roles and patient management approaches of the entire oncology team is imperative for effective communication and optimal cancer treatment. Currently, there is no standard residency or fellowship curriculum to ensure the delivery of fundamental knowledge and skills associated with oncology specialties with which trainees often collaborate. Objective: This study is a systematic review that aims to evaluate the multidisciplinary oncology education in postgraduate medical training. Methods: A systematic literature search was performed using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, APA PsycINFO, and Education Resources Information Center in July 2021. Updates were performed in February 2023 and October 2024. Original studies reporting the effectiveness of multidisciplinary oncology training among residents and fellows were included. Results: A total of 6991 studies were screened and 24 were included. Fifteen studies analyzed gaps in existing multidisciplinary training of residents and fellows from numerous fields, including surgical, medical, and radiation oncology; geriatrics; palliative medicine; radiology; and pathology programs. Trainees reported limited teaching and knowledge of oncology outside of their respective fields and endorsed the need for further multidisciplinary oncology training. The remaining 9 studies assessed the effectiveness of educational interventions, including tumor boards, didactic sessions, clinical rotations, and case-based learning. Trainees reported significant improvements in multidisciplinary oncology knowledge and skills following the interventions. Conclusions: These data suggest postgraduate medical trainees have limited formal multidisciplinary oncology training. Existing educational interventions show promising results in improving trainees? oncology knowledge and skills. There is a need for further research and the development of multidisciplinary oncology curricula for postgraduate medical training programs. Trial Registration: PROSPERO CRD42022271308; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022271308 UR - https://mededu.jmir.org/2025/1/e63655 UR - http://dx.doi.org/10.2196/63655 ID - info:doi/10.2196/63655 ER - TY - JOUR AU - Gouvea Silva, Gabriela AU - da Silva Costa, Dario Carlos AU - Cardoso Gonçalves, Bruno AU - Vianney Saldanha Cidrão Nunes, Luiz AU - Roberto dos Santos, Emerson AU - Almeida de Arnaldo Rodriguez Castro, Natalia AU - de Abreu Lima, Regina Alba AU - Sabadoto Brienze, Maria Vânia AU - Oliani, Hélio Antônio AU - André, César Júlio PY - 2025/5/8 TI - Evolution of Learning Styles in Surgery Comparing Residents and Teachers: Cross-Sectional Study JO - JMIR Med Educ SP - e64767 VL - 11 KW - learning KW - general surgery KW - medical education KW - internship and residency KW - surgeons KW - Brazil N2 - Background: Studies confirm a relationship between learning style and medical career choice in the learning style patterns observed in distinct types of residency programs. Such patterns can also be applied to general surgery, from medical school to the latest stages of training. Aligning teaching strategies with the predominant learning styles in surgical residency programs has the potential to make training more effective. Objective: This study aimed to determine the learning styles of general surgery residents and professors in a Brazilian teaching hospital and compare the results with the existing literature. Methods: This was a cross-sectional study conducted in a teaching hospital of a public university in Brazil. Thirty-four general surgery residents of any year of training and 30 professors participated in the study. Participants completed a sociodemographic survey and David Kolb?s Learning Style Inventory. This was used to classify participants into one of four distinct types of learners: accommodating, diverging, assimilating, and converging. The relationship between sociodemographic data and learning styles was analyzed using the Fisher test, adjusted using the Bonferroni method, and the effect size was measured using the Cramer V test. Results: The learning style distribution was similar in both groups, with 43,75% diverging, 42,18% accommodating, 10.93% assimilating, and 3.12% converging styles. A significant relationship was found between sex and learning style (P=.049) and between age and learning style for professors (P=.029). The effect sizes were strong (0.46) and very strong (0.506). Conclusions: The prevalence of learning styles among general surgery residents and professors at this Brazilian hospital differs from that observed in previous studies, with more diverging and accommodating learners and fewer converging learners, suggesting a shift in learning styles. Understanding learning styles is important for effective surgical training programs. Further research with larger and more diverse populations is needed to confirm these results and explore the factors contributing to the observed differences in learning styles. UR - https://mededu.jmir.org/2025/1/e64767 UR - http://dx.doi.org/10.2196/64767 ID - info:doi/10.2196/64767 ER - TY - JOUR AU - Wang, Peicheng AU - Wu, Ziye AU - Zhang, Jingfeng AU - He, Yanrong AU - Jiang, Maoqing AU - Zheng, Jianjun AU - Wang, Zhenchang AU - Yang, Zhenghan AU - Chen, Yanhua AU - Zhu, Jiming PY - 2025/5/8 TI - Distance Learning During the COVID-19 Lockdown and Self-Assessed Competency Development Among Radiology Residents in China: Cross-Sectional Survey JO - JMIR Med Educ SP - e54228 VL - 11 KW - radiology residents KW - distance learning KW - mental health status KW - self-assessed competency KW - ACGME competencies KW - Accreditation Council of Graduate Medical Education N2 - Background: During the COVID-19 lockdown, it was difficult for residency training programs to conduct on-site, hands-on training. Distance learning, as an alternative to in-person training, could serve as a viable option during this challenging period, but few studies have assessed its role. Objective: This study aims to investigate the impact of distance learning during the lockdown on residents? self-assessed competency development and to explore the moderating effect of poor mental health on the associations. It is hypothesized that radiology residents who were trained through distance learning during the lockdown were more likely to report higher self-assessed competency compared to those who did not receive organized, formal training. Methods: A cross-sectional survey was conducted in 2021 among all of the radiology residents in 407 radiology residency programs across 31 provinces of China. To estimate the long-term outcomes of radiology residents? training after the initial COVID-19 outbreak, this study measured 6 core competencies developed by the US Accreditation Council for Graduate Medical Education reported by radiology residents. Multiple linear regression and moderating effect analysis were conducted to examine the associations between distance learning, mental health status, and self-assessed competencies. Mental health status moderated the association between distance learning and self-assessed competency of radiology residents. Results: A total of 2381 radiology residents (29.7% of the 8,008 nationwide) met the inclusion criteria and were included in the analysis. Among them, 71.4% (n=1699) received distance learning during the COVID-19 lockdown, and 73.2% (n=1742) reported mental health struggles ranging in severity from slight to extremely severe. Radiology residents who were trained through distance learning (?=0.35, 90% CI 0.24?0.45) were more likely to report higher self-assessed competencies. This was particularly true for the competency of ?interpersonal and communication skills? (?=0.55, 90% CI 0.39?0.70). Whereas, the competency of ?patient care and technical skills? (?=0.14, 90% CI 0.01?0.26) benefited the least from distance learning. Poor mental health significantly moderated the relationship between distance learning and competency (?=?0.15, 90% CI ?0.27 to ?0.02). Conclusions: Distance learning, a means of promoting enabling environments during the COVID-19 lockdown, serves its purpose and helps generally improve residents? self-assessed competencies, though different competency domains benefit unequally. The impact of mental health status calls for special attention so that distance learning can fulfill its potential. UR - https://mededu.jmir.org/2025/1/e54228 UR - http://dx.doi.org/10.2196/54228 ID - info:doi/10.2196/54228 ER - TY - JOUR AU - Jandu, Simi AU - Carey, L. Jennifer PY - 2025/2/21 TI - Exploring Social Media Use Among Medical Students Applying for Residency Training: Cross-Sectional Survey Study JO - JMIR Med Educ SP - e59417 VL - 11 KW - social media KW - residency recruitment KW - Instagram KW - Reddit KW - medical students KW - student KW - residency KW - residency training KW - social media engagement KW - training programs KW - social media usage KW - cross-sectional survey KW - survey KW - residency training program KW - thematic analysis N2 - Background: Since the COVID-19 pandemic, residency candidates have moved from attending traditional in-person interviews to virtual interviews with residency training programs. This transition spurred increased social media engagement by residency candidates, in an effort to learn about prospective programs, and by residency programs, to improve recruitment efforts. There is a paucity of literature on the effectiveness of social media outreach and its impact on candidates? perceptions of residency programs. Objective: We aimed to determine patterns of social media platform usage among prospective residency candidates and social media?s influence on students? perceptions of residency programs. Methods: A cross-sectional survey was administered anonymously to fourth-year medical students who successfully matched to a residency training program at a single institution in 2023. These data were analyzed using descriptive statistics, as well as thematic analysis for open-ended questions. Results: Of the 148 eligible participants, 69 (46.6%) responded to the survey, of whom 45 (65.2%) used social media. Widely used social media platforms were Instagram (19/40, 47.5%) and Reddit (18/40, 45%). Social media influenced 47.6% (20/42) of respondents? opinions of programs and had a moderate or major effect on 26.2% (11/42) of respondents? decisions on program ranking. Resident-faculty relations and social events showcasing camaraderie and wellness were the most desired content. Conclusions: Social media is used by the majority of residency candidates during the residency application process and influences residency program ranking. This highlights the importance of residency programs in leveraging social media usage to recruit applicants and provide information that allows the candidate to better understand the program. UR - https://mededu.jmir.org/2025/1/e59417 UR - http://dx.doi.org/10.2196/59417 ID - info:doi/10.2196/59417 ER - TY - JOUR AU - Almeziny, Abdullah AU - Almutairi, Rahaf AU - Altamimi, Amal AU - Alshehri, Khloud AU - Almehaideb, Latifah AU - Shadid, Asem AU - Al Mashali, Mohammed PY - 2025/1/23 TI - The Prevalence of Dermoscopy Use Among Dermatology Residents in Riyadh, Saudi Arabia: Cross-Sectional Study JO - JMIR Dermatol SP - e63861 VL - 8 KW - dermoscopy KW - Saudi Arabia KW - questionnaire KW - skin lesion KW - noninvasive KW - cross-sectional study KW - dermatology N2 - Background: Dermoscopy is a noninvasive technology used to examine the skin?s invisible microstructures in dermatological practice and is gaining prominence as a crucial tool. Dermoscopy is an evidence-based practice used to enhance the early detection of skin malignancies and to help distinguish between various skin conditions, including pigmented and nonpigmented skin malignancies. Currently, the vast majority of global guidelines for skin cancer recommend dermoscopy as a critical component. Dermoscopy use is increasing worldwide, but to date, no study has documented the attitudes toward and use of dermoscopy among future dermatologists in Saudi Arabia. Objective: We aimed to determine the proportion of dermatology residents in Riyadh who use dermoscopy in their clinical practice; identify factors influencing the use of dermoscopy, such as availability of equipment, training, and the perceived importance of dermoscopy in clinical practice; explore barriers to dermoscopy use, including the lack of access to necessary resources (eg, dermoscopes) and insufficient training; and provide insights into the adoption and integration of dermoscopy into dermatology training and clinical practice in Saudi Arabia. Methods: In January 2024, a validated and published questionnaire was modified to meet research requirements and was sent to all registered dermatology residents in the The Saudi Board of Dermatology and Venereology Program. Results: In total, 63 dermatology residents in Riyadh, Saudi Arabia, completed the web-based questionnaire (response rate=87.5%). The sample was predominantly female (n=34, 54.0%), with the majority (n=53, 84.1%) aged between 26 and 30 years. A notable proportion of participants (n=22, 34.9%) were in their final year of residency. Over half of the participants (n=34, 54.0%) owned a dermoscope, and a substantial number of them (n=23, 36.5%) reported conducting 21-30 clinic consultations per month on average. More than half of the participants (n=36, 57.1%) had received dermoscopy training, and 16 (36.4%) had used dermoscopy for 2 years. Additionally, most participants (n=20, 45.5%) had used nonpolarized immersion-contact dermoscopy, while 19 (43.2%) had used polarized light dermoscopy. Furthermore, the majority (n=22, 50.0%) used dermoscopy in fewer than 10% of cases involving patients with inflammatory skin lesions. Statistical analysis revealed significant associations between the participants? ages (P=.003), residency levels (P=.001), and practice centers and the use of dermoscopy (P=.004). Conclusions: Dermoscopy has been widely adopted by dermatology residents in their daily clinical practice due to its benefits in early detection and diagnosis of skin diseases. However, the overall extent of dermoscopy use within the dermatology community remains unclear, highlighting the need for further education. In Saudi Arabia, the key factors influencing dermoscopy use include residents? ages, residency levels, and practice centers. Younger dermatologists have expressed strong interest in improving their dermoscopy knowledge and skills. Expanding access to dermoscopy equipment and providing training during residency could further promote its use across the country. UR - https://derma.jmir.org/2025/1/e63861 UR - http://dx.doi.org/10.2196/63861 ID - info:doi/10.2196/63861 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 - Enich, Michael AU - Morton, Cory AU - Jermyn, Richard PY - 2024/10/28 TI - Naloxone Coprescribing and the Prevention of Opioid Overdoses: Quasi-Experimental Metacognitive Assessment of a Novel Education Initiative JO - JMIR Med Educ SP - e54280 VL - 10 KW - naloxone KW - coprescribing KW - prescription KW - academic detailing KW - metacognition KW - metacognitive evaluation KW - pharmacotherapy KW - pharmaceutic KW - pharmaceutical KW - education KW - educational intervention KW - opioid KW - opioid overdose KW - harm reduction N2 - Background: Critical evaluation of naloxone coprescription academic detailing programs has been positive, but little research has focused on how participant thinking changes during academic detailing. Objective: The dual purposes of this study were to (1) present a metacognitive evaluation of a naloxone coprescription academic detailing intervention and (2) describe the application of a metacognitive evaluation for future medical education interventions. Methods: Data were obtained from a pre-post knowledge assessment of a web-based, self-paced intervention designed to increase knowledge of clinical and organizational best practices for the coprescription of naloxone. To assess metacognition, items were designed with confidence-weighted true-false scoring. Multiple metacognitive scores were calculated: 3 content knowledge scores and 5 confidence-weighted true-false scores. Statistical analysis examined whether there were significant differences in scores before and after intervention. Analysis of overall content knowledge showed significant improvement at posttest. Results: There was a significant positive increase in absolute accuracy of participant confidence judgments, confidence in correct probability, and confidence in incorrect probability (all P values were <.05). Overall, results suggest an improvement in content knowledge scores after intervention and, metacognitively, suggest that individuals were more confident in their answer choices, regardless of correctness. Conclusions: Implications include the potential application of metacognitive evaluations to assess nuances in learner performance during academic detailing interventions and as a feedback mechanism to reinforce learning and guide curricular design. UR - https://mededu.jmir.org/2024/1/e54280 UR - http://dx.doi.org/10.2196/54280 ID - info:doi/10.2196/54280 ER - TY - JOUR AU - Miao, Jing AU - Thongprayoon, Charat AU - Garcia Valencia, Oscar AU - Craici, M. Iasmina AU - Cheungpasitporn, Wisit PY - 2024/10/10 TI - Navigating Nephrology's Decline Through a GPT-4 Analysis of Internal Medicine Specialties in the United States: Qualitative Study JO - JMIR Med Educ SP - e57157 VL - 10 KW - artificial intelligence KW - ChatGPT KW - nephrology fellowship training KW - fellowship matching KW - medical education KW - AI KW - nephrology KW - fellowship KW - United States KW - factor KW - chatbots KW - intellectual KW - complexity KW - work-life balance KW - procedural involvement KW - opportunity KW - career demand KW - financial compensation N2 - Background: The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11% drop in candidates and a mere 66% (321/488) of positions filled. Objective: The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Methods: Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. Results: GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology?s filled rate was 66%, only higher than the 45% (155/348) filled rate of geriatric medicine. Nephrology?s score decreased by 4%?14% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. Conclusions: ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents. UR - https://mededu.jmir.org/2024/1/e57157 UR - http://dx.doi.org/10.2196/57157 ID - info:doi/10.2196/57157 ER - TY - JOUR AU - Yoon, Soo-Hyuk AU - Oh, Kyeong Seok AU - Lim, Gun Byung AU - Lee, Ho-Jin PY - 2024/9/16 TI - Performance of ChatGPT in the In-Training Examination for Anesthesiology and Pain Medicine Residents in South Korea: Observational Study JO - JMIR Med Educ SP - e56859 VL - 10 KW - AI tools KW - problem solving KW - anesthesiology KW - artificial intelligence KW - pain medicine KW - ChatGPT KW - health care KW - medical education KW - South Korea N2 - Background: ChatGPT has been tested in health care, including the US Medical Licensing Examination and specialty exams, showing near-passing results. Its performance in the field of anesthesiology has been assessed using English board examination questions; however, its effectiveness in Korea remains unexplored. Objective: This study investigated the problem-solving performance of ChatGPT in the fields of anesthesiology and pain medicine in the Korean language context, highlighted advancements in artificial intelligence (AI), and explored its potential applications in medical education. Methods: We investigated the performance (number of correct answers/number of questions) of GPT-4, GPT-3.5, and CLOVA X in the fields of anesthesiology and pain medicine, using in-training examinations that have been administered to Korean anesthesiology residents over the past 5 years, with an annual composition of 100 questions. Questions containing images, diagrams, or photographs were excluded from the analysis. Furthermore, to assess the performance differences of the GPT across different languages, we conducted a comparative analysis of the GPT-4?s problem-solving proficiency using both the original Korean texts and their English translations. Results: A total of 398 questions were analyzed. GPT-4 (67.8%) demonstrated a significantly better overall performance than GPT-3.5 (37.2%) and CLOVA-X (36.7%). However, GPT-3.5 and CLOVA X did not show significant differences in their overall performance. Additionally, the GPT-4 showed superior performance on questions translated into English, indicating a language processing discrepancy (English: 75.4% vs Korean: 67.8%; difference 7.5%; 95% CI 3.1%-11.9%; P=.001). Conclusions: This study underscores the potential of AI tools, such as ChatGPT, in medical education and practice but emphasizes the need for cautious application and further refinement, especially in non-English medical contexts. The findings suggest that although AI advancements are promising, they require careful evaluation and development to ensure acceptable performance across diverse linguistic and professional settings. UR - https://mededu.jmir.org/2024/1/e56859 UR - http://dx.doi.org/10.2196/56859 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56859 ER - TY - JOUR AU - Kiani, Parmiss AU - Dolling-Boreham, Roberta AU - Hameed, Saif Mohamed AU - Masino, Caterina AU - Fecso, Andras AU - Okrainec, Allan AU - Madani, Amin PY - 2024/9/10 TI - Usability, Ergonomics, and Educational Value of a Novel Telestration Tool for Surgical Coaching: Usability Study JO - JMIR Hum Factors SP - e57243 VL - 11 KW - augmented reality KW - AR KW - surgical training KW - telestration KW - tele-stration KW - surgical training technology KW - minimally invasive surgery KW - surgery KW - surgeon KW - surgeons KW - surgical KW - surgical coaching KW - surgical teaching KW - telemonitoring KW - telemonitor KW - tele-monitoring KW - tele-monitor KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - digital health KW - digital technology KW - digital intervention KW - digital interventions N2 - Background: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. Objective: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. Methods: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. Results: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device?s size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device?s perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). Conclusions: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training. UR - https://humanfactors.jmir.org/2024/1/e57243 UR - http://dx.doi.org/10.2196/57243 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57243 ER - TY - JOUR AU - Costa, Silva Carlos Dario da AU - Silva, Gouvea Gabriela AU - Santos, dos Emerson Roberto AU - Engel, Carvalho Ana Maria Rita Pedroso Vilela Torres de AU - Costa, Santos Ana Caroline dos AU - da Silva, Morete Taisa AU - da Conceição, Henrique Washington AU - Cristóvão, Helena AU - Lima, Abreu Alba Regina de AU - Brienze, MS Vânia AU - Bizotto, Gastardelo Thaís Santana AU - Oliani, Hélio Antonio AU - André, César Júlio PY - 2024/8/19 TI - Surgical Residents? Perception of Feedback on Their Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e56727 VL - 13 KW - medical education KW - occupational training KW - surgical residents KW - feedback KW - perception N2 - Background: Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner?s perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. Objective: The aim of this study is to identify and map out data from studies that report surgical residents? perception of the feedback received during their education. Methods: The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies? titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. Results: The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. Conclusions: Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents? learning progress. Trial Registration: Open Science Framework yexb; https://osf.io/yexkb. International Registered Report Identifier (IRRID): PRR1-10.2196/56727 UR - https://www.researchprotocols.org/2024/1/e56727 UR - http://dx.doi.org/10.2196/56727 UR - http://www.ncbi.nlm.nih.gov/pubmed/39158942 ID - info:doi/10.2196/56727 ER - TY - JOUR AU - Noori, Sofia AU - Khasnavis, Siddharth AU - DeCroce-Movson, Eliza AU - Blay-Tofey, Morkeh AU - Vitiello, Evan PY - 2024/5/13 TI - A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study JO - JMIR Form Res SP - e41573 VL - 8 KW - digital psychiatry KW - digital mental health KW - didactic curriculum KW - residency training KW - psychiatry residency KW - training classes KW - trainee response KW - residency curriculum KW - trainee feedback N2 - Background: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. Objective: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Methods: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Results: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient?s digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed ?somewhat comfortable? on any of the above measures. Conclusions: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum. UR - https://formative.jmir.org/2024/1/e41573 UR - http://dx.doi.org/10.2196/41573 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739423 ID - info:doi/10.2196/41573 ER - TY - JOUR AU - Ulin, Lindsey AU - Bernstein, A. Simone AU - Nunes, C. Julio AU - Gu, Alex AU - Hammoud, M. Maya AU - Gold, A. Jessica AU - Mirza, M. Kamran PY - 2023/12/25 TI - Improving Transparency in the Residency Application Process: Survey Study JO - JMIR Form Res SP - e45919 VL - 7 KW - data elaboration KW - information transparency KW - medical school KW - residency application KW - residency programs KW - resident N2 - Background: Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process. Objective: This study aims to determine the information applicants find most beneficial from residency programs when deciding where to apply, by type of medical school education background. Methods: Match 2023 applicants voluntarily completed an anonymous survey through the Twitter and Instagram social media platforms. We asked the respondents to select 3 top factors from a multiple-choice list of what information they would like from residency programs to help determine if the characteristics of their application align with program values. We examined differences in helpful factors selected by medical school backgrounds using ANOVA. Results: There were 4649 survey respondents. When responses were analyzed by United States-allopathic (US-MD), doctor of osteopathic medicine (DO), and international medical graduate (IMG) educational backgrounds, respondents chose different factors as most helpful: minimum United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Step 2 scores (565/3042, 18.57% US-MD; 485/3042, 15.9% DO; and 1992/3042, 65.48% IMG; P<.001), resident hometown region (281/1132, 24.82% US-MD; 189/1132, 16.7% DO; and 662/1132, 58.48% IMG; P=.02), resident medical school region (476/2179, 22% US-MD; 250/2179, 11.5% DO; and 1453/2179, 66.7% IMG; P=.002), and percent of residents or attendings underrepresented in medicine (417/1815, 22.98% US-MD; 158/1815, 8.71% DO; and 1240/1815, 68.32% IMG; P<.001). Conclusions: When applying to residency programs, this study found that the factors that respondents consider most helpful from programs in deciding where to apply differ by educational background. Across all educational groups, respondents want transparency around standardized exam scores, geography, and the racial or ethnic backgrounds of residents and attendings. UR - https://formative.jmir.org/2023/1/e45919 UR - http://dx.doi.org/10.2196/45919 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145482 ID - info:doi/10.2196/45919 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 - Ozair, Ahmad AU - Bhat, Vivek AU - Detchou, E. Donald K. PY - 2023/8/17 TI - Authors? Reply to: Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on ?The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators? JO - JMIR Med Educ SP - e50109 VL - 9 KW - admission KW - assessment KW - postgraduate training KW - selection KW - standardized testing KW - graduate medical education KW - medical education UR - https://mededu.jmir.org/2023/1/e50109 UR - http://dx.doi.org/10.2196/50109 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590044 ID - info:doi/10.2196/50109 ER - TY - JOUR AU - Sow, Yacine AU - Gangal, Ameya AU - Yeung, Howa AU - Blalock, Travis AU - Stoff, Benjamin PY - 2023/8/17 TI - Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on ?The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators? JO - JMIR Med Educ SP - e47763 VL - 9 KW - admission KW - assessment KW - postgraduate training KW - selection KW - standardized testing KW - USMLE KW - medical school KW - medical students KW - residency application KW - research training UR - https://mededu.jmir.org/2023/1/e47763 UR - http://dx.doi.org/10.2196/47763 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590047 ID - info:doi/10.2196/47763 ER - TY - JOUR AU - Dunn, Tyler AU - Patel, Shyam AU - Milam, J. Adam AU - Brinkman, Joseph AU - Gorlin, Andrew AU - Harbell, W. Monica PY - 2023/6/29 TI - Influence of Social Media on Applicant Perceptions of Anesthesiology Residency Programs During the COVID-19 Pandemic: Quantitative Survey JO - JMIR Med Educ SP - e39831 VL - 9 KW - anesthesiology residency KW - application KW - COVID-19 pandemic KW - social media KW - impact KW - residency KW - anesthesia KW - anesthesiology KW - pandemic KW - effectiveness KW - restrictions KW - barriers KW - rotations KW - visits KW - interviews KW - applicants KW - perception KW - students KW - program N2 - Background: Social media may be an effective tool in residency recruitment, given its ability to engage a broad audience; however, there are limited data regarding the influence of social media on applicants? evaluation of anesthesiology residency programs. Objective: This study evaluates the influence of social media on applicants? perceptions of anesthesiology residency programs during the COVID-19 pandemic to allow programs to evaluate the importance of a social media presence for residency recruitment. The study also sought to understand if there were differences in the use of social media by applicant demographic characteristics (eg, race, ethnicity, gender, and age). We hypothesized that given the COVID-19 pandemic restrictions on visiting rotations and the interview process, the social media presence of anesthesiology residency programs would have a positive impact on the recruitment process and be an effective form of communication about program characteristics. Methods: All anesthesiology residency applicants who applied to Mayo Clinic Arizona were emailed a survey in October 2020 along with statements regarding the anonymity and optional nature of the survey. The 20-item Qualtrics survey included questions regarding subinternship rotation completion, social media resource use and impact (eg, ?residency-based social media accounts positively impacted my opinion of the program?), and applicant demographic characteristics. Descriptive statistics were examined, and perceptions of social media were stratified by gender, race, and ethnicity; a factor analysis was performed, and the resulting scale was regressed on race, ethnicity, age, and gender. Results: The survey was emailed to 1091 individuals who applied to the Mayo Clinic Arizona anesthesiology residency program; there were 640 unique responses recorded (response rate=58.6%). Nearly 65% of applicants reported an inability to complete 2 or more planned subinternships due to COVID-19 restrictions (n=361, 55.9%), with 25% of applicants reporting inability to do any visiting student rotations (n=167). Official program websites (91.5%), Doximity (47.6%), Instagram (38.5%), and Twitter (19.4%) were reported as the most used resources by applicants. The majority of applicants (n=385, 67.3%) agreed that social media was an effective means to inform applicants, and 57.5% (n=328) of them indicated that social media positively impacted their perception of the program. An 8-item scale with good reliability was created, representing the importance of social media (Cronbach ?=.838). There was a positive and statistically significant relationship such that male applicants (standardized ?=.151; P=.002) and older applicants (?=.159; P<.001) had less trust and reliance in social media for information regarding anesthesiology residency programs. The applicants? race and ethnicity were not associated with the social media scale (?=?.089; P=.08). Conclusions: Social media was an effective means to inform applicants, and generally positively impacted applicants? perception of programs. Thus, residency programs should consider investing time and resources toward building a social media presence to improve resident recruitment. UR - https://mededu.jmir.org/2023/1/e39831 UR - http://dx.doi.org/10.2196/39831 UR - http://www.ncbi.nlm.nih.gov/pubmed/37205642 ID - info:doi/10.2196/39831 ER - TY - JOUR AU - Mahajan, Arnav AU - Hawkins, Austin PY - 2023/6/15 TI - Current Implementation Outcomes of Digital Surgical Simulation in Low- and Middle-Income Countries: Scoping Review JO - JMIR Med Educ SP - e23287 VL - 9 KW - adaptation KW - digital surgery KW - global surgery KW - simulation KW - surgery KW - systematic review KW - technology KW - video game N2 - Background: Digital surgical simulation and telecommunication provides an attractive option for improving surgical skills, widening access to training, and improving patient outcomes; however, it is unclear whether sufficient simulations and telecommunications are accessible, effective, or feasible in low- and middle-income countries (LMICs). Objective: This study aims to determine which types of surgical simulation tools have been most widely used in LMICs, how surgical simulation technology is being implemented, and what the outcomes of these efforts have been. We also offer recommendations for the future development of digital surgical simulation implementation in LMICs. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials to look for qualitative studies in published literature discussing implementation and outcomes of surgical simulation training in LMICs. Eligible papers involved surgical trainees or practitioners who were based in LMICs. Papers that include allied health care professionals involved in task sharing were excluded. We focused specifically on digital surgical innovations and excluded flipped classroom models and 3D models. Implementation outcome had to be reported according to Proctor?s taxonomy. Results: This scoping review examined the outcomes of digital surgical simulation implementation in LMICs for 7 papers. The majority of participants were medical students and residents who were identified as male. Participants rated surgical simulators and telecommunications devices highly for acceptability and usefulness, and they believed that the simulators increased their anatomical and procedural knowledge. However, limitations such as image distortion, excessive light exposure, and video stream latency were frequently reported. Depending on the product, the implementation cost varied between US $25 and US $6990. Penetration and sustainability are understudied implementation outcomes, as all papers lacked long-term monitoring of the digital surgical simulations. Most authors are from high-income countries, suggesting that innovations are being proposed without a clear understanding of how they can be incorporated into surgeons? practical training. Overall, the study indicates that digital surgical simulation is a promising tool for medical education in LMICs; however, additional research is required to address some of the limitations in order to achieve successful implementation, unless scaling efforts prove futile. Conclusions: This study indicates that digital surgical simulation is a promising tool for medical education in LMICs, but further research is necessary to address some of the limitations and ensure successful implementation. We urge more consistent reporting and understanding of implementation of science approaches in the development of digital surgical tools, as this is the critical factor that will determine whether we are able to meet the 2030 goals for surgical training in LMICs. Sustainability of implemented digital surgical tools is a pain point that must be focused on if we are to deliver digital surgical simulation tools to the populations that demand them the most. UR - https://mededu.jmir.org/2023/1/e23287 UR - http://dx.doi.org/10.2196/23287 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318901 ID - info:doi/10.2196/23287 ER - TY - JOUR AU - Ulbrich, Max AU - Van den Bosch, Vincent AU - Bönsch, Andrea AU - Gruber, Johannes Lennart AU - Ooms, Mark AU - Melchior, Claire AU - Motmaen, Ila AU - Wilpert, Caroline AU - Rashad, Ashkan AU - Kuhlen, Wolfgang Torsten AU - Hölzle, Frank AU - Puladi, Behrus PY - 2023/1/19 TI - Advantages of a Training Course for Surgical Planning in Virtual Reality for Oral and Maxillofacial Surgery: Crossover Study JO - JMIR Serious Games SP - e40541 VL - 11 KW - virtual surgical planning KW - virtual reality KW - Elucis KW - 3D Slicer KW - oral and maxillofacial surgery N2 - Background: As an integral part of computer-assisted surgery, virtual surgical planning (VSP) leads to significantly better surgery results, such as for oral and maxillofacial reconstruction with microvascular grafts of the fibula or iliac crest. It is performed on a 2D computer desktop screen (DS) based on preoperative medical imaging. However, in this environment, VSP is associated with shortcomings, such as a time-consuming planning process and the requirement of a learning process. Therefore, a virtual reality (VR)?based VSP application has great potential to reduce or even overcome these shortcomings due to the benefits of visuospatial vision, bimanual interaction, and full immersion. However, the efficacy of such a VR environment has not yet been investigated. Objective: This study aimed to demonstrate the possible advantages of a VR environment through a substep of VSP, specifically the segmentation of the fibula (calf bone) and os coxae (hip bone), by conducting a training course in both DS and VR environments and comparing the results. Methods: During the training course, 6 novices were taught how to use a software application in a DS environment (3D Slicer) and in a VR environment (Elucis) for the segmentation of the fibula and os coxae, and they were asked to carry out the maneuvers as accurately and quickly as possible. Overall, 13 fibula and 13 os coxae were segmented for each participant in both methods (VR and DS), resulting in 156 different models (78 fibula and 78 os coxae) per method (VR and DS) and 312 models in total. The individual learning processes in both environments were compared using objective criteria (time and segmentation performance) and self-reported questionnaires. The models resulting from the segmentation were compared mathematically (Hausdorff distance and Dice coefficient) and evaluated by 2 experienced radiologists in a blinded manner. Results: A much faster learning curve was observed for the VR environment than the DS environment (?=.86 vs ?=.25). This nearly doubled the segmentation speed (cm3/min) by the end of training, leading to a shorter time (P<.001) to reach a qualitative result. However, there was no qualitative difference between the models for VR and DS (P=.99). The VR environment was perceived by participants as more intuitive and less exhausting, and was favored over the DS environment. Conclusions: The more rapid learning process and the ability to work faster in the VR environment could save time and reduce the VSP workload, providing certain advantages over the DS environment. UR - https://games.jmir.org/2023/1/e40541 UR - http://dx.doi.org/10.2196/40541 UR - http://www.ncbi.nlm.nih.gov/pubmed/36656632 ID - info:doi/10.2196/40541 ER - TY - JOUR AU - Ozair, Ahmad AU - Bhat, Vivek AU - Detchou, E. Donald K. PY - 2023/1/6 TI - The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators JO - JMIR Med Educ SP - e37069 VL - 9 KW - admission KW - assessment KW - postgraduate training KW - selection KW - standardized testing UR - https://mededu.jmir.org/2023/1/e37069 UR - http://dx.doi.org/10.2196/37069 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607718 ID - info:doi/10.2196/37069 ER - TY - JOUR AU - Barlow, Emma AU - Zahra, Wajiha AU - Hornsby, Jane AU - Wilkins, Alex AU - Davies, M. Benjamin AU - Burke, Joshua PY - 2022/12/21 TI - Defining a Role for Webinars in Surgical Training Beyond the COVID-19 Pandemic in the United Kingdom: Trainee Consensus Qualitative Study JO - JMIR Med Educ SP - e40106 VL - 8 IS - 4 KW - webinars KW - surgical training KW - trainee consensus KW - teaching KW - training KW - integration KW - trainee experience KW - user experience KW - perception KW - education KW - medical education KW - surgical skills N2 - Background: The COVID-19 pandemic posed several challenges for surgical training, including the suspension of many in-person teaching sessions in lieu of webinars. As restrictions have eased, both prepandemic and postpandemic training methods should be used. Objective: This study investigates trainees? experiences of webinars during the COVID-19 pandemic to develop recommendations for their effective integration into surgical training going forward. Methods: This project was led by the Association of Surgeons in Training and used an iterative process with mixed qualitative methods to consolidate arguments for and against webinars, and the drivers and barriers to their effective delivery, into recommendations. This involved 3 phases: (1) a web-based survey, (2) focus group interviews, and (3) a consensus session using a nominal group technique. Results: Trainees (N=281) from across specialties and grades confirmed that the COVID-19 pandemic led to an increase in webinars for surgical training. While there were concerns, particularly around the utility for practical training (80.9%), the majority agreed that webinars had a role in training following the COVID-19 pandemic (90.2%). The cited benefits included improved access or flexibility and potential standardization of training. The majority of limitations were technical. These perspectives were refined through focus group interviews (n=18) into 25 recommendations, 23 of which were ratified at a consensus meeting, which was held at the Association of Surgeons in Training 2021 conference. Conclusions: Webinars have a role in surgical training following the COVID-19 pandemic. The 23 recommendations encompass indications and technical considerations but also discuss important knowledge gaps. They should serve as an initial framework for ensuring that webinars add value and continue to evolve as a tool for training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055325; http://www.chictr.org.cn/showprojen.aspx?proj=142802 UR - https://mededu.jmir.org/2022/4/e40106 UR - http://dx.doi.org/10.2196/40106 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542431 ID - info:doi/10.2196/40106 ER - TY - JOUR AU - Jensen, Katherine AU - Yan, Qi AU - Davies, G. Mark PY - 2022/6/29 TI - Critical Comparison of the Quality and Content of Integrated Vascular Surgery, Thoracic Surgery, and Interventional Radiology Residency Training Program Websites: Qualitative Study JO - JMIR Med Educ SP - e35074 VL - 8 IS - 2 KW - training KW - recruitment KW - website KW - content KW - quality KW - vascular surgery KW - thoracic surgery KW - interventional radiology KW - radiology KW - surgery KW - web-based KW - web resource KW - surgeon KW - comparison KW - residency KW - integrated program N2 - Background: With the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery, and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program. Objective: The aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs. Methods: A list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) database. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software. Results: Of ACGME-accredited programs, 56 of 61 (92%) vascular surgery, 27 of 27 (100%) thoracic surgery, and 74 of 85 (87%) interventional radiology programs had functional websites (P=.12). Vascular surgery websites contained a median of 26 (IQR 20-32) content items, thoracic surgery websites contained a median of 27 (IQR 21-32) content items, and interventional radiology websites contained a median of 23 (IQR 18-27) content items. Two content items considered highly influential to applicant program decisions are procedural experience and faculty mentorship, which were reported at 32% (18/56) and 11% (6/56) for vascular surgery, 19% (5/27) and 11% (3/27) for thoracic surgery, and 50% (37/74) and 15% (11/74) for interventional radiology (P=.008 and P=.75), respectively. Key deficits were work hours, debt management, and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; and operative experiences and the program director?s contact and message for thoracic surgery. Interventional radiology deficits were work hours, and thoracic surgery deficits were procedural experience. Both interventional radiology and thoracic surgery websites lacked information on evaluation criteria and faculty mentorship. Conclusions: This study has uncovered key differences in the availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content to attract valuable candidates. UR - https://mededu.jmir.org/2022/2/e35074 UR - http://dx.doi.org/10.2196/35074 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767342 ID - info:doi/10.2196/35074 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 - 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 - Kunkes, Taylor AU - Makled, Basiel AU - Norfleet, Jack AU - Schwaitzberg, Steven AU - Cavuoto, Lora PY - 2022/4/21 TI - Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis JO - JMIR Perioper Med SP - e34522 VL - 5 IS - 1 KW - knowledge elicitation KW - knowledge acquisition KW - medical simulation KW - medical training KW - medical assessment KW - critical care KW - cognitive task analysis KW - qualitative methods KW - qualitative KW - endotracheal intubation KW - preoperative KW - training KW - health care professional KW - medical education KW - cognitive skill N2 - Background: Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. Objective: This study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties. Methods: A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task. Results: The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment. Conclusions: Although the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices. UR - https://periop.jmir.org/2022/1/e34522 UR - http://dx.doi.org/10.2196/34522 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451970 ID - info:doi/10.2196/34522 ER - TY - JOUR AU - Gibney, Ryan AU - Cantwell, Christina AU - Wray, Alisa AU - Boysen-Osborn, Megan AU - Wiechmann, Warren AU - Saadat, Soheil AU - Smart, Jonathan AU - Toohey, Shannon PY - 2022/4/5 TI - Influence of Factors Relating to Sex and Gender on Rank List Decisions and Perceptions of Residency Training: Survey Study JO - JMIR Med Educ SP - e33592 VL - 8 IS - 2 KW - residency KW - sex KW - gender KW - graduate medical education KW - emergency medicine KW - residents KW - program leadership KW - rank list N2 - Background: Females make up more than half of medical school matriculants but only one-third of emergency medicine (EM) residents. Various factors may contribute to why fewer females choose the field of EM, such as the existing presence of females in the specialty. Objective: This study is a follow-up to previous work, and a survey is used to assess current residents? attitudes and perceptions on various factors, including those relating to sex and gender on creating rank lists as medical students and in perceived effects on residency education. Methods: A web-based survey consisting of Likert scale questions regarding a variety of factors influencing a student?s decision to create a rank list and in perceived effects on residency education was sent to current EM residents in 2020. Results: Residents from 17 programs participated in the survey with an 18.2% (138/758) response rate. The most important factors in creating a rank list were the personality of residents in the program, location, and facility type. For factors specifically related to gender, respondents who answered affirmatively to whether the gender composition of residents affected the selection of a program in making a rank list were more likely to also answer affirmatively to subsequent questions related to the gender of program leadership (P<.001) and gender composition of attending physicians (P<.001). The personality of residents was also the most important factor perceived to affect residency education. For factors influencing rank list and residency education, female respondents placed higher importance on subcategories related to gender (ie, gender composition of the residents, of the program leadership, and of the attending physicians) to a significant degree compared with their male counterparts. Conclusions: Although factors such as location and resident personality show the most importance in influencing residency selection, when stratifying based on respondent sex, females tend to indicate that factors relating to gender have more influence on rank list and residency education compared with males. UR - https://mededu.jmir.org/2022/2/e33592 UR - http://dx.doi.org/10.2196/33592 UR - http://www.ncbi.nlm.nih.gov/pubmed/35380547 ID - info:doi/10.2196/33592 ER - TY - JOUR AU - Sanavro, M. Sanne AU - van der Worp, Henk AU - Jansen, Danielle AU - Koning, Paul AU - Blanker, H. Marco AU - PY - 2022/4/1 TI - Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study JO - JMIR Hum Factors SP - e33630 VL - 9 IS - 2 KW - primary care KW - digital consultation KW - interdisciplinary KW - specialist care N2 - Background: Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective: This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods: We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results: In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions: Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking. UR - https://humanfactors.jmir.org/2022/2/e33630 UR - http://dx.doi.org/10.2196/33630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363155 ID - info:doi/10.2196/33630 ER - TY - JOUR AU - 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 - Tamblyn, Robert AU - Brieva, Jorge AU - Cain, Madeleine AU - Martinez, Eduardo F. PY - 2022/3/7 TI - The Effects of Introducing a Mobile App?Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study JO - JMIR Hum Factors SP - e35199 VL - 9 IS - 1 KW - logbook KW - education KW - training KW - central venous catheter KW - CVC KW - intensive care KW - smartphone KW - mobile phone KW - mobile apps KW - mHealth KW - mobile health KW - accreditation program KW - digital health KW - digital record N2 - Background: To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU). Objective: The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook. Methods: This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients? electronic medical records appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor?s signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. Results: Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72%) were included and separated into cohorts before and after the app?s introduction. Following the introduction of the app-based logbook, the percentage of CVC insertions appearing as logbook entries increased from 3.6% (38/1059) to 20.5% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor?s signature before and after the introduction of the app, with 76.3% (29/38) and 83.2% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3% (13/85) to 62.8% (54/86; P<.001). Adherence to one?s logbook was similar in both groups with 60% (6/10) of first-time users in the before group and 79.5% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU. Conclusions: The addition of an electronic app-based logbook to a preexisting paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook use observed without a reduction in the quality of logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted. UR - https://humanfactors.jmir.org/2022/1/e35199 UR - http://dx.doi.org/10.2196/35199 UR - http://www.ncbi.nlm.nih.gov/pubmed/35051900 ID - info:doi/10.2196/35199 ER - TY - JOUR AU - Sadeghi, H. Amir AU - Peek, J. Jette AU - Max, A. Samuel AU - Smit, L. Liselot AU - Martina, G. Bryan AU - Rosalia, A. Rodney AU - Bakhuis, Wouter AU - Bogers, JJC Ad AU - Mahtab, AF Edris PY - 2022/3/2 TI - Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study JO - JMIR Serious Games SP - e30456 VL - 10 IS - 1 KW - cardiac surgery KW - cardiopulmonary resuscitation KW - emergency resternotomy KW - virtual reality KW - simulation training KW - serious games KW - virtual reality simulation KW - digital health KW - medical training KW - virtual training N2 - Background: Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim. Objective: We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery. Methods: Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator?s usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity. Results: Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87%) felt actively involved in the simulation, and 23 (77%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80%) and thought that the software responded adequately (n=21, 70%). All 15 (100%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87%) of the expert participants would recommend VR training to other colleagues, and 14 (93%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post?cardiac surgery emergencies requiring CPR. Additionally, 10 (91%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario. Conclusions: We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform. UR - https://games.jmir.org/2022/1/e30456 UR - http://dx.doi.org/10.2196/30456 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234652 ID - info:doi/10.2196/30456 ER - TY - JOUR AU - Zombre, David AU - Kortenaar, Jean-Luc AU - Zareef, Farhana AU - Doumbia, Moussa AU - Doumbia, Sekou AU - Haidara, Fadima AU - McLaughlin, Katie AU - Sow, Samba AU - Bhutta, A. Zulfiqar AU - Bassani, G. Diego PY - 2021/12/10 TI - Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial JO - JMIR Res Protoc SP - e28644 VL - 10 IS - 12 KW - perinatal mortality KW - low dose high frequency training KW - maternal and newborn health outcomes KW - Mali N2 - Background: Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. Objective: This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality. Methods: The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. Results: The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol. Conclusions: The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237 International Registered Report Identifier (IRRID): DERR1-10.2196/28644 UR - https://www.researchprotocols.org/2021/12/e28644 UR - http://dx.doi.org/10.2196/28644 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889776 ID - info:doi/10.2196/28644 ER - TY - JOUR AU - Wu, Andrew AU - Radhakrishnan, Varsha AU - Targan, Elizabeth AU - Scarella, M. Timothy AU - Torous, John AU - Hill, P. Kevin PY - 2021/10/6 TI - Self-Reported Preferences for Help-Seeking and Barriers to Using Mental Health Supports Among Internal Medicine Residents: Exploratory Use of an Econometric Best-Worst Scaling Framework for Gathering Physician Wellness Preferences JO - JMIR Med Educ SP - e28623 VL - 7 IS - 4 KW - residency program KW - choice KW - burnout KW - wellness N2 - Background: Burnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions. Objective: This study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers. Methods: Internal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options. Results: Of the 163 invited residents, 77 (47.2% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71%; worst: 0.6%) and support from friends and family (best: 70%; worst: 1.6%). Top-ranking barriers to seeking counseling included time (best: 75%; worst: 5%) and money (best: 35%; worst: 21%). Conclusions: Overall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework. UR - https://mededu.jmir.org/2021/4/e28623 UR - http://dx.doi.org/10.2196/28623 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612838 ID - info:doi/10.2196/28623 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 - Naaseh, Ariana AU - Thompson, Sean AU - Tohmasi, Steven AU - Wiechmann, Warren AU - Toohey, Shannon AU - Wray, Alisa AU - Boysen-Osborn, Megan PY - 2021/10/5 TI - Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study JO - JMIR Med Educ SP - e29486 VL - 7 IS - 4 KW - residency application KW - social media KW - medical education KW - resident KW - medical student KW - perspective KW - residency recruitment KW - virtual application KW - virtual residency N2 - Background: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media?based communication and dissemination of information. Objective: We sought to determine social media?s impact on residency applicants during an entirely virtual application cycle. Methods: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. Results: A total of 72 participants (15.5% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53% (n=38) reported following prospective residency accounts on social media, and 89% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74%) increasing the number of programs to which they applied. Survey respondents ranked social media?s effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86%) felt that programs should use social media in future application cycles even if they are nonvirtual. Conclusions: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match. UR - https://mededu.jmir.org/2021/4/e29486 UR - http://dx.doi.org/10.2196/29486 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591779 ID - info:doi/10.2196/29486 ER - TY - JOUR AU - Rebelo, Artur AU - Ukkat, Jörg AU - Klose, Johannes AU - Ronellenfitsch, Ulrich AU - Kleeff, Jörg PY - 2021/10/5 TI - Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e31212 VL - 10 IS - 10 KW - meta-analysis KW - cholangiocarcinoma KW - arterial resection KW - surgery KW - vascular resections KW - cardiology KW - outcomes KW - mortality KW - morbidity KW - perioperative KW - cancer KW - tumor KW - liver KW - liver cancer N2 - Background: In light of recent advances in multimodality treatment, an analysis of vascular resection outcomes in surgery for hilar cholangiocarcinoma is lacking. Objective: The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma. Methods: A systematic literature search in the databases PubMed/MEDLINE, Cochrane Library, and CINAHL, and the trial registries ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform will be carried out. Predefined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication), vascular complications (thrombosis or stenosis of the portal vein or hepatic artery, pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3-, and 5-year survival), complete/incomplete resection rates, histologic arterial invasion, and lymph node positivity (number of positive lymph nodes and lymph node ratio). Results: Database searches will commence in December 2020. The meta-analysis will be completed by December 2021. Conclusions: Our findings will enable us to present the current evidence on the feasibility, safety, and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. Our data will support health care professionals and patients in their clinical decision-making. Trial Registration: PROSPERO 223396; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223396 International Registered Report Identifier (IRRID): DERR1-10.2196/31212 UR - https://www.researchprotocols.org/2021/10/e31212 UR - http://dx.doi.org/10.2196/31212 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609321 ID - info:doi/10.2196/31212 ER - TY - JOUR AU - Mok, Tsz-Ngai AU - Chen, Junyuan AU - Pan, Jinghua AU - Ming, Wai-Kit AU - He, Qiyu AU - Sin, Tat-Hang AU - Deng, Jialin AU - Li, Jieruo AU - Zha, Zhengang PY - 2021/7/12 TI - Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e27544 VL - 9 IS - 3 KW - virtual reality simulators KW - tendon suture KW - medical education N2 - Background: Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective: The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods: In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the ?Kessler tendon repair with 2 interrupted tendon repair knots? (KS) method and the ?Bunnell tendon repair with figure 8 tendon repair? (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results: Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions: Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180 UR - https://games.jmir.org/2021/3/e27544 UR - http://dx.doi.org/10.2196/27544 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255649 ID - info:doi/10.2196/27544 ER - TY - JOUR AU - Thompson, Daniel PY - 2021/5/13 TI - Utilization of the iOS Shortcuts App to Generate a Surgical Logbook Tool: Feasibility Study JO - JMIR Perioper Med SP - e24644 VL - 4 IS - 1 KW - app KW - audit KW - data collection KW - data KW - feasibility KW - medical education KW - mHealth KW - surgery KW - surgical audit KW - surgical education KW - utility N2 - Background: Surgical audit is an essential aspect of modern reflective surgical practice and is key to improving surgical outcomes. The surgical logbook is an important method of data collection for both personal and unit audits; however, current electronic data collection tools, especially mobile apps, lack the minimum recommended data fields. Objective: This feasibility study details the creation of a free, effective surgical logbook tool with the iOS Shortcuts app and investigates the time investment required to maintain a surgical logbook with this tool. In addition, we investigate the potential utility of the Shortcuts app in creating medical data collection tools. Methods: Using the iOS Shortcuts app, we created a shortcut ?Operation Note,? which collects surgical logbook data by using the minimum and extended audit data sets recommended by the Royal Australasian College of Surgeons. We practically assessed the feasibility of the tool, assessing the time requirement for entry, accuracy, and completeness of the entered data. Results: The shortcut collected accurate and useful data for a surgical audit. Data entry took on average 65 seconds per case for the minimum data set, and 135 seconds per case for the extended data set, with a mean difference of 68 seconds (P<.001; 95% CI 61.6-77.7). Conclusions: This feasibility study demonstrates the utility of the iOS Shortcuts app in the creation of a surgical logbook and the time-consuming nature of data collection for surgical audit. Our iOS Operation Note shortcut is a free, rapid, and customizable alternative to currently available logbook apps and offers surgical trainees and consultants a method for recording surgical operations, complications, and demographic data. UR - https://periop.jmir.org/2021/1/e24644 UR - http://dx.doi.org/10.2196/24644 UR - http://www.ncbi.nlm.nih.gov/pubmed/33983132 ID - info:doi/10.2196/24644 ER - TY - JOUR AU - Haq, Ul Irfan AU - Hameed, Ali Mansoor AU - Thomas, Marry Merlin AU - Syed, Shahzada Khezar AU - Othman, Mahmoud Ahmad Mohammad AU - Ahmed, Shakeel AU - Alabbas, Abdallah Abbas AU - Ahmad, Mushtaq PY - 2021/5/12 TI - Knowledge of Sleep Disorders Among Physicians at a Tertiary Care Hospital in Qatar: Cross-sectional Study JO - Interact J Med Res SP - e25606 VL - 10 IS - 2 KW - sleep disordered breathing KW - obstructive sleep apnea KW - sleep KW - physician KW - physician knowledge KW - sleep disorder KW - survey method KW - attitudes KW - practice N2 - Background: Sleep disorders constitute a major health problem because of their relatively high and rising prevalence. Several studies worldwide have analyzed health care providers? knowledge of sleep disorders. Objective: In this study, we aimed to assess the knowledge of sleep disorders among physicians in Qatar. Methods: A total of 250 physicians were surveyed regarding their knowledge of sleep medicine by using the validated 30-item Assessment of Sleep Knowledge in Medical Education (ASKME) Survey. The participants included residents, fellows, and consultants in medicine and allied subspecialties. A high score was defined as ?60% of correctly answered questions, implying the respondent has adequate knowledge of sleep disorders. Results: Responses were received from 158 of the 250 physicians, with a response rate of 63.2%. This included responses from 34 residents, 74 clinical fellows, and 50 consultants. The overall mean score was 15.53 (SD 4.42), with the highest possible score of 30. Only 57 of 158 (36.1%) respondents were able to answer ?60% of the questions correctly. No statistically significant difference was found in the scores of participants with regard to their ranks (ie, residents, fellows, or consultants) or years of medical training. Conclusions: This study demonstrates that health care providers in Qatar have decreased awareness and knowledge about sleep medicine, which may reflect reduced emphasis on sleep disorders during medical school and training. Increasing awareness regarding sleep medicine among nonspecialist physicians will allow early detection and treatment of sleep disorders, thereby reducing the morbidity associated with these disorders. UR - https://www.i-jmr.org/2021/2/e25606 UR - http://dx.doi.org/10.2196/25606 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978594 ID - info:doi/10.2196/25606 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 - Poole, Jane Grace Olivia AU - Melamed, Naomi AU - Hubbard, Ella PY - 2021/3/4 TI - Addressing Disciplinary Misconceptions: Mentorship Programs and Student-Led Surgical Societies. Comment on ?Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study? JO - Interact J Med Res SP - e17237 VL - 10 IS - 1 KW - medical education KW - plastic surgery KW - students UR - https://www.i-jmr.org/2021/1/e17237 UR - http://dx.doi.org/10.2196/17237 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661131 ID - info:doi/10.2196/17237 ER - TY - JOUR AU - Hamidian Jahromi, Alireza AU - Arnautovic, Alisa AU - Konofaos, Petros PY - 2020/11/17 TI - Impact of the COVID-19 Pandemic on the Education of Plastic Surgery Trainees in the United States JO - JMIR Med Educ SP - e22045 VL - 6 IS - 2 KW - COVID-19 KW - coronavirus KW - education KW - plastic surgery residency KW - plastic surgery fellowship KW - surgery residency KW - impact KW - trainee UR - http://mededu.jmir.org/2020/2/e22045/ UR - http://dx.doi.org/10.2196/22045 UR - http://www.ncbi.nlm.nih.gov/pubmed/33119537 ID - info:doi/10.2196/22045 ER - TY - JOUR AU - Hejjaji, Vittal AU - Malik, O. Ali AU - Peri-Okonny, A. Poghni AU - Thomas, Merrill AU - Tang, Yuanyuan AU - Wooldridge, David AU - Spertus, A. John AU - Chan, S. Paul PY - 2020/5/19 TI - Mobile App to Improve House Officers? Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study JO - JMIR Mhealth Uhealth SP - e15762 VL - 8 IS - 5 KW - cardiac arrest KW - advanced cardiac life support KW - mHealth KW - quality improvement KW - medical education N2 - Background: Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective: The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers? adherence to ACLS guidelines. Methods: As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results: Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference ?0.7 [95% CI ?0.3 to ?1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions: This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown. UR - https://mhealth.jmir.org/2020/5/e15762 UR - http://dx.doi.org/10.2196/15762 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427115 ID - info:doi/10.2196/15762 ER - TY - JOUR AU - IJgosse, Wouter AU - van Goor, Harry AU - Rosman, Camiel AU - Luursema, Jan-Maarten PY - 2020/5/7 TI - Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study JO - JMIR Serious Games SP - e17222 VL - 8 IS - 2 KW - laparoscopy KW - surgery KW - training KW - education KW - serious game KW - resident training KW - skills development KW - psychomotor skills KW - simulation center N2 - Background: Surgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents? motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training. Objective: The aim of this study was to establish construct validity for the laparoscopic serious game Underground. Methods: All study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience. Results: Controlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable. Conclusions: We established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed. UR - http://games.jmir.org/2020/2/e17222/ UR - http://dx.doi.org/10.2196/17222 UR - http://www.ncbi.nlm.nih.gov/pubmed/32379051 ID - info:doi/10.2196/17222 ER - TY - JOUR AU - Abduljabbar, H. Ahmed AU - Alnajjar, F. Sara AU - Alshamrani, Hussein AU - Bashamakh, F. Lujain AU - Alshehri, Z. Hisham AU - Alqulayti, M. Waleed AU - Wazzan, A. Mohammad PY - 2020/4/28 TI - The Influence of Gender on the Choice of Radiology as a Specialty Among Medical Students in Saudi Arabia: Cross-Sectional Study JO - Interact J Med Res SP - e14666 VL - 9 IS - 2 KW - gender KW - radiology KW - specialty choice N2 - Background: Medical undergraduates are the future doctors of the country. Therefore, determining how medical students choose their areas of specialty is essential to obtain a balanced distribution of physicians among all specialties. Although gender is a significant factor that affects specialty choice, the factors underlying gender differences in radiology are not fully elucidated. Objective: This study examined the factors that attracted medical students to and discouraged them from selecting diagnostic radiology and analyzed whether these factors differed between female and male medical students. Methods: This cross-sectional study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, used an electronic questionnaire sent to medical students from all medical years during February 2018. Subgroup analyses for gender and radiology interest were performed using the chi-square test and Cramér?s V test. Results: In total, 539 students (276 women; 263 men) responded. The most common factor preventing students from choosing radiology as a career was the lack of direct patient contact, which deterred approximately 47% who decided against considering this specialty. Negative perceptions by other physicians (P<.001), lack of acknowledgment by patients (P=.004), and lack of structured radiology rotations (P=.007) dissuaded significantly more male students than female students. Among those interested in radiology, more female students were attracted by job flexibility (P=.01), while more male students were attracted by focused patient interactions with minimal paperwork (P<.001). Conclusions: No significant difference was found between the genders in terms of considering radiology as a specialty. Misconception plays a central role in students? judgment regarding radiology. Hence, early exposure to radiology, assuming a new teaching method, and using a curriculum that supports the active participation of students in a radiology rotation are needed to overcome this misconception. UR - http://www.i-jmr.org/2020/2/e14666/ UR - http://dx.doi.org/10.2196/14666 UR - http://www.ncbi.nlm.nih.gov/pubmed/32141832 ID - info:doi/10.2196/14666 ER - TY - JOUR AU - Li, Shuang AU - Li, Guoqing AU - Liu, Ying AU - Xu, Wanying AU - Yang, Ningning AU - Chen, Haoyuan AU - Li, Ning AU - Luo, Kunpeng AU - Jin, Shizhu PY - 2020/3/23 TI - Development and Assessment of a Gastroscopy Electronic Learning System for Primary Learners: Randomized Controlled Trial JO - J Med Internet Res SP - e16233 VL - 22 IS - 3 KW - e-learning KW - gastroscopy KW - endoscopy KW - randomized controlled trial N2 - Background: Endoscopic examination is a popular and routine procedure for the diagnosis and treatment of gastrointestinal (GI) diseases. Skilled endoscopists are in great demand in clinical practice, but the training process for beginners to become endoscopy specialists is fairly long. Convenience and a self-paced, learner-centered approach make electronic learning (e-learning) an excellent instructional prospect. Objective: This study aimed to develop and apply an e-learning system in gastroscopy teaching and learning and to evaluate its effectiveness and user satisfaction. Methods: The e-learning software Gastroscope Roaming System was developed for primary learners. The system simulates the real structure of the upper gastrointestinal (UGI) tract to teach the main characteristics of gastroscopy under both normal conditions and conditions of common UGI tract diseases. A randomized controlled trial was conducted. Participants were randomly allocated to an e-learning group (EG)or a non?e-learning control group after a pretest. On completing the training, participants undertook a posttest and gastroscopy examination. In addition, the EG completed a satisfaction questionnaire. Results: Of the 44 volunteers, 41 (93%) completed the gastroscopy learning and testing components. No significant pretest differences were found between the intervention and control groups (mean 50.86, SD 6.12 vs mean 50.76, SD 6.88; P=.96). After 1 month of learning, the EG?s posttest scores were higher (mean 83.70, SD 5.99 vs mean 78.76, SD 7.58; P=.03) and improved more (P=.01) than those of the control group, with better performance in the gastroscopy examination (mean 91.05, SD 4.58 vs mean 84.38, SD 5.19; P<.001). Overall, 85% (17/20) of the participants were satisfied with the e-learning system, and 95% (19/20) of the participants considered it successful. Conclusions: E-learning is an effective educational strategy for primary learners to acquire skills in gastroscopy examination and endoscopic imaging of the GI tract. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17013091; http://www.chictr.org.cn/showproj.aspx?proj=22142 UR - http://www.jmir.org/2020/3/e16233/ UR - http://dx.doi.org/10.2196/16233 UR - http://www.ncbi.nlm.nih.gov/pubmed/32202507 ID - info:doi/10.2196/16233 ER - TY - JOUR AU - Katz, Daniel AU - Shah, Ronak AU - Kim, Elizabeth AU - Park, Chang AU - Shah, Anjan AU - Levine, Adam AU - Burnett, Garrett PY - 2020/3/12 TI - Utilization of a Voice-Based Virtual Reality Advanced Cardiac Life Support Team Leader Refresher: Prospective Observational Study JO - J Med Internet Res SP - e17425 VL - 22 IS - 3 KW - video game KW - experimental game KW - virtual reality KW - advanced cardiac life support N2 - Background: The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of training are expensive, time consuming, and difficult to scale, which necessitates improvements in advanced cardiac life support (ACLS) training. Virtual reality (VR) has been proposed as an alternative or adjunct to high-fidelity simulation (HFS) in several environments. No evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills and demonstrate a cost comparison. Objective: This study aimed to explore the utility of a voice-based VR ACLS team leader refresher as compared with HFS. Methods: This prospective observational study performed at an academic institution consisted of 25 postgraduate year 2 residents. Participants were randomized to HFS or VR training and then crossed groups after a 2-week washout. Participants were graded on technical and nontechnical skills. Participants also completed self-assessments about the modules. Proctors were assessed for fatigue and task saturation, and cost analysis based on local economic data was performed. Results: A total of 23 of 25 participants were included in the scoring analysis. Fewer participants were familiar with VR compared with HFS (9/25, 36% vs 25/25, 100%; P<.001). Self-reported satisfaction and utilization scores were similar; however, significantly more participants felt HFS provided better feedback: 99 (IQR 89-100) vs 79 (IQR 71-88); P<.001. Technical scores were higher in the HFS group; however, nontechnical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 (IQR 19-24) min shorter than HFS sessions, the National Aeronautics and Space Administration task load index scores for proctors were lower in each category, and VR sessions were estimated to be US $103.68 less expensive in a single-learner, single-session model. Conclusions: Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction. The VR module was more cost-effective and was easier to proctor; however, HFS was better at delivering feedback to participants. Optimal education strategies likely contain elements of both modalities. Further studies are needed to examine the utility of VR-based environments at scale. UR - http://www.jmir.org/2020/3/e17425/ UR - http://dx.doi.org/10.2196/17425 UR - http://www.ncbi.nlm.nih.gov/pubmed/32163038 ID - info:doi/10.2196/17425 ER - TY - JOUR AU - García-Carbajal, Santiago AU - Pipa-Muniz, María AU - Múgica, Luis Jose PY - 2020/2/27 TI - Using String Metrics to Improve the Design of Virtual Conversational Characters: Behavior Simulator Development Study JO - JMIR Serious Games SP - e15349 VL - 8 IS - 1 KW - spoken interaction KW - string metrics KW - virtual conversational characters KW - serious games KW - e-learning N2 - Background: An emergency waiting room is a place where conflicts often arise. Nervous relatives in a hostile, unknown environment force security and medical staff to be ready to deal with some awkward situations. Additionally, it has been said that the medical interview is the first diagnostic and therapeutic tool, involving both intellectual and emotional skills on the part of the doctor. At the same time, it seems that there is something mysterious about interviewing that cannot be formalized or taught. In this context, virtual conversational characters (VCCs) are progressively present in most e-learning environments. Objective: In this study, we propose and develop a modular architecture for a VCC-based behavior simulator to be used as a tool for conflict avoidance training. Our behavior simulators are now being used in hospital environments, where training exercises must be easily designed and tested. Methods: We define training exercises as labeled, directed graphs that help an instructor in the design of complex training situations. In order to increase the perception of talking to a real person, the simulator must deal with a huge number of sentences that a VCC must understand and react to. These sentences are grouped into sets identified with a common label. Labels are then used to trigger changes in the active node of the graph that encodes the current state of the training exercise. As a consequence, we need to be able to map every sentence said by the human user into the set it belongs to, in a fast and robust way. In this work, we discuss two different existing string metrics, and compare them to one that we use to assess a designed exercise. Results: Based on the similarities found between different sets, the proposed metric provided valuable information about ill-defined exercises. We also described the environment in which our programs are being used and illustrated it with an example. Conclusions: Initially designed as a tool for training emergency room staff, our software could be of use in many other areas within the same environment. We are currently exploring the possibility of using it in speech therapy situations. UR - http://games.jmir.org/2020/1/e15349/ UR - http://dx.doi.org/10.2196/15349 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130121 ID - info:doi/10.2196/15349 ER - TY - JOUR AU - Sapci, Hasan A. AU - Sapci, Aylin H. PY - 2020/1/21 TI - Teaching Hands-On Informatics Skills to Future Health Informaticians: A Competency Framework Proposal and Analysis of Health Care Informatics Curricula JO - JMIR Med Inform SP - e15748 VL - 8 IS - 1 KW - health informatics curriculum KW - skill-based training KW - hands-on health informatics training N2 - Background: Existing health informatics curriculum requirements mostly use a competency-based approach rather than a skill-based one. Objective: The main objective of this study was to assess the current skills training requirements in graduate health informatics curricula to evaluate graduate students? confidence in specific health informatics skills. Methods: A quantitative cross-sectional observational study was developed to evaluate published health informatics curriculum requirements and to determine the comprehensive health informatics skill sets required in a research university in New York, United States. In addition, a questionnaire to assess students? confidence about specific health informatics skills was developed and sent to all enrolled and graduated Master of Science students in a health informatics program. Results: The evaluation was performed in a graduate health informatics program, and analysis of the students? self-assessments questionnaire showed that 79.4% (81/102) of participants were not confident (not at all confident or slightly confident) about developing an artificial intelligence app, 58.8% (60/102) were not confident about designing and developing databases, and 54.9% (56/102) were not confident about evaluating privacy and security infrastructure. Less than one-third of students (24/105, 23.5%) were confident (extremely confident and very confident) that they could evaluate the use of data capture technologies and develop mobile health informatics apps (10/102, 9.8%). Conclusions: Health informatics programs should consider specialized tracks that include specific skills to meet the complex health care delivery and market demand, and specific training components should be defined for different specialties. There is a need to determine new competencies and skill sets that promote inductive and deductive reasoning from diverse and various data platforms and to develop a comprehensive curriculum framework for health informatics skills training. UR - http://medinform.jmir.org/2020/1/e15748/ UR - http://dx.doi.org/10.2196/15748 UR - http://www.ncbi.nlm.nih.gov/pubmed/31961328 ID - info:doi/10.2196/15748 ER - TY - JOUR AU - Mortada, Hisham Hatan AU - Alqahtani, Aayed Yara AU - Seraj, Zakaria Hadeel AU - Albishi, Khalid Wahbi AU - Aljaaly, A. Hattan PY - 2019/04/03 TI - Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study JO - Interact J Med Res SP - e12999 VL - 8 IS - 2 KW - plastic surgery KW - perception KW - knowledge KW - medical students KW - media KW - King Abdulaziz University KW - Jeddah KW - Saudi Arabia N2 - Background: Although plastic surgery has been gaining a lot of popularity recently, there seems to be limited perception and a poor understanding of this field by both medical professionals, including medical students, and the general public. This might alter referral patterns as well as medical students? choice to pursue a career in plastic surgery. Objective: The purpose of this study was to assess knowledge and perception of plastic surgery among medical students and to explore the influencing factors underlying particular beliefs. Methods: Data for this cross-sectional study were collected between August 22 and December 22, 2017. The questionnaire was formulated on the basis of our own study objectives and from available questionnaires with similar objectives. It was composed of 14 questions divided into three main parts: demographics, the specialty of plastic surgery, and media involvement and its effect on plastic surgery. The study was conducted via an online questionnaire among medical students in all years at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20. Results: A total of 886 medical students participated in this study. We achieved a response rate of 56.79%. The mean age of the participants was 21.2 years. The mean awareness score was 9.7 (SD 4.2) for female students and 8.3 (SD 4.2) for male students (P<.001). The condition most commonly known to be treated by a plastic surgeon was burns (70.3% of responses). Conclusions: Medical students do not have adequate awareness of plastic surgery, and early exposure to this specialty may enhance their awareness. UR - http://www.i-jmr.org/2019/2/e12999/ UR - http://dx.doi.org/10.2196/12999 UR - http://www.ncbi.nlm.nih.gov/pubmed/30942694 ID - info:doi/10.2196/12999 ER - TY - JOUR AU - Nandiwada, Rani Deepa AU - Fischer, S. Gary AU - Updike, Glenn AU - Conroy, B. Margaret PY - 2018/06/15 TI - Resident and Attending Physicians? Perceptions of Patient Access to Provider Notes: Comparison of Perceptions Prior to Pilot Implementation JO - JMIR Med Educ SP - e15 VL - 4 IS - 1 KW - access to information KW - electronic health records KW - physicians KW - internal medicine KW - surveys and questionnaires N2 - Background: As electronic health records have become a more integral part of a physician?s daily life, new electronic health record tools will continue to be rolled out to trainees. Patient access to provider notes is becoming a more widespread practice because this has been shown to increase patient empowerment. Objective: In this analysis, we compared differences between resident and attending physicians? perceptions prior to implementation of patient access to provider notes to facilitate optimal use of electronic health record features and as a potential for patient empowerment. Methods: This was a single-site study within an academic internal medicine program. Prior to implementation of patient access to provider notes, we surveyed resident and attending physicians to assess differences in perceptions of this new electronic health record tool using an open access survey provided by OpenNotes. Results: We surveyed 37% (20/54 total) of resident physicians and obtained a 100% response rate and 72% (31/44 total) of attending physicians. Similarities between the groups included concerns about documenting sensitive topics and anticipation of improved patient engagement. Compared with attending physicians, resident physicians were more concerned about litigation, discussing weight, offending patients, and communicated less overall with patients through electronic health record. Conclusions: Patient access to provider notes has the potential to empower patients but concerns of the resident physicians need to be validated and addressed prior to its utilization. UR - http://mededu.jmir.org/2018/1/e15/ UR - http://dx.doi.org/10.2196/mededu.8904 UR - http://www.ncbi.nlm.nih.gov/pubmed/29907558 ID - info:doi/10.2196/mededu.8904 ER - TY - JOUR AU - Khan, Zubair AU - Darr, Umar AU - Khan, Ali Muhammad AU - Nawras, Mohamad AU - Khalil, Basmah AU - Abdel-Aziz, Yousef AU - Alastal, Yaseen AU - Barnett, William AU - Sodeman, Thomas AU - Nawras, Ali PY - 2018/03/13 TI - Improving Internal Medicine Residents? Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study JO - JMIR Med Educ SP - e10 VL - 4 IS - 1 KW - colorectal cancer KW - cancer screening KW - early detection of cancer KW - residents? education KW - smartphone KW - mobile apps N2 - Background: Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective: The objective of our study was to assess the improvement in internal medicine residents? CRC screening knowledge via a pilot approach using a smartphone app. Methods: We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents? knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. Results: A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. Conclusions: In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents? knowledge about CRC screening. UR - http://mededu.jmir.org/2018/1/e10/ UR - http://dx.doi.org/10.2196/mededu.9635 UR - http://www.ncbi.nlm.nih.gov/pubmed/29535080 ID - info:doi/10.2196/mededu.9635 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 - 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 -